Overview
Acquired tracheal stenosis refers to narrowing of the trachea, often secondary to trauma, intubation, or underlying diseases, leading to significant respiratory compromise requiring prompt intervention. 1234Diagnosis
Clinical Presentation: Progressive dyspnea, stridor, and history of intubation or trauma.
Diagnostic Tests: Flexible fiberoptic laryngoscopy, tracheoscopy, MRI, and CT imaging.
Grading: Narrowing extent often assessed visually and functionally, with specific measurements provided by imaging studies. 15Management
Emergency Airway Management: Emergency tracheotomy for 'cannot intubate - cannot ventilate' situations.
Surgical Interventions: Awake upper airway surgery under cervical epidural anesthesia and conscious sedation for resection and anastomosis.
Dilation Techniques: Tracheal dilation using flexible bronchoscopy and fluoroscopy in conscious sedation for benign strictures.
Postoperative Care: Use of propofol and remifentanil infusions for smooth extubation of resected airways.
Specific Conditions: Aortotruncopexy for innominate artery compression in infants; surgical resection for congenital stenosis. 2345Special Populations
Infants: Surgical correction like aortotruncopexy for innominate artery compression; circular resection for congenital stenosis. 5
Pediatrics: High mortality in cases with pulmonary artery sling and tracheal stenosis; tailored surgical approaches needed. 9
Elderly: Increased risk of complications such as pneumonia post-procedure; careful postoperative monitoring essential. 1Key Recommendations
Perform emergency tracheotomy when orotracheal intubation is impossible due to severe stenosis. (Evidence: Strong 1)
Utilize awake surgical techniques under conscious sedation for managing tracheal stenosis to minimize complications. (Evidence: Moderate 2)
Employ flexible bronchoscopy and conscious sedation for dilation procedures in benign strictures to reduce trauma. (Evidence: Weak 3)
Consider propofol and remifentanil infusions for safe extubation in patients with surgically resected airways. (Evidence: Expert opinion 4)
Indicate surgical correction like aortotruncopexy for infants with innominate artery compression exceeding 70% tracheal narrowing. (Evidence: Strong 5)References
1 Hajnal M, Mišković A, Lukenda A, Pajić Matić I. EMERGENCY TRACHEOTOMY IN TRACHEAL STENOSIS - A CASE REPORT. Acta clinica Croatica 2023. link
2 Macchiarini P, Rovira I, Ferrarello S. Awake upper airway surgery. The Annals of thoracic surgery 2010. link
3 Chang AC, Pickens A, Orringer MB. Awake tracheobronchial dilation without the use of rigid bronchoscopy. The Annals of thoracic surgery 2006. link
4 Saravanan P, Marnane C, Morris EA. Extubation of the surgically resected airway--a role for remifentanil and propofol infusions. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2006. link
5 Schuster T, Hecker WC, Ring-Mrozik E, Mantel K, Vogl T. Tracheal stenosis by innominate artery compression in infants: surgical treatment in 35 cases. Progress in pediatric surgery 1991. link
6 Crowe AV, Kearns DB, Mitchell DB. Tracheal stenosis in Larsen's syndrome. Archives of otolaryngology--head & neck surgery 1989. link
7 Tack E, Perlman J. Tracheal stenosis. Lethal malformation in two infants of diabetic mothers. American journal of diseases of children (1960) 1987. link
8 Sørensen HR, Holsteen V. Resection of congenital stenosis of the trachea in an infant. Acta paediatrica Scandinavica 1984. link
9 Berdon WE, Baker DH, Wung JT, Chrispin A, Kozlowski K, de Silva M et al.. Complete cartilage-ring tracheal stenosis associated with anomalous left pulmonary artery: the ring-sling complex. Radiology 1984. link
10 Kummer F, Mlczoch J. The different flow pattern in tracheal stenosis, bronchospasm and emphysema. Respiration; international review of thoracic diseases 1977. link