HSC Section 6 Nov2016 Green Book

C. Tracheobronchial Disorders D’Anza B, Knight J, Greene JS. Does body mass index predict tracheal airway size? Laryngoscope . 2015; 125(5):1093-1097. EBM level 4..........................................156-160 Summary: This study reviewed information on 123 patients who underwent tracheotomy over a 4-year period who also had CT imaging of the trachea in the 3 months preceding tracheostomy. The size of the endotracheal tube at time of the tracheotomy was also noted. Measurements were taken at the level of the first tracheal ring, as this was the most likely area for cuff-related injury of the airway. Important findings from the study were that airway area was correlated with height, and body mass index was inversely related to tracheal width after controlling for gender and age. Gelbard A, Francis DO, Sandulache VC, et al. Causes and consequences of adult laryngotracheal stenosis. Laryngoscope . 2015; 125(5):1137-1143. EBM level 4.......................................................................................................................161-167 Summary: This study looked at 340 patients with tracheal or laryngeal stenosis at two different sites. The etiology categories were idiopathic, iatrogenic, autoimmune, and trauma. The trauma group had significantly younger patients, whereas the idiopathic group had significantly more females. Comorbidities such as cardiovascular disease, peripheral vascular disease, and diabetes were more prevalent in the iatrogenic group. The idiopathic group also had the least-severe degree of laryngotracheal stenosis, with significantly fewer patients (none in this study) having had tracheostomy. As expected, patients with higher-grade stenosis (Cotton-Myer grades III or IV) had higher odds of being tracheostomy-dependent. The presence of tracheomalacia increased the odds of requiring a tracheostomy in the iatrogenic group. Kettunen WW, Helmer SD, Haan JM. Incidence of overall complications and symptomatic tracheal stenosis is equivalent following open and percutaneous tracheostomy in the trauma patient. Am J Surg . 2014; 208(5):770-774. EBM level 3.......................................................................................................................168-172 Summary: This is a large (N = 616) retrospective comparative study of the rate of tracheal stenosis in trauma patients who underwent either percutaneous (N = 351) versus open (N = 265) tracheostomy. The authors found no significant difference in the rate of tracheal stenosis in the open (1.9%) versus percutaneous (1.1%) groups. They did find that patients who developed tracheal stenosis were younger ( p = 0.02) and had longer mechanical ventilation periods ( p = 0.055). In addition, mortality was significantly higher in open tracheostomy patients, but this may be secondary to selection bias since patients with higher acuity of illness may be more likely to undergo open procedures. Kraft SM, Sykes K, Palmer A, Schindler J. Using pulmonary function data to assess outcomes in the endoscopic management of subglottic stenosis. Ann Otol Rhinol Laryngol . 2015; 124(2):137-142. EBM level 4......................................................173-178 Summary: This retrospective case series described the utility of using pulmonary function tests to evaluate the efficacy of interventions for idiopathic subglottic stenosis. The pulmonary function parameters of PEF, PIF, FEV1/PEF, and FIF50% appeared to be the most valuable in judging response to endoscopic management and were significantly improved after airway dilation. PIF was the only parameter that was significantly associated with balloon size used for dilation. This study suggests that changes in PFTs are individualistic and need to be compared pre- and postprocedure for each patient (ie, there was no proposed “cut off” for intervention).