Survival Rate of Patient with Post-Intubation Subglottic Stenosis in Buriram Hospital
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Abstract
Background: Endotracheal intubation is a standard treatment in critical care to assist patient breathing. However, it can lead to respiratory complications. Subglottic stenosis is one such complication found after extubation, causing symptoms such as stridor, difficulty breathing, and exhaustion. This condition may require an emergency tracheostomy; otherwise, it can be fatal. The definitive causative factors of subglottic stenosis remain inconclusive. Some cases result from endotracheal intubation leading to laryngeal injury. Contributing factors include multiple intubation attempts, prolonged intubation (exceeding 7 days), and infections of the larynx and respiratory tract. Additionally, comorbidities such as obesity, diabetes, and gastroesophageal reflux disease (GERD) are significant risk factors.
Objective: To evaluate the survival rate and median survival time of patients with post-intubation subglottic stenosis over an 18-years follow-up period, and to identify clinical risk factors associated with survival.
Methodology: This study is a retrospective study based on inpatient and outpatient medical records from Buriram Hospital, covering patients treated from January 1, 2007, to July 31, 2024. Data were analyzed using descriptive statistics. The Kaplan-Meier method and Cox Proportional Hazards Regression model were employed to identify independent factors associated with survival rates.
Results: Among 46 patients with post-intubation subglottic stenosis, 7 (15.2%) were cured, 23 (50.0%) required long-term tracheostomy, and 16 (34.8%) died. The median survival time was 1,185 days (equivalent to 3.2 years). The survival rates at 1, 5, and 10 years were 73.9%, 39.1%, and 6.5%, respectively. The most significant risk factor associated with increased mortality was pneumonia (HR = 2.859). In contrast, age, severity of stenosis, tracheostomy, and duration of intubation had no significant effect on survival.
Conclusion: Patients with post-intubation subglottic stenosis had a 5-year survival rate of 39.1%, with a median survival time of 1,185 days. Pneumonia was identified as a poor prognostic factor; therefore, special consideration should be given to this condition when planning treatment. Furthermore, high-quality patient care both before and after intubation is essential to reduce the incidence of subglottic stenosis.
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References
Dorris ER, Russell J, Murphy M. Post-intubation subglottic stenosis: aetiology at the cellular and molecular level. Eur Respir Rev 2021;30(159):200218. doi: 10.1183/16000617.0218-2020.
Manica D, Schweiger C, Maróstica PJ, Kuhl G, Carvalho PR. Association between length of intubation and subglottic stenosis in children. Laryngoscope 2013;123(4):1049-54. doi: 10.1002/lary.23771.
ณัฐธิดา ภานิชาภัทร, ปวีณา วิจักษณ์ประเสริฐ. ปัจจัยเสี่ยงของการเกิดภาวะอุดกั้นทางเดินหายใจส่วนบนหลังถอดท่อช่วยหายใจ ผู้ป่วยเด็กที่เข้ารับการรักษาในโรงพยาบาลมหาราชนครราชสีมา. วารสารกุมารเวชศาสตร์ 2567;63(1):68–81.
Tobi KU, Agbedia S, Okhakhu Al, Ediale J. Subglottic Stenosis following prolonged endotracheal intubation in the Intensive Care Unit: Two Case Studies and a review of the literature. Rwanda Med J 2017;3:17-19.
Pappal RB, Burruss CP, Witt MA, Harryman C, Ali SZ, Bush ML, et al. Risk factors for developing subglottic and tracheal stenosis from the medical intensive care unit. Laryngoscope Investig Otolaryngol 2023;8(3):699-707. doi: 10.1002/lio2.1051.
Pasick LJ, Anis MM, Rosow DE. An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management. Curr Pulmonol Rep.2022;11(2):29-38. doi: 10.1007/s13665-022-00286-6.
Myer CM 3rd, O'Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994 ;103(4 Pt 1):319-23. doi: 10.1177/000348949410300410.
D'Andrilli A, Venuta F, Rendina EA.Subglottic tracheal stenosis. J Thorac Dis 2016;8(Suppl 2):S140-7. doi: 10.3978/j.issn.2072-1439.2016.02.03.
Tantinikorn W, Sinrachtanant C, Assanasen P. How to overcome laryngotracheal stenosis. J Med Assoc Thai 2004;87(7):800-9. PMID: 15521236
Küçük O, Aydemir S, Zengіn M, Alagöz A. Long-term results of intensive care patients with post-intubation tracheal stenosis: 7 years follow-up. BMC Pulm Med 2024;24(1):561. doi: 10.1186/s12890-024-03384-0.
