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CLINICAL AND PARACLINICAL CHARACTERISTICS IN PATIENTS WITH TRACHEAL STENOSIS AFTER ENDOTRACHEAL INTUBATION AND TRACHEOSTOMY TREATED WITH INTERVENTIONAL BRONCHOSCOPY AT THE NATIONAL LUNG HOSPITAL, 2020–2024
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Abstract
Objective: To describe the clinical, radiological and endoscopic features of post-intubation (PITS) and post-tracheostomy (PTTS) tracheal stenosis in patients at the National Lung Hospital from 2020 to 2024. Subjects and Methods: This was a descriptive, retrospective study conducted on 92 patients diagnosed with post-intubation (PITS) and post-tracheostomy (PTTS) tracheal stenosis who were managed with interventional bronchoscopy at the National Lung Hospital from January 2020 to December 2024. Results: The mean age of the study population was 54.0 years, with the age group >60 years being the largest (41.3%). Male patients predominated (70.7%). A statistically significant difference was found in the indication for airway intervention between the two groups (p=0.001): respiratory causes were most common in PITS (35.7%), while neurological causes predominated in PTTS (40%). The mean duration of endotracheal intubation and tracheostomy was 14.3 days and 184.3 days, respectively (p=0.000). The most frequent clinical symptoms were dyspnea (100%), stridor (66.3%), and cough (41.3%). The most common location of stenosis was the upper third of the trachea (77.2%), with 6 cases of multi-segmental stenosis (6.5%). The mean stenotic segment length was 16.3 mm. There was a significant difference in the morphology of the lesion between the two groups (p=0.012): PITS was predominantly characterized by stricture/scar (fibrotic) (69%), while PTTS mostly presented as intraluminal granulation tissue (52%). Stenosis severity according to the Freitag classification was: Grade 0-2 (8.7%), Grade 3-4 (29.3%), and Grade 5 (62%); according to the Cotton-Myer classification, Grade I-II (34.8%), and Grade III-IV (65.2%). Conclusion: PITS and PTTS are acquired tracheal stenosis conditions that require heightened clinical attention. Diagnosis remains a challenge due to clinical symptoms that often mimic other obstructive airway diseases. The use of bronchoscopy and chest computed tomography with tracheobronchial tree reconstruction is helpful for diagnosis, lesion assessment, and formulating an appropriate treatment plan. Treatment is multimodal, in which interventional bronchoscopy is considered an ideal option for patients who are unsuitable for surgery.
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Keywords
tracheal stenosis, interventional bronchoscopy, post-intubation, post-tracheostomy.
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