Department of Thoracic Surgery, NRITLD, Shaheed Beheshti University of Medical Sciences and Health Services, TEHRAN-IRAN
Background: Tracheal intubation is a very common procedure for maintaining patency of airway in critically ill patients. Intubation may lead to local complications such as tracheal destruction and post-intubation stenosis. There are two different therapeutic approaches for such patients. The first one is surgical end-to-end anastomosis suitable for severe destructions and fibrosis formations. The second and novel method is utilization of Nd-YAG Laser that can correct intraluminal airway lesions including webs, granulation tissues and fibrous bands. Nd-YAG laser employment decreases hospitalization period, complications and, expenses; in addition, it saves medical staff’s time and energy. Materials and Methods: An uncontrolled clinical trial was performed in post-intubation tracheal stenosis cases admitted to “National Research Institute of Tuberculosis and Lung Disease” (NRITLD) between 1994 to 1999. Bronchoscopy was performed for all patients, and those with the following inclusion criteria underwent Laser therapy: length of stenosis less than 2 cm, tracheal lumen diameter more than 5mm, and granulation tissue type lesions. Patients who did not meet the aforementioned criteria were referred for surgical interventions. Laser therapy was employed by fiberoptic bronchoscopy under local anesthesia. For those patients with tracheal lumen diameter between 5-10 mm rigid bronchoscopy was performed under general anesthesia. Results: Of 32 patients, 25 met the primary criteria for Laser therapy, from which 22 (88%) were completely cured. Because of poor general condition, 5 of 7 other patients who had been referred for surgery, underwent Laser therapy, therefore a total of 30 patients (93%) took advantage of this technique. Overall, 23 patients were treated only with Laser therapy, 2 patients only with surgery and 7 patients with a combination of these two approaches. Conclusion: This trial revealed that if patients with post-intubation tracheal stenosis are selected correctly, Laser therapy can be used as a beneficial and safe method with satisfactory results. (Tanaffos 2002; 1(1):36-40).