Airway management during unusual tracheal stenosis: A clinical feasibility trial

Abstract

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
• flow‐controlled ventilation
• tracheal stenosis
• Tritube