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Introduction The mucopolysaccharidoses are a group of hereditary disorders pathologically characterized by tissue accumulation of glycosaminoglycans due to deficient lysosomal metabolism which often leads to progressive airway stenosis and respiratory insufficiency. Relentless and treatment-refractory narrowing of the lower airways with ensuing severe limitation of quality of life is a challenging problem in mucopolysaccharidoses. Case reports We report 2 cases of MPS (Hunter's and Maroteaux-Lamy's syndrome resp.) in whom tracheal stents were placed to relieve severe tracheal obstruction. The first patient could be weaned from mechanical ventilation after stent placement but showed significant long-term stent-related morbidity. The second patient suffered a severe procedure-related complication due to positioning problems typical for MPS. Conclusions Very good short-term success can be achieved with airway stent placement in patients with MPS and severe lower airway stenosis but a high risk of severe complications and important long-term morbidity have to be weighed against potential individual benefit. [ABSTRACT FROM AUTHOR]

Resumo O manejo anestésico de pacientes com grandes massas situadas no mediastino pode ser complicado por causa dos efeitos da pressão da massa sobre as vias aéreas ou grandes vasos. Relatamos o manejo anestésico bem‐sucedido de uma paciente de 64 anos com uma grande massa mediastinal que invadiu os grandes vasos e comprimiu a traqueia. Um stent traqueal foi colocado para aliviar a compressão da traqueia, sob anestesia geral. A ventilação espontânea foi mantida durante o período perioperatório com o uso de uma máscara laríngea clássica. Discutimos a utilidade da máscara laríngea para o manejo da colocação de stent traqueal em pacientes com massas situadas no mediastino. The anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64‐year‐old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses. [ABSTRACT FROM AUTHOR]

Trachea injury caused by tracheomalacia, stenosis or atresia can result in severe dyspnea, even asphyxia. With the development of trachea reconstruction technology, trachea stents have become an alternative treatment method. Here, we fabricated a kind of shape memory PCL/Fe 3 O 4 composites (SMPC-PCL) by mixing different weight fractions of benzoyl peroxide and Fe 3 O 4 nanoparticles. The addition of magnetic nanoparticles endowed SMPC-PCL with the capability of remote non-contact actuation, which exhibited unique advantages in minimally invasive implantation and adaptive ability. Further, based on fully observing the unique reticular structure of glass sponges, two types of biomimetics stents were designed and fabricated, and the mechanical properties were thoroughly investigated by experiments and finite element analysis. The minimally invasive implant performance and biological characterization were carried out to evaluate its availability. The excellent mechanical properties, minimally invasive implant performance and biological properties suggest the application potential in tracheal stents. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: Extracorporeal membrane oxygenation (ECMO) is useful for providing hypoxic patients with ventilatory support, but its usefulness in the management of patients with central airway obstruction has rarely been reported. Nineteen cases in one center where venovenous (VV) ECMO was used to support patients with severe central airway obstruction while they underwent lifesaving interventions are reported here. Methods: In total, 113 cases of VV ECMO were performed in Asan Medical Center between January 2009 and June 2012. In 19 cases (18 patients), VV ECMO was used to support patients with severe airway obstruction. Results: Of the 18 patients, 13 were male, and their median age was 62.5 (range, 16-82) years. The main reasons for using ECMO to provide airway security were malignant mass removal with a rigid bronchoscope (8 cases) and insertion of a tracheal stent (7 cases). The median ECMO time was 20.9 (range, 2.2-113.4) hours. In 1 case, a patient died of massive bleeding after a malignant mass was removed. Weaning off ECMO therapy occurred successfully in the remaining 18 cases. Conclusions: Venovenous ECMO may be useful in patients with central airway obstruction because it provides short-term airway security while lifesaving procedures are being performed. [ABSTRACT FROM AUTHOR]

Dogs with tracheal collapse may present with life-threatening upper airway obstruction. In most instances, a conservative approach to treatment including oxygen support coupled with sedation and cooling measures will relieve respiratory effort and thus relieve airway obstruction. Dogs that fail this conservative approach require endotracheal intubation to ensure a patent airway. This population of patients would benefit from a more definitive, yet palliative treatment option to acutely relieve upper airway obstruction. Placement of a self-expanding metallic stent that spans the affected portion of the trachea will acutely provide the patient with a sustained patent airway and optimize the likelihood of a positive outcome. [ABSTRACT FROM AUTHOR]

Abstract: The design of customized biomedical devices is certainly relevant nowadays, and to achieve higher implantation accuracy, custom-made implants need to be developed. The aim of this work is to present an integrated tool for the design of a tracheal stent to meet the most important requirements or needs of physicians, hospital administrators and patients. The methodology is based on the synergy between several methods such as attribute listing, quality function deployment (QFD), and the theory of inventive problem solving (TRIZ), for solving physical contradictions related to geometry and material. The result is a stent shape approved by physicians. Moreover, a parameterization tool was used to modify the stent’s general dimensions to fit a specific patient. Lastly, the final conceptual design was printed using an additive manufacturing technology known as Fab@Home. [Copyright &y& Elsevier]

