Prevalence and Characteristics of Tracheal Lesions Obascserved in Tracheostomized Patients.

Este estudio nos permite conocer la prevalencia de lesiones traqueales en una población de pacientes especiales, como son los pacientes post terapia intensiva. Además, la evaluación no se realiza en pacientes sintomáticos y esto permite conocer la prevalencia de lesiones incipientes conociendo el posible desarrollo de progresión con el tiempo. La observación durante un período prolongado de los ingresos de nuestro centro de desvinculación de la ventilación mecánica y rehabilitación se ve fortalecida por la evaluación del mismo médico con largos años de experiencia en endoscopías.

Planells FVillalba DViviana FLeiva VScrigna MDistéfano ECollins JRocco AMatesa AÁreas LGolfarini NGil-Rossetti GPini MPHannun MBoni SGrimaldi SPedace PDíaz-Ballvé PAndreu MBuñirigo PNoval D.

ABSTRACT
Background:
Our objective was to describe the prevalence and characteristics of tracheal lesions observed in flexile bronchoscopies of tracheostomized patients, and to determine those factors associated with severe injuries.

Methods:
This is an analytical, observational, and transversal study. The flexible bronchoscopies of tracheostomized patients from our database were reviewed to assess their lesions. The tracheal lesions were classified according to their severity; lesions obstructing above 50% of the lumen were interpreted as severe and those obstructing <50% as mild. The lesions were also classified according to location as glottic, subglottic, at the level of the tracheal ostomy, tracheal, and bronchial. The types of lesions found were granuloma, stenosis, and excessive central airway collapse. Possible predictors of severe lesions were assessed.

Results:
A total of 414 patients were included in the study, the mean age being 65 years (±16.2?y). Of all the bronchoscopies assessed, 202 (49%) showed mild lesions, and 91 (22%) were severe. We found granulomas in 230 patients (55%), and 32 (26%) were severe. Of the 27 patients with stenosis (7%), 17 (63%) were severe. Excessive central airway collapse was seen in 120 patients (31.8%), and 65 (54%) were severe. There were statistically significant differences related to age in the group that developed severe lesions (mean age, 73 y; Q1 to Q3, 58 to 81) compared with the group free of lesions (mean age, 69 y; Q1 to Q3, 55.7 to 75; P = 0.001) and also in the duration requiring an artificial airway (mean, 84.5 d; Q1 to Q3, 49 to 135.5) compared with the group free of lesions (mean of 59.5 d; Q1 to Q3, 42 to 98; P = 0.035).

Conclusion:
There was a high prevalence of tracheal lesions, mainly subglottic granulomas. Age and the duration for which the patient required an artificial airway were related to the presence of severe lesions.

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