Treatment of post-intubation tracheal stenosis with the Nd-YAG laser at the NRITLD

Background and objective

Tracheal intubation is a common procedure for critically ill patients and may lead to local complications such as tracheal destruction and post-intubation stenosis. Utilization of the Nd-YAG laser can correct intraluminal airway lesions including webs, granulation tissues and fibrous bands. It decreases the hospitalization period, complications and expenses and also saves the medical staff's time and energy.

Materials and methods

An uncontrolled clinical trial was performed in post-intubation tracheal stenosis cases admitted to the NRITLD between 1994 and 1999. Based on bronchoscopic findings, patients with the following inclusion criteria underwent laser therapy: length of stenosis less than 2 cm, tracheal lumen diameter more than 5 mm and lesions with granulation tissue type. Others candidated for surgery. Laser therapy was carried out by fiberoptic bronchoscopy under local anesthesia. For those patients with tracheal lumen diameter between 5 and 10 mm rigid bronchoscopy was performed under general anesthesia.

Results

Of the total 32 patients, 25 met the primary criteria for laser therapy, from which 22 (88%) were completely cured. Because of poor general condition, five of seven other patients who had been referred for surgery also underwent laser therapy; therefore, a total of 30 patients (93%) took advantage of this technique. Overall, 23 patients were treated only with a laser, two patients only with surgery and seven patients with a combination of these two approaches.

Conclusions

This trial revealed that if patients with post-intubation tracheal stenosis are selected correctly, laser therapy could be used as a beneficial and safe method with satisfactory results.