Dataset Information

Severe tracheal stenosis due to prolonged tracheostomy tube placement: a case report.

ABSTRACT: Tracheal stenosis is the most common late airway complication of tracheostomy. Severe tracheal stenosis resulted in hemodynamic deterioration and impairment of respiratory system mechanics. We cared for an 86-year-old man with severe tracheal stenosis due to prolonged placement of a tracheostomy tube for 42-months. At the distal tip of the tracheostomy tube, bronchoscopy revealed severe tracheal luminal obstructions by granulation tissue. During pressure-controlled ventilation, the peak airway pressure was much higher than the inspiratory pressure. For patients with clinical signs of tracheal stenosis after tracheotomy, bronchoscopy should be done as early as possible.

SUBMITTER: Zhou W

PROVIDER: S-EPMC2769338 | biostudies-literature | 2009 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Severe tracheal stenosis due to prolonged tracheostomy tube placement: a case report.

Zhou Wei W Ding Shi Fang SF Zhai Qian Q Wu Da Wei DW

Cases journal 20090918

Tracheal stenosis is the most common late airway complication of tracheostomy. Severe tracheal stenosis resulted in hemodynamic deterioration and impairment of respiratory system mechanics. We cared for an 86-year-old man with severe tracheal stenosis due to prolonged placement of a tracheostomy tube for 42-months. At the distal tip of the tracheostomy tube, bronchoscopy revealed severe tracheal luminal obstructions by granulation tissue. During pressure-controlled ventilation, the peak airway p ...[more]

PMID: 19918508

Similar Datasets

Project description:BackgroundTracheostomy tube capping is a commonly used test to determine if the tracheostomy tube can be removed. The success of the capping trial depends on the patient's ability to maintain sufficient spontaneous breathing with an occluded tracheostomy tube. The impact of an occluded tracheotomy tube on airway resistance is currently unknown. The aim of this study was to investigate tracheal pressure during capping or stoma button insertion and potential determinants concerning cuff.MethodsEight cuffed and uncuffed tracheostomy tubes and three stoma buttons of various manufacturers and sizes were inserted into the trachea model. Cuffs were completely deflated or contained atmospheric pressure. The trachea was ventilated bidirectional with a respirator in volume-controlled mode and volume flows 15-60 L/min. Tracheal pressure drop during inspiration as a parameter of pressure required to move gas through the airway was measured.ResultsTracheal pressure drops occurred linearly or irregularly during capping trials to a maximum of 4.2 kPa at flow rates of 60 L/min for atmospheric pressure cuffs. In tracheostomy tubes with completely deflated cuffs, pressure drop in the trachea reaches a maximum of 3.4 kPa at a flow rate of 60 L/min. For tracheostomy tubes with cuff smaller inner or outer diameters do not regularly result in lower tracheal pressure drop. The pressure drop varies between different tracheostomy tubes depending on the manufacturer. In cuffed tracheostomy tubes, we observed three phenomena: sail-like positioning, folding over, and tightening of the cuff during flow. The maximum tracheal pressure drop during stoma button insertion reaches 0.014 kPa.ConclusionsThe cuff is a central element for the pressure drop in the airway and thus airway resistance during spontaneous translaryngeal breathing with a capped TT. Complete deflation reduces the pressure drop in the trachea. Due to deformation of the cuff, measured pressures are irregular as the volume flow is increased. Incomplete deflated cuffs and material characteristics of tracheostomy tubes and cuffs in addition to anatomical and clinical variables may cause unsuccessful capping trials due to increased airway resistance. All stoma buttons showed that pressure drop and thus airway resistance due to stoma buttons has no clinical relevance.

Project description:BackgroundDouble‑lumen tubes (DLTs) are commonly used for differential pulmonary ventilation during thoracic surgery. Few reports exist on subglottic stenosis among patients who underwent surgery involving DLTs; we lack immediate postoperative period documentation leading up to the onset and subsequent recovery of subglottic stenosis. Herein, we present a case of a 75-year-old woman successfully treated for subglottic stenosis after DLT.Case descriptionA 75-year-old woman presented to our hospital with an abnormal chest shadow, which was identified during a medical examination. Chest computed tomography revealed an anterior mediastinal mass with a poor contrast effect measuring 6.0 cm × 3.1 cm × 1.9 cm, which grew from 2.2 to 6.0 cm over 21 months. Low and high signals were detected on T1- and T2-weighted thoracic magnetic resonance imaging, respectively. Concordantly, a thymic cyst was suspected. The patient underwent robotic-assisted thoracoscopic resection via the right lateral approach. A 35-Fr left-sided DLT was used for intubation and differential lung ventilation. Hoarseness and stridor were observed on postoperative day (POD) 1. Laryngoscopy showed submucosal hemorrhage around the vocal cords and mild subglottic stenosis; however, there was no arytenoid dislocation or findings necessitating emergency treatment. On POD 4, her stridor became more severe and laryngoscopy was re-performed and revealed subglottic stenosis progression prompting emergency tracheotomy. The stenosis further progressed, and almost complete airway obstruction was observed on POD 7. By POD 9, partially improving the subglottic stenosis, thereafter the subglottic stenosis was almost completely alleviated by POD 12. The tracheal cannula was removed on POD 22. Trachea-cutaneous fistula closure was performed on POD 35, and she was discharged on POD 42, remaining well. The pathological examination of the anterior mediastinal tumor confirmed the diagnosis of thymic cyst.ConclusionsAirway obstruction owing to subglottic stenosis may occur several days post-surgery with a DLT. Prompt tracheostomy is recommended to prevent complete airway obstruction in patients with progressive subglottic stenosis.

Project description:Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare monogenic disorder, associated with endocrine deficiencies and non-endocrine involvement. Gastrointestinal (GI) manifestations appear in approximately 25% of patients and are the presenting symptom in about 10% of them. Limited awareness among pediatricians of autoimmune enteropathy (AIE) caused by destruction of the gut endocrine cells in APECED patients delays diagnosis and appropriate therapy. We describe an 18-year-old female presenting at the age of 6.10 years with hypoparathyroidism, oral candidiasis and vitiligo. The clinical diagnosis of APECED was confirmed by sequencing the autoimmune regulator-encoding (AIRE) gene. Several characteristics of the disease-Hashimoto's thyroiditis, Addison's disease, diabetes mellitus type 1 and primary ovarian insufficiency-developed over the years. She had recurrent episodes of severe intractable hypocalcemia. Extensive GI investigations for possible malabsorption, including laboratory analyses, imaging and endoscopy with biopsies were unremarkable. Revision of the biopsies and chromogranin A (CgA) immunostaining demonstrated complete loss of enteroendocrine cells in the duodenum and small intestine, confirming the diagnosis of AIE. Management of hypocalcemia was challenging. Only intravenous calcitriol maintained calcium in the normal range. Between hypocalcemic episodes, the proband maintained normal calcium levels, suggesting a fluctuating disease course. Repeated intestinal biopsy revealed positive intestinal CgA immunostaining. The attribution of severe hypocalcemic episodes to AIE emphasizes the need for increased awareness of this unique presentation of APECED. The fluctuating disease course and repeated intestinal biopsy showing positive CgA immunostaining support a reversible effect of GI involvement. CgA immunostaining is indicated in patients with APECED for whom all other investigations have failed to reveal an explanation for the malabsorption.

Dataset Information

Severe tracheal stenosis due to prolonged tracheostomy tube placement: a case report.

Publications

Severe tracheal stenosis due to prolonged tracheostomy tube placement: a case report.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets