Critical Care |

Tracheostomy, Is It Really Innocent? FREE TO VIEW

Mustafa Calik, MD; Saniye Calik, MD; Mustafa Cihat Avunduk, MD; Ogun Kadir Aribas
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Konya Education and Research Hospital, Konya, Turkey

Chest. 2015;148(4_MeetingAbstracts):300A. doi:10.1378/chest.2281105
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SESSION TITLE: Mechanical Ventilation and Respiratory Failure Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Even though its broad range of indications, tracheostomy is generally indicated for ventilator-dependent patients. Therefore, it is the most commonly performed surgical procedures in ICUs with appreciable morbidity and complications (8-45%). Its complications are ranging from intraoperative that can be rapidly life threatening to late or chronic postoperative that may become apparent much later such as tracheal stenosis and granulation. Clinically significant stenosis is very rare and occurs in approximately 1% of patients. We aimed to investigate the histopathological changes which lead to stenosis in tracheal epithelia after the conventional tracheostomy in rabbit model.

METHODS: Twenty-four male New Zealand White rabbits were used for this study. They were randomly divided into three equal groups. Classic tracheostomy was carried out in sixteen subjects. Group 1 which was made ​​any surgical procedure served as control for tracheal measurements. After tracheostomy, we applied sterile saline in Group 2, Mitomycin-C (0.8 mg/ml) (MMC) in Group 3 around tracheotomy for 5 minutes. At 3 weeks after surgery, tracheas were evaluated by morphometric and histopathological examination with the inclusion of tracheal lumen diameter, number of capillary vessels, subepithelial tissue thickness, fibroblasts and inflammatory cells

RESULTS: There were statistically significant differences between tracheostomy and control group for tracheal lumen diameter (P=0.35), number of capillary vessels (P=0.06), subepithelial tissue thickness, fibroblasts and number of lymphocyte (p < 0.001). Histopathological analysis showed the decreased fibrosis in the group treated with MMC.

CONCLUSIONS: Current treatment modalities of Tracheal stenosis one of the most difficult and devastating problems in airway surgery tend to fail due to the new scar formation and restenosis. We are believed to wound healing modulation may prevent scar formation and no need further surgery. Even if, there are undoubtedly many advantages of tracheostomy these must be balanced against the real risk of the procedure.

CLINICAL IMPLICATIONS: As a result, tracheostomy is not an innocent procedure. In patients who underwent tracheostomy, scarring and granulation tissue formation should always be kept in mind.

DISCLOSURE: The following authors have nothing to disclose: Mustafa Calik, Saniye Calik, Mustafa Cihat Avunduk, Ogun Kadir Aribas

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