Treatment of Post-intubation Tracheal Stenosis with Nd-YAG Laser

Tracheal intubation is a very common procedure for maintaining patency of airway in critically ill patients.Intubation may lead to local complications such as tracheal destruction and post-intubation stenosis. There are twodifferent therapeutic approaches for such patients. The first one is surgical end-to-end anastomosis suitable for severedestructions and fibrosis formations. The second and novel method is utilization of Nd-YAG Laser that can correctintraluminal airway lesions including webs, granulation tissues and fibrous bands. Nd-YAG laser employment decreaseshospitalization period, complications and, expenses; in addition, it saves medical staff’s time and energy.

An uncontrolled clinical trial was performed in post-intubation tracheal stenosis casesadmitted to “National Research Institute of Tuberculosis and Lung Disease” (NRITLD) between 1994 to 1999.Bronchoscopy was performed for all patients, and those with the following inclusion criteria underwent Laser therapy:length of stenosis less than 2 cm, tracheal lumen diameter more than 5mm, and granulation tissue type lesions. Patientswho did not meet the aforementioned criteria were referred for surgical interventions. Laser therapy was employed byfiberoptic bronchoscopy under local anesthesia. For those patients with tracheal lumen diameter between 5-10 mm rigidbronchoscopy was performed under general anesthesia.

Of 32 patients, 25 met the primary criteria for Laser therapy, from which 22 (88%) were completely cured.Because of poor general condition, 5 of 7 other patients who had been referred for surgery, underwent Laser therapy,therefore a total of 30 patients (93%) took advantage of this technique. Overall, 23 patients were treated only with Lasertherapy, 2 patients only with surgery and 7 patients with a combination of these two approaches.

This trial revealed that if patients with post-intubation tracheal stenosis are selected correctly, Lasertherapy can be used as a beneficial and safe method with satisfactory results. (Tanaffos 2002; 1(1):36-40).