Post-intubation Tracheal Stenosis After a Single Day of Intubation

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Post-intubation tracheal stenosis (PITS) is an iatrogenic complication after tracheal stenosis. It is usually associated with longer duration of intubation and long-term complications are usually rare with intubation less than a week. Herein, we present a case of tracheal stenosis after a single day of intubation. A 22-year-old female with no significant PMH was admitted to the hospital for a cardiac arrest. Patient had altered mental status and was intubated (8 mm ETT) on first attempt without complications. Patient had another episode of cardiac arrest overnight requiring 30 seconds of CPR. Mental status improved and she was extubated the next day. However, due to recurrent uncontrolled arrhythmia, electrophysiology recommended elective re-intubation for further evaluation which was complicated by existing laryngeal edema and took multiple attempts. Dexamethasone reduced laryngeal edema and patient was extubated after four days. Post-extubation, she had a mild stridor which was treated with steroids and racemic epinephrine and patient was discharged. However, she presented to the ED multiple times for difficulty breathing and stridor and was admitted again 2.5 weeks after discharge. CT neck was reviewed by ENT and indicated tracheal stenosis. Bronchoscopy showed complex tracheal stenosis 4 mm in diameter, 25 mm long and 40 mm below the cords. She underwent rigid and flexible bronchoscopy with cryotherapy and mechanical dilation/destruction of stenosis to 12 mm. In the following month, patient continued to present with recurrent tracheal stenosis and underwent four additional sessions of bronchoscopy with mechanical or balloon dilation. Given the recurrent nature and worsening stenosis, patient underwent tracheal resection with partial upper sternotomy. Tracheal stenosis is a well-recognized yet underdiagnosed complication of intubation. It is more often seen in prolonged intubations with an incidence of 2% in less than 6-day intubations. Common factors include cuff pressure, size of the tube relative to the tracheal lumen, duration of intubation, cardiovascular (CV) status during intubation, movement of the tube, sex and age of patient and adverse effects of steroids. [2] In our case, the laryngeal edema after the first intubation indicated tracheal damage. The overnight cardiac arrest requiring CPR while patient was intubated seems to be the culprit with combined effect of underlying hypotension and mechanical trauma from ETT during CPR. This case highlights the consideration of PITS even after a brief period of intubation and the importance of variables that contribute to tracheal damage including the CV status during intubation.

Volume

211

First Page

A2018

Last Page

A2018

Comments

American Thoracic Society International Conference, May 16-25, 2025, San Francisco, CA

DOI

10.1164/ajrccm.2025.211.Abstracts.A2018

ISSN

1535-4970

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