Tracheal stenosis due to endotracheal tube cuff hyperinflation: a preventable complication

Endotracheal intubation injuries are rare, but may be devastating—mostly among the pediatric patients or when these occur in the distal trachea. Such complications typify a therapeutic challenge, which, besides requiring intellectual and technical resources, takes a long time to reach a resolution. The authors present the case of a 15-year-old girl admitted with an abnormal state of consciousness due to diabetic ketoacidosis. She was submitted to endotracheal intubation with hyperinflation of the tube cuff, which rendered tracheal necrosis and detachment of the tracheal mucosa, and consequent obstruction. Later, she developed scarring retraction and stenosis. The patient was successfully treated with an endotracheal prosthesis insertion. The aim of this report is to illustrate a preventable complication

Tracheobronchial stents: terapeutic option for acquired tracheobronchial stenosis

A estenose traqueobrônquica é uma condição que cursa com dispnéia, estridor epneumonia obstrutiva, causada por diversas condições como tumores, compressão extrínseca e traqueobroncomalacia, porém a causa mais freqüente é a complicação resultante de intubação prolongada, sendo que ocorre em aproximadamente 1% das intubações. O tratamento de escolha para esta condição é a ressecção cirúrgica do segmento atingido, entretanto este procedimento não é possível em todos os pacientes e isto levou à adoção de técnicas endoscópicas paliativas. O uso de endopróteses para manter uma via aérea pérvia está entre as técnicas endoscópicas com melhores resultados. As endopróteses utilizadas atualmente dividem-se, principalmente, em próteses de silicone e metálicas expansíveis, cada uma com vantagens e desvantagens específicas. A presente monografia visa apresentar os principais modelos de endopróteses, comparando suas vantagens e desvantagens e índices de complicações, procurando sistematizar as indicações ideais para cada tipo de prótese.Tracheobronchial stenosis curses with dyspnea, stridor and obstructive pneumonia, and can be caused by tumors, extrinsic compression and tracheobronchomalacia, butthe most frequent cause is the sequel resulting of prolonged intubation, occurring in about 1% intubations. The treatment of choice for such condition is resection of the compromised segment; however this procedure isn't possible in every patient and this led to the development of endoscopic palliative technique. Tracheobronchial stentintg is between one of such techniques that obtain the best results. Tracheobronchial stents can be divided manly between silicone tubes and self-expandable metallic stents, each one with specific advantages and disadvantages. The present study presents the main stent models, comparing their advantagese disadvantages and complications rates, aiming to systematize the ideal indications for every type of stent

Tracheoesophageal fistula associated with paracoccidioidomicosis

Paracoccidioidomycosis is a systemic fungal disease caused byParacoccidioides brasiliensis, agent geographically distributed to certainareas of Central and South America. The infection by P. brasiliensis hasbeen reported from north Mexico to south Argentina. Paracoccidioidomycosispresents similar clinical findings of many other diseases whatever in acute or chronic scenarios. Chronic pulmonary paracoccidioidomycosis is frequentlymisdiagnosed as malignancy or tuberculosis. The authors present a caseof a 57 year-old man admitted to the hospital due to a chronic consumptivesyndrome. He underwent anti-tuberculous treatment with rifampin, isoniazid andpyrazinamide 1 year ago without resolution of the simptoms. During the clinicalinvestigation, pulmonary paracoccidioidomycosis with tracheoesophagealfistula was diagnosed. The systemic infection was treated with deoxicolate Bamphotericin followed by sulfametoxazole and trimetoprin due to acute renalfunction impairment. The fistula was endoscopically treated; inittialy with theprotection of left main bronchus with a tracheal prosthesis followed by theesophageal fistula’s ostium clipping.A paracoccidioidomicose é uma micose sistêmica causada peloParacoccidioides brasiliensis, que é encontrado em regiões da América doSul e Central, com casos relatados do norte do México ao sul da Argentina.As infecções causadas pelo P. brasiliensis frequentemente mimetizam outrasdoenças. A paracoccidioidomicose pulmonar crônica é frequentementeconfundida com neoplasia ou tuberculose. Os autores apresentam o casode um homem de 57 anos internado com quadro de tosse crônica, fraqueza,disfagia, mal estar e síndrome consumptiva. Fora submetido a tratamentopara tuberculose com rifampicina, pirazinamida e isoniazida há 1 ano semmelhora dos sintomas. Durante a investigação clínica foi diagnosticadaparacoccidioidomicose pulmonar com fistula traqueo-esofágica. A infecção foitratada com anfotericina B deoxicolato e posteriormente com sulfametoxazole trimetoprim devido a desenvolvimento de insuficiência renal aguda. A fístulafoi tratada endoscopicamente com implante de prótese traqueal para protegero brônquio esquerdo, seguido de clipagem do óstio esofágico da fístula

Biocompatibility of a new device of self-expandable covered and non-covered tracheal stent: comparative study in rats

PURPOSE: To investigate the compatibility of a new model of self-expandable tracheal stent in rats. METHODS: A new device of polyurethane covered and non - covered stent was placed in the trachea of Wistar rats. Animals were distributed in two groups: the polyurethane covered and non-covered group. Macroscopic parameters included position within the tracheal lumen, adherence to the mucosa, degree of dilatation, permeability and internal diameter. Microscopic findings evaluated were: incorporation, inflammatory activity, granulation tissue and epithelial revetment injuries. The observation follow-up was six weeks. All parameters were quantified based on determined score values. Incorporation of the stents was evaluated based on the observation if the stent was fixed into the trachea or if it could be removed. Degree of dilatation was performed by external diameter measurements. Granulation tissue was evaluated by measurements of height of the tissue growing into the tracheal lumen. RESULTS: 100% of non-covered stents had total attachment to mucosa and 100% of polyurethane covered type had adherence only. Regarding dilatation, granulation tissue, inflammatory activity and internal diameter measurements, there were no significant differences between the groups. Pathological tracheal wall injuries were present in both groups. CONCLUSION: Both models of stent demonstrated biocompatibility with the trachea. Rats are suitable for an experimental model of tracheal stent study