Search

Introduction: The novel Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, may need intensive care unit (ICU) admission in up to 12% of all positive cases for massive interstitial pneumonia, with possible long-term endotracheal intubation for mechanical ventilation and subsequent tracheostomy. The most common airway-related complications of such ICU maneuvers are laryngotracheal granulomas, webs, stenosis, malacia and, less commonly, tracheal necrosis with tracheo-esophageal or tracheo-arterial fistulae. Materials and methods: This paper gathers the opinions of experts of the Laryngotracheal Stenosis Committee of the European Laryngological Society, with the aim of alerting the medical community about the possible rise in number of COVID-19-related laryngotracheal stenosis (LTS), and the aspiration of paving the way to a more rationale concentration of these cases within referral specialist airway centers. Results: A range of prevention strategies, diagnostic work-up, and therapeutic approaches are reported and framed within the COVID-19 pandemic context. Conclusions: One of the most important roles of otolaryngologists when encountering airway-related signs and symptoms in patients with previous ICU hospitalization for COVID-19 is to maintain a high level of suspicion for LTS development, and share it with colleagues and other health care professionals. Such a condition requires specific expertise and should be comprehensively managed in tertiary referral centers. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Delivering evidence-based patient care is predicated on the availability of objective and validated outcome measures. We aimed to calculate physiology-based minimum clinically important difference (MCID) values for adult laryngotracheal stenosis (LTS). Study Design: Prospective observational study. Methods: Patient demographics, morbidities, and stenosis severity were assessed preoperatively. Flow-volume loops and Medical Research Council (MRC) dyspnea grades were measured in 21 males and 44 females before and 6 to 8 weeks after airway surgery, and before treating recurrent disease in 10 patients. Anchor and distribution-based methodologies were used to calculate MCIDs for treatment efficacy and disease recurrence respectively. The mean age at treatment was 46 ± 16 years. The most common etiology was idiopathic subglottic stenosis (38%). Most lesions (66%) obstructed >70% of the lumen. There were strong correlations between treatment-related changes in total peak flow (TPF) (ΔTPF) (peak expiratory flow + |peak inspiratory flow|) and the ratio of area under the flow-volume loop (AUC) to forced vital capacity (FVC) (ΔAUCTotal/FVC), and treatment-related changes in the MRC grade (ΔMRC) (r = -0.76 and r = -0.82, respectively). Both TPF and AUCTotal/FVC discriminated between effective (ΔMRC <0) and ineffective (ΔMRC ≥0) interventions, yielding MCID values of 4.2 L/s for TPF and 2.1 L²/s for AUCTotal/FVC, respectively. Ten patients required airway treatment for recurrent disease, and TPF and AUCTotal/FVC levels had distribution-based MCID values of 0.9 and 0.6, respectively. Conclusions: Flow-volume loops provide a quantitative method of objectively assessing outcomes in LTS. TPF is the most convenient index for this purpose, but AUCTotal/FVC provides marginally greater sensitivity and specificity. [ABSTRACT FROM AUTHOR]

The article presents a study on the use of the expiratory disproportion index (EDI) to diagnose laryngotracheal stenosis (LTS) and other respiratory diseases. Topics include the symptoms of LTS, which may present as a complication of mechanical ventilation or vasculitis; the spirometry results of nonstenosis pulmonary patients and those with LTS; and an evaluation of the use of EDI to diagnose LTS using respiratory function data.

Objectives/Hypothesis To assess the utility of intraoperative pressure-volume curves as an objective method of physiological disease stratification and outcomes assessment in adult laryngotracheal stenosis. Study Design Prospective observational study. Methods We prospectively studied 42 tracheotomy-free patients undergoing endoscopic laryngotracheoplasty over 18 months. Patient and lesion characteristics were obtained. Dyspnea severity was assessed using the Medical Research Council scale. Preoperative spirometry and intraoperative pulmonary compliance were recorded. Results There were 19 male and 23 female patients, and the mean age at treatment was 44 ± 16 years. There were 14 Myer-Cotton 1 lesions and 14 and 13 patients had grade 2 or 3 stenoses, respectively. Pulmonary compliance was strongly correlated with anatomical stenosis severity ( r = 0.8, P < .0001) and perceptual dyspnea severity ( r = 0.73, P < .0001). The strengths of correlation between pulmonary compliance and anatomical stenosis severity was significantly greater than those between forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and peak expiratory flow. The strength of correlation between pulmonary compliance and perceptual dyspnea severity was significantly greater than those between FEV1 and FVC with perceptual dyspnea severity. The two independent determinants of pulmonary compliance were Myer-Cotton stenosis severity ( P < .0001) and patient age ( P = .013). Conclusions Pulmonary compliance provides an objective measure of physiological airway impairment. It correlates well with anatomical disease severity and perceptual dyspnea severity. Its more widespread use in adult patients and research into its utility in pediatric airway stenosis is recommended. Level of Evidence 4 Laryngoscope, 123:2735-2741, 2013 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To evaluate the efficacy of endoscopic resection tracheoplasty (ERT) for treating post-tracheotomy stomal stenosis caused by inward collapse of tracheal ring remnants. Study design Prospective observational study. Methods Between 2007 and 2012, we treated 40 patients with 'lambdoid' tracheal deformity with a two-staged minimally invasive procedure undertaken using suspension microtracheoscopy and high-frequency jet ventilation. The first procedure entailed CO2 laser photoablation of collapsed tracheal rings and dilatation. The second procedure, performed 6 to 8 weeks later, involved ablation of residual structural obstruction, removal of granulation tissue, and intralesional corticosteroid injection. Perioperative patient and lesion characteristics and results of treatment were assessed. Results There were 22 males and 18 females, and mean age at first treatment was 59 years. There were 17 cases of scarring at the postero-lateral tracheal groove (trachealis blunting), and 22 patients had age-adjusted Charlson comorbidity scores greater than 4. All patients without trachealis blunting were successfully managed endoscopically, with only one patient requiring one additional endoscopic treatment. Seven patients with trachealis blunting needed additional treatment, and four patients had tracheal resection ( P = 0.013). All patients were decannulated, and 75% of patients achieved good dyspnea outcomes. Patients with low morbidities were significantly more likely to achieve good dyspnea outcomes ( P < 0.027). There were no treatment-related worsenings of voice or swallowing. Conclusions ERT is an effective minimally invasive treatment for intubation-related lambdoid tracheal stenosis. It achieves a successful outcome while avoiding the risks associated with open surgery. We recommend its more widespread use for treating patients with this condition. Level of Evidence 4. Laryngoscope, 2012 [ABSTRACT FROM AUTHOR]