Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis
Abstract Objective Peristomal subglottic stenosis (SGS) is a common sequela after tracheostomy, with severe cases precluding decannulation. Predictors of decannulation success in these patients following endoscopic intervention are not well studied. The aim of this study is to investigate predictors...
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Wiley
2024-10-01
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| Online Access: | https://doi.org/10.1002/oto2.70033 |
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| author | Nader Wehbi David Ahmadian Claire Gleadhill Helena T. Yip |
| author_facet | Nader Wehbi David Ahmadian Claire Gleadhill Helena T. Yip |
| author_sort | Nader Wehbi |
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| description | Abstract Objective Peristomal subglottic stenosis (SGS) is a common sequela after tracheostomy, with severe cases precluding decannulation. Predictors of decannulation success in these patients following endoscopic intervention are not well studied. The aim of this study is to investigate predictors of successful decannulation and inform treatment decisions. Study Design This study is a retrospective case series of 22 adult patients presenting to the senior author with a tracheostomy and peristomal SGS precluding decannulation between 2018 and 2023. Setting Department of Otolaryngology–Head & Neck Surgery, University of Arizona College of Medicine–Tucson. Methods Patient demographics, relevant clinical factors, stenosis characteristics, and the number of endoscopic procedures performed were analyzed to identify predictors of successful decannulation. Endoscopic interventions were generally performed 3 months apart with CO2 laser debridement, balloon dilation, and intralesional injection of steroid, all done with a laser‐safe endotracheal tube in place through the stoma. Results Out of the 22 patients in the study, 9 (40.9%) achieved decannulation, all through an endoscopic approach. Body mass index (BMI) and age were identified as significant negative predictors of decannulation success (P = .02; P = .05, respectively). Stenosis characteristics, such as the presence of tracheomalacia, excessive dynamic airway collapse, multilevel stenosis, posterior glottic stenosis, and anterior granulation tissue shelf did not significantly impact decannulation success. Conclusion A 40.9% decannulation rate was achieved in our cohort. BMI and age were identified as negative predictors of decannulation success. Stenosis characteristics did not significantly affect decannulation outcomes. Further investigation is warranted to establish reliable predictors of decannulation. |
| format | Article |
| id | doaj-art-541b7ff1a7ac4537a24d9fa4a53c9dd8 |
| institution | DOAJ |
| issn | 2473-974X |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Wiley |
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| series | OTO Open |
| spelling | doaj-art-541b7ff1a7ac4537a24d9fa4a53c9dd82025-08-20T02:56:01ZengWileyOTO Open2473-974X2024-10-0184n/an/a10.1002/oto2.70033Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic StenosisNader Wehbi0David Ahmadian1Claire Gleadhill2Helena T. Yip3College of Medicine–Phoenix University of Arizona Phoenix Arizona USACollege of Medicine–Tucson University of Arizona Tucson Arizona USADepartment of Otolaryngology College of Medicine–Tucson, University of Arizona Tucson Arizona USADepartment of Otolaryngology College of Medicine–Tucson, University of Arizona Tucson Arizona USAAbstract Objective Peristomal subglottic stenosis (SGS) is a common sequela after tracheostomy, with severe cases precluding decannulation. Predictors of decannulation success in these patients following endoscopic intervention are not well studied. The aim of this study is to investigate predictors of successful decannulation and inform treatment decisions. Study Design This study is a retrospective case series of 22 adult patients presenting to the senior author with a tracheostomy and peristomal SGS precluding decannulation between 2018 and 2023. Setting Department of Otolaryngology–Head & Neck Surgery, University of Arizona College of Medicine–Tucson. Methods Patient demographics, relevant clinical factors, stenosis characteristics, and the number of endoscopic procedures performed were analyzed to identify predictors of successful decannulation. Endoscopic interventions were generally performed 3 months apart with CO2 laser debridement, balloon dilation, and intralesional injection of steroid, all done with a laser‐safe endotracheal tube in place through the stoma. Results Out of the 22 patients in the study, 9 (40.9%) achieved decannulation, all through an endoscopic approach. Body mass index (BMI) and age were identified as significant negative predictors of decannulation success (P = .02; P = .05, respectively). Stenosis characteristics, such as the presence of tracheomalacia, excessive dynamic airway collapse, multilevel stenosis, posterior glottic stenosis, and anterior granulation tissue shelf did not significantly impact decannulation success. Conclusion A 40.9% decannulation rate was achieved in our cohort. BMI and age were identified as negative predictors of decannulation success. Stenosis characteristics did not significantly affect decannulation outcomes. Further investigation is warranted to establish reliable predictors of decannulation.https://doi.org/10.1002/oto2.70033decannulationendoscopic treatmentperistomal subglottic stenosistracheostomy |
| spellingShingle | Nader Wehbi David Ahmadian Claire Gleadhill Helena T. Yip Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis OTO Open decannulation endoscopic treatment peristomal subglottic stenosis tracheostomy |
| title | Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis |
| title_full | Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis |
| title_fullStr | Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis |
| title_full_unstemmed | Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis |
| title_short | Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis |
| title_sort | investigating predictors of decannulation through endoscopic approach in patients with tracheostomy and peristomal subglottic stenosis |
| topic | decannulation endoscopic treatment peristomal subglottic stenosis tracheostomy |
| url | https://doi.org/10.1002/oto2.70033 |
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