A case of cuff stenosis following tracheostomy responding well to T-tube stent insertion: with special reference to methods of dilating the stenosed site.
A 74-year-old man, receiving home oxygen therapy (HOT), required tracheal intubation and artificial ventilation because of methicillin-resistant staphylococcus aureus (MRSA)-induced pneumonia. Tracheostomy was additionally performed. One month later, he had recovered from pneumonia and the tracheostomy tube was withdrawn, allowing the patient to be discharged. One month after discharge, the patient began to complain of wheezing and difficulty in breathing and was thus admitted again to the hospital. Emergency bronchoscopy revealed cuff stenosis. A bronchofiberscope, 4.8 mm in outer diameter (o.d.), was unable to pass through the stenosed site. After the airway was secured by passing a Mini-Trach II tube (4.0 mm in inner diameter (i.d.) and 5.4 mm o.d.) through the stenosed site via the previous tracheostomy stoma, we changed the inserted tracheal tube every other day, replacing it each time with a tube of progressively larger i.d. and o.d. We went from 5.0 mm i.d. (6.9 mm o.d.) to 6.0 mm i.d. (8.2 mm o.d.), 7.0 mm i.d. (9.6 mm o.d.) and finally to 8.0 mm i.d. (10.9 mm o.d.). In this way, the stenosed site was gradually dilated. Finally, a silicon T-tube with 9.0 mm i.d. (11.0 mm o.d.) was inserted via the tracheostomy hole into the trachea and left there. At present, 2 years after the procedure, the patient is continuing HOT and is being followed at an outpatient internal medicine clinic. Cuff stenosis affects the trachea concentric-circumferentially and often relapses even after laser therapy. For these reasons, stent insertion is usually considered as necessary when dealing with cuff stenosis. Our technique of tracheal dilation is safe and simple, and does not require any special device or tool other than tracheal tubes. We report that silicon T-tube stents are optimal for treatment in cases of cuff stenosis.
Shimizu
Junzo
J
Department of Surgery, KKR Hokuriku Hospital, Kanazawa, Ishikawa, Japan.
Arano
Yoshihiko
Y
Yachi
Tsuyoshi
T
Tabata
Shigeki
S
Hirano
Yasumitsu
Y
Waseda
Ryuichi
R
Ogawa
Haruhiko
H
D000368:Aged; D001999:Bronchoscopy; D015505:Chest Tubes; D004106:Dilatation / Q000379:methods*; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D015607:Stents; D014135:Tracheal Stenosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D014139:Tracheostomy / Q000009:adverse effects*