PURPOSE: Tracheostomy is one of the most commonly performed elective procedures in patients receiving long-term mechanical ventilation. One of the common complications resulting from tracheostomy is tracheal stenosis. The objective of this study was to determine the incidence, severity, and sites of tracheal stenosis after surgically created tracheostomy.
METHODS: Fifty-six patients with tracheostomy were evaluated from October, 2003 to February, 2008. All patients had plastic tubes with inflatable high-compliance balloons. Patients with tracheostomy tubes had bronchoscopy for evaluation of airway, tracheal stenosis, and possible removal of the tracheal tube. The tracheal narrowing was evaluated by using Olympus model 550 fiberoptic laryngotracheoscopy (FOL). Tracheal stenosis was defined as more than 10% tracheal narrowing.
RESULTS: Out of fifty-six patients, thirty-seven (66%) patients had tracheal stenosis. Seventeen (30%) had mild stenosis, sixteen patients (29%) had moderate stenosis, two patients (4%) had severe stenosis. Mild stenosis is defined as less than twenty-five percent of the tracheal narrowing, moderate stenosis is defined as tracheal narrowing between 25–30%, and severe stenosis is defined as tracheal narrowing greater than 75%. With regards to the location of the stenosis, two patients (4%) had stenosis at the level of the stoma, twelve patients (27%) had stenosis supra-stomal anterior level of the stoma, eleven patients (24%) had stenosis in the middle third of the trachea, and twenty patients (44%) had stenosis in the upper third of the trachea. Stenosis located at the upper third of the trachea showed higher incidence of moderate and severe tracheal stenosis. At the time of the examination, thirty five patients (63%) had their tracheostomy removed.
CONCLUSION: Tracheal stenosis is a common complication resulting from tracheostomy, which may cause upper airway obstruction. The incidence of tracheal stenosis in our study was high, with 66 percent of patients found to have significant tracheal narrowing during flexible laryngotracheoscopy.
CLINICAL IMPLICATIONS: Flexible laryngotracheoscopy is a reliable method of evaluating tracheal stenosis among patients with surgically created tracheostomy.
DISCLOSURE: Roberto Santos, No Financial Disclosure Information; No Product/Research Disclosure Information