Role of Primary Aetiology of Intubation in Acquired Laryngotracheal Stenosis: An Institutional Audit and Review of Liter
- PDF / 249,451 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 113 Downloads / 166 Views
ORIGINAL ARTICLE
Role of Primary Aetiology of Intubation in Acquired Laryngotracheal Stenosis: An Institutional Audit and Review of Literature Prasanna Kumar Saravanam1
•
Vinoth Manimaran1
Received: 13 August 2020 / Accepted: 25 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Aetiology of acquired laryngotracheal stenosis (ALTS) is complex and heterogenous. The aim of this study is to discuss the role of primary aetiology of intubation in the development and outcomes of Post intubation Laryngo tracheal stenosis (PILTS). A retrospective review of patients diagnosed and managed as PILTS from May 2008 to January 2017 was conducted. Demography, primary aetiology of intubation, grade of stenosis, length of the stenotic segment, treatment and outcomes of these patients were recorded and analysed. Based on aetiology of intubation, patients were divided into Poisoning (I), Neurogenic (II) and Rest of aetiologies (III) group respectively. Group I had 28/52 patients (53.8%) followed by group II, 15/52(28.8%) and group III, 9/52(17.3%) respectively. Organophosphorus compound poisoning (OPP) (44.2%) was the commonest cause overall followed by Brain injury (23.1%) and Acute Respiratory Distress Syndrome (ARDS) (11.5%). Trachea (46.15%) was the commonest subsite involved in this study. 24/28(85.7%) of patients had advanced (either grade 3 or 4) subglottic stenosis. The average length of stenotic segment in the study was 18.5 ± 9.2 mm (7–34 mm). 39/52(74.9%) of patients underwent open surgical approaches like cricotracheal resection and anastomosis, Laryngotracheal reconstruction or Shian-Yan Lee technique. 48/52(92.3%) patients were decannulated successfully. There was no significant association between primary etiology of intubation and outcomes. We conclude that OPP and neurological disease patients are more susceptible to airway injury. The authors & Vinoth Manimaran [email protected] 1
Department of Otolaryngology and Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, India
emphasize that clinicians should be aware of these facts and manage these susceptible patients accordingly. Keywords Acquired Laryngotracheal stenosis Primary etiology of intubation Poisoning Neurological Outcomes
Introduction Aetiology of acquired laryngotracheal stenosis (ALTS) is complex and heterogenous. Based on the aetiology, ALTS can be grouped into iatrogenic, idiopathic, autoimmune and traumatic. Identifying the primary aetiology of intubation helps in characterization of the disease, comparison and prognostication of treatment outcome. Iatrogenic aetiology is the most common cause for ALTS in Indian subcontinent. Securing and maintaining airway either by intubation or tracheostomy are the major causative factors for iatrogenic ALTS. The etiopathogenesis following intubation is due to the development of ischemia, leading to necrosis of the laryngotracheal mucosa, submucosa and cartilage, ultimately leading to scarring, fibrosis and stenosis [1]. Many risk factors have been identified
Data Loading...
