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Lower airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Kimberley R. Kaspy, Sara M. Zak
Tracheal stenosisTracheal stenosis involves significant narrowing of the trachea. The most common cause is congenital complete tracheal rings,15,16 in which the tracheal cartilage forms a complete ring (as opposed to the typical ~300 degree C-shaped ring) as shown in Figure 5.5. Congenital tracheal stenosis can present with life-threatening respiratory failure and often requires surgical intervention.17 Complete tracheal rings can characteristically be associated with cardiovascular anomalies such as pulmonary artery sling or with trisomy 21.Acquired tracheal stenosis can occur from prolonged intubation, infection, or inflammation.17Idiopathic tracheal stenosis can occur in pediatric patients but is generally seen in adult women.17,18 This can involve small sections of the trachea or the entire trachea.
Diagnostic Imaging in Inhalation Lung Injury
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Caroline Chiles, Laurence W. Hedlund, Charles E. Putman
In the months to years following the acute inhalational event, patients may continue to exhibit upper airway and pulmonary dysfunction. The chronic sequelae of inhalation injury include bronchiolitis obliterans, bronchiectasis, and tracheal stenosis. Tracheal stenosis can occur as a result of chemical irritation of the tracheobronchial mucosa, and also as a result of tracheostomies performed during the patient’s hospitalization (Perez-Guerra et ah, 1971; Pruitt et al., 1975). This lesion is best evaluated by bronchoscopy or linear tomography, but may sometimes be visualized on chest radiographs (Fig. 7). CT may also demonstrate tracheal stenosis, but often overestimates the severity of the stenosis (Gamsu and Webb, 1982).
Percutaneous tracheostomy
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
In one study, percutaneous tracheostomy was performed on cadaveric specimens, which demonstrated significant peristomal mucosal tear and cartilaginous fractures.17 Tracheal ring fractures have also been demonstrated during a PercuTwist tracheostomy procedure.18 Most of the cases heal spontaneously with consequent tracheal stenosis.
Effect of tracheostomy timing on outcomes in patients with traumatic brain injury
Published in Baylor University Medical Center Proceedings, 2022
Talha Mubashir, Hongyin Lai, Emmanuella Oduguwa, Rabail Chaudhry, Julius Balogh, George W. Williams, Vahed Maroufy
Demographic information including age, sex, and race were extracted. Tracheostomy-related in-hospital complications, such as tracheal stenosis (519.02) and infection of tracheostomy site (519.01), were recorded. Timing data were unavailable for the aforementioned complications with respect to tracheostomy. The Charlson Comorbidity Index (CCI)13 was calculated based on ICD-9-CM codes and categorized into four comorbidity groups: none, 0; mild, 1–2; moderate, 3–4; and severe, ≥5. Furthermore, the Abbreviated Injury Scale (AIS), which is an anatomical-based coding system that describes a traumatic injury based on injury type, location, and severity,14 was generated based on ICD-9-CM codes and categorized into three groups: mild, 1 or 2; moderate, 3; and severe, 4 or 5. In this study, TBI patients with a AIS head score of 6 were excluded, as they were likely deemed nonsurvivable on admission.
Sirolimus use in patients with subglottic stenosis in the context of granulomatosis with polyangiitis (GPA), suspected GPA, and immunoglobulin G4-related disease
Published in Scandinavian Journal of Rheumatology, 2021
SX Poo, RJ Pepper, L Onwordi, K Ghufoor, G Sandhu, AD Salama
Demographic, clinical, and laboratory data were extracted from medical records. The dose and duration of sirolimus in addition to previous medical treatment were recorded. Ear, nose and throat (ENT) disease activity was assessed endoscopically. All vasculitis patients fulfilled the Watts criteria for GPA: (i) tracheal stenosis; (ii) endoscopic/histological findings suggestive of vasculitis and/or positive anti-neutrophil cytoplasmic antibodies (ANCA) by indirect immunofluorescence where enzyme-linked immunosorbent assay was unavailable; and (iii) exclusion of other diagnoses; and all but one according to the American College of Rheumatology classification (9, 10) (Supplementary table S1). This was subdivided into limited and generalized GPA, where the former has respiratory and ENT-restricted disease.
Usefulness of extracorporeal membrane oxygenation in status asthmaticus with severe tracheal stenosis
Published in Baylor University Medical Center Proceedings, 2020
Chibuzo Odigwe, Jake Krieg, William Owens, Cathy Lopez, Rohan Ranjit Arya
Status asthmaticus remains a lethal condition, with an estimated 2000 deaths annually in the United States.12 ECMO has also been used in refractory cases of status asthmaticus and refractory bronchospasm.13,14 In cases of intractable respiratory acidosis, where it is impossible to adequately ventilate the patient, ECMO can be an invaluable resource, as it can be much more efficient at carbon dioxide removal.12,13 This was seen in our patient with the rapid drop in her pCO2 once she was placed on VV ECMO. The major determinants of how quickly this can be achieved are the sweep gas flow and the partial pressure of carbon dioxide in arterial blood entering the membrane lung, i.e., the higher the pCO2, the higher the efficiency with which the carbon dioxide will be removed. In our case, the successful application of VV ECMO facilitated her treatment, resolved her asthma exacerbation, and supported her until her tracheal stenosis could be treated. Our case is unique, as our patient had concurrent central and distal airway obstruction with successful treatment with VV ECMO and bedside dilation of the tracheal stenosis.