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. 2023 Sep 2;8(5):1169-1177.
doi: 10.1002/lio2.1151. eCollection 2023 Oct.

Airway management during unusual tracheal stenosis: A clinical feasibility trial

Demet Altun  1 , Mert Canbaz  1 , Dilek Altun  2 , Cömert Sen  3 , Emre Çamcı  1
Affiliations

Airway management during unusual tracheal stenosis: A clinical feasibility trial

Demet Altun et al. Laryngoscope Investig Otolaryngol. .

Abstract

Objectives: Prolonged intubation is a known risk factor of LTS. LTS related to COVID-19 may result in a different phenotype: pronation affects the location of stenosis and COVID-19 pneumonia can decline lung mechanics. Therefore, airway management in these patients may carry unique challenges for both anesthesiologists and surgeons.This prospective observational feasibility trial aims to evaluate the use of a novel thin, cuffed, endotracheal tube (Tritube) in combination with flow-controlled ventilation (FCV) in the management of patients with COVID-19-related LTS undergoing laryngeal surgery.

Methods: 20 patients suffering from COVID-19-related LTS, as diagnosed by CT, requiring endolaryngeal surgery, with or without CO2 laser, were included. Ultrathin endotracheal tube Tritube, together with FCV was used for airway management and ventilation. Feasibility, ventilation efficiency, and surgical exposure were evaluated.

Results: Median duration of mechanical ventilation during their ICU stay was 17 days, (range, 7-27), and all patients had been pronated. In 18/20 patients, endoscopic diagnosis confirmed the initial CT diagnosis: posterior subglottic stenosis. Surgeons' satisfaction on the view was rated 9 out of 10 (range 7-10), where 0 was the worst view and 10 was the best view. Hemodynamic and respiratory variables were within the normal clinical range during the surgical procedure. One patient that had a SpO2 of 90% before induction of anesthesia, a temporal drop to 89%, caused meeting the predefined requirement of "respiratory complication."

Conclusion: This study demonstrates the feasibility of using Tritube with FCV in patients with relatively unusual subglottic posterior location tracheal stenosis, undergoing laryngotracheal surgery. Tritube provides a good surgical field and FCV provides highly adequate ventilation especially in patients with compromised lung mechanics.

Level of evidence: IV, non-comparitive prospective clinical trial with 20 patients.

Keywords: COVID‐19 pnemonia; Tritube; flow‐controlled ventilation; tracheal stenosis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
External view of the Tritube.
FIGURE 2
FIGURE 2
Flow‐controlled ventilation (FCV) compared to volume‐controlled ventilation (VCV) and pressure‐controlled ventilation (PCV). FCV relies on a high resistant breathing circuit to enable a full control of ventilation. FCV is a fully dynamic ventilation providing stable gas flow into and out of the patient's lungs. FCV aims for linear increases and decreases in intratracheal pressures and a constant flow during inspiration and expiration.
FIGURE 3
FIGURE 3
CT scan, endoscopic view of stenosis, and Tritube with Evone ventilator. (A) CT scan of the stenotic segment, narrowing the trachea posterolateral at the inferior of the cricoid cartilage. (B) Endoscopic view of the stenotic segment, narrowing the trachea posterolaterally. (C) Patient with Tritube connected to the Evone ventilator.
FIGURE 4
FIGURE 4
Study flow diagram.
See this image and copyright information in PMC

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