Early endoscopic treatment of acute inflammatory airway lesions improves the outcome of postintubation airway stenosis.
OBJECTIVE
The objective of this study was to compare the results of treating acute postintubation stenotic airway lesions with the results of treating mature lesions and to assess whether early intervention improves the outcome.


METHODS
Patients without previous surgery, treated for postintubation airway stenosis, were reviewed. Those with airway lesions presenting within weeks of intubation (n = 11) were treated with intralesional steroids, laser reduction, and balloon dilatation. Patients with mature airway lesions (n = 20) were initially treated with laser, balloon dilatation, and topical mitomycin C. Preoperative patient and lesion characteristics, details of the treatment, and intervention-free intervals were recorded. Data were compared with unpaired Student t test or chi test as appropriate, and intervention-free intervals were compared with log-rank statistics. Cox regression was used to identify independent predictors of intervention-free interval.


RESULTS
There were 18 males and 13 females. The average age at presentation was 47 +/- 2.7 years. The two groups were statistically comparable for demographic and lesion characteristics. Patients treated for acute injury required significantly fewer interventions (P < .03), the majority being treated with a single treatment. They had a significantly longer intervention-free interval (P < .02; log-rank analysis) and did not require external laryngotracheal reconstruction (P < .001) compared with patients treated for mature fibrotic scars leading to airway stenosis.


CONCLUSIONS
Early treatment of acute fibroinflammatory airway lesions has the potential to favorably modify the natural history of postintubation tracheal injury, raising the tantalizing possibility of an early cure. These findings have significant implications for early identification, referral, and treatment of postintubation tracheal stenosis and need to be confirmed with further studies.
Nouraei
S A Reza
SA
Airway Reconstruction Unit, Royal National Throat Nose and Ear Hospital, London, UK. RN@cantab.net
Singh
Arvind
A
Patel
Anil
A
Ferguson
Catriona
C
Howard
David J
DJ
Sandhu
Guri S
GS
D000208:Acute Disease; D000402:Airway Obstruction / Q000601:surgery* / Q000628:therapy; D002404:Catheterization; D005260:Female; D006801:Humans; D007249:Inflammation; D015552:Injections, Intralesional; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007828:Laryngoscopy; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D013256:Steroids / Q000008:administration & dosage; D014132:Trachea / Q000293:injuries
D013256:Steroids