Abstract: Tracheomalacia associated with esophageal atresia (EA) is a well-known condition. However, complete absence of tracheal rings (TRs) is extremely rare. Our aim is to describe a novel triad of conditions and to discuss the best treatment. An expremature male operated for EA presented with severe respiratory distress. The diagnosis of absent cartilage rings, suspected on bronchoscopy, was confirmed by optical coherence tomography. The absence of TRs was localized to a short tracheal segment, and the carina trifurcated into right upper lobe, right intermediate, and left main bronchus. The patient was treated with resection and anastomosis with a completely satisfactory course. Absence of TRs was previously reported by us in 2 other cases, both with associated EA and trifurcation of the carina. One child was treated with tracheostomy and the other with a stent, but the outcome was far from optimal. The patient with tracheostomy eventually underwent resection and anastomosis with tracheostomy closure. Congenital absence of TRs is extremely rare. Although localized, it is responsible for severe symptoms owing to complete tracheal collapse and may be misdiagnosed as tracheomalacia. In our experience, it has been associated with EA and trifurcated carina. Our limited experience suggests resection of the abnormal segment and tracheal anastomosis as the best treatment. [Copyright &y& Elsevier]

Objective: While tracheal resection for management of tracheal stenosis is an effective technique that has been well described in adults, the results in children have been less encouraging, as children tolerate anastomotic tension less well than adults. We describe our current technique for the management of severe tracheal stenosis in older children. Methods: Four teenagers, 16–17 years of age, presented with severe tracheal stenosis. A 16-year-old girl had sustained tracheal stenosis following prolonged intubation, and presented with a severe Grade III stenosis having had 25 endoscopic procedures, and a failed resection at another institute. Two 17-year-old boys and a 17-year-old girl presented with Grade IV stenosis at the suprastomal area following previous intubation injuries. All four children had an identical procedure with tracheal resection over a Hood tracheal stent. Results: All four children were extubated in the operating room. Chin-to-chest sutures were removed between 7 and 10 days, as was the Hood stent. All four are currently asymptomatic with no airway stenosis. Conclusions: Although tracheal resection for tracheal stenosis in children is associated with a higher failure rate than is seen in the adult population, even severe stenosis and long segment resection may achieve excellent results. We feel that important factors influencing outcome in this series included anastomosis to an intact cricoid ring, and support of the anastomosis with a tracheal stent. [Copyright &y& Elsevier]

The tracheal stent is an alternative nonsurgical management tool for patients with tracheal stenosis caused by disease or iatrogenic trauma. Some patients with tracheal stent may need to be anesthetized to allow invasive techniques or surgery to be performed. In these patients, general anesthesia by endotracheal intubation may dislodge the stent distally or cause lethal complications such as bleeding. We describe three patients with a tracheal stent in place, who were anesthetized using a Laryngeal Mask Airway for surgery, with smooth results. [Copyright &y& Elsevier]

Esophageal coins rarely migrate extraluminally or cause systemic illness and the development of tracheoesophageal fistulae (TEF) secondary to coin ingestion is rare. When they do occur, surgical repair may be complicated by a contaminated operative site and systemic instability. As a means to review treatment options in this setting, we present a rare case of a 16-year-old female with a history of longstanding esophageal foreign body complicated by a large tracheoesophageal fistula, mediastinitis, and sepsis. She was ultimately managed by means of endoscopic diversion and tracheal stenting to reduce wound contamination in preparation for definitive open repair. A comprehensive literature review is performed and our approach to this patient's management is discussed. In the setting of a mediastinal leak, infection and systemic instability, endoscopic techniques and novel clip applicators may be employed to control wound contamination prior to definitive repair. [ABSTRACT FROM AUTHOR]

A 70-year-old woman diagnosed with advanced, non-resectable programmed cell death ligand 1-positive-non-small-cell lung carcinoma was treated with pembrolizumab as first-line therapy. Soon after therapy initiation, she presented with severe dyspnea, and chest computed tomography revealed a soft tissue mass in the lower trachea of the right main bronchus. During bronchoscopy, she became severely hypoxic, and we performed endoscopic tumor ablation and Dumon Y-stent placement. We considered this severe deterioration caused by pseudoprogression, and suggest that it is necessary to perform bronchoscopy and to prepare for the bronchial intervention when treating patients with immune checkpoint inhibitors. [ABSTRACT FROM AUTHOR]

Endotracheal and endobronchial stenting, particularly with uncovered stents, can be complicated by stent fracture, granulation tissue formation, direct airway injury, and airway obstruction. While stent removal is possible, it can result in significant complications and long-term benefit is not guaranteed. Argon plasma coagulation can be employed to trim fractured stent fragments and remove granulation tissue simultaneously. In this manuscript, we report a case and describe our experience with using this technique. [ABSTRACT FROM AUTHOR]