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Post-intubation tracheal stenosis — Clinical Guidelines

Overview

Post-intubation tracheal stenosis refers to narrowing of the trachea that develops following endotracheal intubation, often due to trauma or prolonged intubation 6.

Diagnosis

Clinical Presentation: Dyspnea, stridor, and respiratory distress 6.

Diagnostic Tests: Flexible fiberoptic bronchoscopy for visualization and grading of stenosis 6.

Grading: Typically assessed using the Cotton-Myer grading system 6.

Management

Surgical Interventions: Tracheal resection and reconstruction for severe cases 6.

Endoscopic Dilatation: Repeated dilatations for moderate stenosis 6.

Medical Management: Use of corticosteroids to reduce inflammation 6.

Preventive Measures: Minimizing intubation duration and optimizing intubation technique 1 6.

Special Populations

Novice Intubators: Higher incidence of complications may necessitate advanced laryngoscope training (e.g., videolaryngoscopes) to improve intubation success and reduce trauma 1 3 5.

Experience Impact: Experienced intubators show reduced forces and improved technique, suggesting prolonged training benefits 4 7.

Key Recommendations

Utilize videolaryngoscopes (e.g., McGrath MAC, Pentax Airway Scope) to enhance intubation success and reduce complications in novice practitioners (Evidence: Moderate) 1 3.

Implement prolonged training programs to achieve expertise in tracheal intubation techniques, aiming for over 75 successful attempts (Evidence: Moderate) 2.

Employ fiberoptic stylet visualization during training to improve trainee technique and reduce tracheal trauma (Evidence: Weak) 6.

References

1 Yamamoto Y, Kimura S, Kuniyoshi H, Hiroe T, Terui T, Kase Y. Novice residents' endotracheal intubation skill retention on a simulated mannequin after rotating at an anaesthesiology department: a randomized controlled study. The Journal of international medical research 2023. link 2 Cortellazzi P, Caldiroli D, Byrne A, Sommariva A, Orena EF, Tramacere I. Defining and developing expertise in tracheal intubation using a GlideScope(®) for anaesthetists with expertise in Macintosh direct laryngoscopy: an in-vivo longitudinal study. Anaesthesia 2015. link 3 Sharma DJ, Weightman WM, Travis A. Comparison of the Pentax Airway Scope and McGrath Videolaryngoscope with the Macintosh laryngoscope in tracheal intubation by anaesthetists unfamiliar with videolaryngoscopes: a manikin study. Anaesthesia and intensive care 2010. link 4 Waddington MS, Paech MJ, Kurowski IH, Reed CJ, Nicholls GJ, Guy DT et al.. The influence of gender and experience on intubation ability and technique: a manikin study. Anaesthesia and intensive care 2009. link 5 Low D, Healy D, Rasburn N. The use of the BERCI DCI Video Laryngoscope for teaching novices direct laryngoscopy and tracheal intubation. Anaesthesia 2008. link 6 Takizawa D, Sato E, Saruki N, Goto F, Saito S. Use of a fibreoptic stylet to visually evaluate tracheal intubation technique. Anaesthesia and intensive care 2000. link 7 Bishop MJ, Harrington RM, Tencer AF. Force applied during tracheal intubation. Anesthesia and analgesia 1992. link 8 Dyson A, Harris J, Bhatia K. Rapidity and accuracy of tracheal intubation in a mannequin: comparison of the fibreoptic with the Bullard laryngoscope. British journal of anaesthesia 1990. link

Post-intubation tracheal stenosis