Tracheal Stenosis: Preventable morbidity on the increase in our intensive care units

Abstract

Following a marked increase in patients with tracheal stenosis at Groote Schuur Hospital, we re-examined this problem to identify new trends. Practitioners should be aware of this problem and that tracheal stenosis is an avoidable complication of endotracheal (ET) intubation. It is invariably difficult to treat, a heavy treatment burden and has an associated significant morbidity and reduction in quality of life. A 10-year retrospective review of patients that presented with or were referred to our service with tracheal stenosis showed no new patterns to be responsible for the increase incidence of stenosis. Therefore we conducted a survey of endotracheal tube (ETT) cuff pressures and cuff monitoring practises in local intensive care units (ICUs). This revealed that cuff pressures were dangerously elevated in 30% of all intubated patients surveyed in the ICUs. We are concerned that poor cuff pressure monitoring practises may be responsible for the increase in tracheal stenosis.