2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Ann Thorac Surg 2017;103:246 – 53

SHADMEHR ET AL

SYSTEMIC STEROIDS IN TRACHEAL STENOSIS

number of patients. So we have already started a national study, fi rst to fi nd the incidence rate of postintubation tracheal stenosis in our country, and then fi nd our own national risk factors for this. DR SHRAGER: It would be really interesting to know, I am sure you have the data, how many got tracheostomies and how many are from endotracheal tubes. Maybe the country in general is not doing early tracheostomies, and maybe that is a reason. I do not know. DR SHADMEHR: Yes. I do not have the exact data for you, but I know that about 30% to 40% of our patients are referred to us with tracheostomy, and we realize that these cases are more complicated. But for this study, we excluded all of them except those who at presentation to us did not have any tra- cheostomy but a scar of tracheostomy. Sometimes they had prolonged intubation, and they got stridor or dyspnea in an outside hospital, and the patient underwent a tracheostomy, then got extubated, and again after a couple of weeks was referred to us. DR SHRAGER: And do you have a standard approach to how many times you will try bronchoscopy and dilation? Unless your fi rst bronchoscopy is during the in fl ammatory phase, you can tell if you are doing bronchoscopy a few months later whether it is going to require surgery or not right away at your fi rst look.

DR SHADMEHR: We do not have any protocol for that, and it depends on each patient. We individualize for each patient because as long as the patient is not ready for resectional airway surgery, we have to do repeated bronchoscopic dilation, or as for couple of patients that I showed in this slide that we excluded from this study, if a patient needs a repeated bronchoscopic dilation at short intervals, we do a tracheostomy or replace a T tube, and then give time for the patient to recover from his or her comorbid disease or be prepared for surgical resection. DR CHADRICK E. DENLINGER (Charleston, SC): I have one more question. I agree with Dr Shrager that the number of tracheal stenoses is quite high. I did miss, though, what your de fi nition of a tracheal stenosis was? Was it a certain percent narrowing, a certain diameter, symptomatic based, fl ow-volume restriction, or something else? DR SHADMEHR: Yes. Actually, any patient who is referred to us with respiratory symptoms suggestive of tracheal stenosis, like dyspnea or stridor, and has history of prolonged intubation for more than 24 hours, we do a bronchoscopy and if we see any tracheal narrowing, we consider the case as tracheal stenosis. Those patients are not included in this study because we fi rst do a bronchoscopy, and if we saw a signi fi cant tracheal stenosis, then we included those patients after talking to the patients about the risk of corticosteroid treatment, take the patient an informed consent form, and enroll them in this study.

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