Patient selection: 2 or more reintubations
Criteria for severe tracheal stenosis:
(1) clinical signs of upper airway obstruction
(1a) exercise dyspnea (dyspnea on exertion)
(1b) wheezing
(1c) stridor
(1d) coughing
(1e) choking
(1f) difficulty clearing tracheal secretions
(2) marked flattening of the flow-loop tracing
Clinical signs were not graded because of subjectivity. Exercise testing might be a way to make some findings more objective.
Risk factors for severe tracheal stenosis:
(1) number of reintubations (in the implementation risk set if >=3)
(2) difficulty during reintubations
(3) other sources of trauma to the larynx or trachea
(4) female gender AND diabetes AND prolonged intubation
(5) inhalation burn injury AND prolonged intubation
(6) laryngeal edema
In the study group none of the patients undergoing tracheostomy developed severe tracheal stenosis.
