Mehmet KEFELİ, Ahmet BAŞOĞLU, Ayşen Taslak ŞENGÜL, Ömer Serdar BEKDEMİR, Tamer KUTLU, Tülin Durgun YETİM

The high risk of postintubation tracheal stenosis in patients intubated for organophosphate poisoning

Amaç: Bu çalışmada entübasyon sonrası trakea stenozu gelişen hastalar, entübasyonun birincil nedeni ve tedavisine göre tekrar değerlendirildi. Çalışma planı: Ocak 2001 - Aralık 206 tarihleri arasında yoğun bakım ünitesinde çeşitli nedenler ile endotrakeal entübasyon uygulanan 230 hasta arasından entübasyon sonrası trakeal stenoz gelişen 14 hasta retrospektif olarak incelendi. Hastaların tümü boyun ve göğüs bilgisayarlı tomografi taraması ile değerlendirildi ve trakeal anastomoz yapıldı. Rezeke edilen stenotik trakeal halkalar, histopatolojik olarak değerlendirildi. Bulgular: Hastaların toplam 201’ine genel travma (GT), 29’una ise organik fosfor zehirlenmesi (OFZ) nedeni ile endotrakeal entübasyon uygulandı. On dört olguda trakeal stenoz gelişti, bu olguların dokuzu OFZ, beşi GT hastası idi. Organik fosfor zehirlenmesi olan hastalarda yüksek doz atropin veya pralidoksim tedavisi dışında, medikal tedavi ve bakım her iki grupta genel olarak benzer idi. Rezeke edilen stenotik trakeal halkalarda, yaygın kronik aktif inflamasyon, fibrozis ve epitel kaybı OFZ grubunda, GT grubundan daha fazla idi. Sonuç: Entübasyonun birincil nedeni ve medikal tedavinin, entübasyon sonrası trakeal stenoz gelişimine etkisi olabilir.

Organik fosfor zehirlenmesi olan hastalarda yüksek postentübasyon trakeal stenoz riski

Background: This study aims to reevaluate patients who developed postintubation tracheal stenosis with regard to the primary reason for intubation and therapy. Methods: Between January 2001 and December 2006, 14 of 230 patients who underwent endotracheal intubation for various reasons in the intensive care unit (ICU) and then developed postintubation tracheal stenosis were analyzed retrospectively. All patients were examined with a neck and chest computed tomography (CT) scan, and tracheal anastomosis was performed. The resected stenotic tracheal rings were evaluated histopathologically. Results: A total of 201 patients underwent endotracheal intubation due to general trauma (GT), and 29 of these were due to organophosphate poisoning (OPP). Fourteen of these patients developed tracheal stenosis, including nine with OPP and five with GT. The medical therapy and care were generally similar in both groups, except that high doses of atropine and/or pralidoxime were administered to the OPP patients. Diffused chronic active inflammation, fibrosis, and epithelial loss in the resected stenotic tracheal rings were more common in the OPP group than in the GT group. Conclusion: The primary cause of intubation and the medical therapy employed may have an effect on postintubation tracheal stenosis.

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