The application of mechanical respiratory therapy can improve respiratory function with good clinical efficacy, and the number of treated cases is increasing. With the widespread use of mechanical respiratory therapy, complications such as tracheal stenosis following tracheotomy and intubation have also become more common.

bubble_chart Etiology

A tracheostomy performed too high, injuring the first cartilage ring, can lead to erosion and inflammation of the cricoid cartilage, as well as difficult-to-treat subglottic grade III stenosis. During tracheostomy, excessive removal of the anterior tracheal wall tissue can result in the formation of granulation tissue and fibrous scar tissue later on. Pressure from the tracheal tube on the anterior tracheal wall can cause inward collapse of the tissue above the incision, while excessive weight from externally connected tubing can compress the tracheal wall, leading to tissue erosion and subsequent fibrous scar formation. Additionally, overinflation of the external cuff used to seal the tracheal lumen can exert excessive pressure on the entire circumference of the tracheal wall, causing tissue erosion and necrosis. In severe cases, this may lead to the formation of circumferential cicatricial stenosis or even tracheoesophageal fistula and tracheoinnominate artery fistula. The mortality rates for these latter two complications are very high. Therefore, during tracheostomy and intubation, attention should be paid to the location of the incision, avoiding excessive removal of anterior tracheal wall tissue. The size and length of the tracheal tube should be appropriate, cuff inflation pressure should not be excessive, and connected tubing should be lightweight and flexible to reduce the incidence of tracheal stenosis complications.

Clinical manifestations Common symptoms include airway obstruction leading to shortness of breath and difficulty breathing, which worsen with physical activity and increased respiratory secretions, often accompanied by wheezing. In cases with a history of tracheostomy and intubation presenting these symptoms, tracheal scar stenosis should be considered first. Anteroposterior, lateral, and oblique tracheal tomograms can clearly show the location, degree, length, and morphological changes of the stenosis.

bubble_chart Treatment Measures

The tracheal tube has been removed, and mechanical ventilation is no longer required, but for those with severe tracheal stenosis, a moving qi tube reconstruction surgery is generally necessary. For cases where respiratory function has not fully recovered, conservative treatments such as periodic tracheal dilation, tracheal reconstruction, tracheostomy tube insertion, or placement of a ventilation tube in the narrowed segment to support the tracheal lumen can be employed to maintain ventilation and prolong life.