Tongsakulrungruang K. Prolonged endotracheal intubation: complications and prevention. Chula Med J 1986;30(2):119-26. DOI: https://doi.org/10.58837/CHULA.CMJ.30.2.2
Fang H, Codipilly DC, Ravi K, Ekbom DC, Kasperbauer JL, Halland M. Gastroesophageal Reflux Characteristics and Patterns in Patients with Idiopathic Subglottic Stenosis. Gastroenterol Res Pract 2018;2018:8563697. doi: 10.1155/2018/8563697.
Wasserzug O, Derowe A. Subglottic Stenosis: Current Concepts and Recent Advances.
IJHNS 2016;7(2):97-103.
Prgomet D, Leović D, Šimić I, Gugić-Radojković I, Feljan H, Blivajs I. TREATMENT OF SUBGLOTTIC STENOSIS: A SINGLE INSTITUTION EXPERIENCE. Acta Clin Croat 2023;62(Suppl1):42-8. doi: 10.20471/acc.2023.62.s1.05.
Feinstein AJ, Goel A, Raghavan G, Long J, Chhetri DK, Berke GS, et al. Endoscopic Management of Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg 2017;143(5):500-5. doi: 10.1001/jamaoto.2016.4131.
Pan DR, Rosow DE. Office-based corticosteroid injections as adjuvant therapy for subglottic stenosis. Laryngoscope Investig Otolaryngol 2019;4(4):414-9. doi: 10.1002/lio2.284.
Bitar MA, Al Barazi R, Barakeh R. Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis. Braz J Otorhinolaryngol 2017;83(3):299-312. doi: 10.1016/j.bjorl.2016.03.012.
Palacios JM, Bellido DA, Valdivia FB, Ampuero PA, Figueroa CF, Medina C, et al. Tracheal stenosis as a complication of prolonged intubation in coronavirus disease 2019 (COVID-19) patients: a Peruvian cohort. J Thorac Dis 2022;14(4):995-1008. doi: 10.21037/jtd-21-1721.
Melkane AE, Matar NE, Haddad AC, Nassar MN, Almoutran HG, Rohayem Z, et al. Management of postintubation tracheal stenosis: appropriate indications make outcome differences. Respiration 2010;79(5):395-401. doi: 10.1159/000279225.
Ghiani A, Tsitouras K, Paderewska J, Munker D, Walcher S, Neurohr C, et al. Tracheal stenosis in prolonged mechanically ventilated patients: prevalence, risk factors, and bronchoscopic management. BMC Pulm Med 2022;22(1):24. doi: 10.1186/s12890-022-01821-6.
Sultan P, Carvalho B, Rose BO, Cregg R. Endotracheal tube cuff pressure monitoring: a review of the evidence. J Perioper Pract 2011;21(11):379-86. doi: 10.1177/175045891102101103.
Khan MU, Khokar R, Qureshi S, Al Zahrani T, Aqil M, Shiraz M. Measurement of endotracheal tube cuff pressure: Instrumental versus conventional method. Saudi J Anaesth 2016;10(4):428-31. doi: 10.4103/1658-354X.179113.
Braz JR, Navarro LH, Takata IH, Nascimento Júnior P. Endotracheal tube cuff pressure: need for precise measurement. Sao Paulo Med J 1999;117(6):243-7. doi: 10.1590/s1516-31801999000600004.
Lizy C, Swinnen W, Labeau S, Poelaert J, Vogelaers D, Vandewoude K, et al. Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation. Am J Crit Care 2014;23(1):e1-8. doi: 10.4037/ajcc2014489.
Beccaria LM, Doimo TMA, Polletti NAA, Barbosa TP, Silva DCD, Werneck AL. Tracheal cuff pressure change before and after the performance of nursing care. Rev Bras Enferm 2017;70(6):1145-50. doi: 10.1590/0034-7167-2016-0486.
Walner DL, Stern Y, Gerber ME, Rudolph C, Baldwin CY, Cotton RT. Gastroesophageal reflux in patients with subglottic stenosis. Arch Otolaryngol Head Neck Surg 1998;124(5):551-5. doi: 10.1001/archotol.124.5.551.
Cardoso PFG, Minamoto H, Bibas BJ, Pego-Fernandes PM. Impact of gastroesophageal reflux in the pathogenesis of tracheal stenosis. Transl Cancer Res 2020;9(3):2123-35. doi: 10.21037/tcr.2020.03.24.
สิรินทร์ แซ่อึ้ง. การศึกษาเปรียบเทียบระหว่างการเจาะคอเร็วและช้าในผู้ป่วยวิกฤตโรงพยาบาลท่าศาลา. มหาราชนครศรีธรรมราชเวชสาร 2565;5(2):47-58.
El-Anwar MW, Nofal AA, Shawadfy MA, Maaty A, Khazbak AO. Tracheostomy in the Intensive Care Unit: a University Hospital in a Developing Country Study. Int Arch Otorhinolaryngol 2017;21(1):33-7. doi: 10.1055/s-0036-1584227.
