Ventilation strategy and anesthesia management in patients with severe tracheal stenosis undergoing urgent tracheal stenting

医学 气管狭窄 气管导管 气管插管 通风(建筑) 狭窄 插管 气道 外科 麻醉 声门下狭窄 支气管镜检查 机械通风 气道管理 心脏病学 机械工程 工程类
作者
Jianhua Zhu,Min Lei,Enguo Chen,Qing Qiao,Tai-di Zhong
出处
期刊:Acta Anaesthesiologica Scandinavica [Wiley]
卷期号:62 (5): 600-607 被引量:13
标识
DOI:10.1111/aas.13062
摘要

Background Stenting of airway stenosis is a common procedure in specialized centers. The aim of this study was to summarize our clinical experience in ventilation strategy and anesthesia management of patients undergoing urgent tracheal stenting. Methods Clinical data of 22 patients with severe tracheal stenosis who underwent urgent endoscopic placement of a tracheal stent during a 2‐year period were retrospectively reviewed. The efficacy and safety of different ventilation strategies and veno‐arterial extracorporeal membrane oxygenation ( ECMO ), individualized based on the cause and location of tracheal narrowing, were evaluated. Results Sufficient ventilation was successfully established in all patients; ECMO was used in five patients with stenosis in the mid‐trachea who were unable to tolerate conventional intubation; a laryngeal mask airway ( LMA ) was used in five patients with post‐intubation tracheal stenosis; a cuffed tracheal tube was used in eight patients with lower tracheal stenosis; and low‐frequency jet ventilation in rigid bronchoscopy was used in four patients with mid‐ or lower tracheal stenosis. Tracheal stents were successfully placed and there were significant improvements in dyspnea. There were significant increases in the partial pressure of carbon dioxide in patients ventilated with the LMA and cuffed tracheal tube. There was no hypoxia during the operative period. Conclusion Establishment of effective airway ventilation in patients with severe tracheal stenosis should be based on the cause, location, and severity of tracheal narrowing. Veno‐ arterial ECMO may be considered in patients with severe stenosis, if they are judged unable to tolerate conventional ventilation or jet ventilation.
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