Intubation was successful in all cases in this series. A total of 118 prostheses were inserted in the 66 patients, more than one prosthesis having been used in some patients either successively (17 cases: two to seven prostheses) or simultaneously (11 cases: two to three prostheses). The prosthesis was placed in the trachea in 59 cases, in the left main stem bronchus in 34, in the right main stem bronchus in 16, in the right lower lobe bronchus in five, in the left lower lobe bronchus in one and in the bronchus intermedius in one case. In the remaining two cases, a long prosthesis extending from the trachea into the left main stem bronchus was used. In three patients, tracheobronchial intubation was associated with esophageal intubation.
Immediate relief of respiratory symptoms with significant quality survival was achieved in all but two cases. Mean follow-up at the time of this writing is 3.5 months with the longest follow-up 19 months. All of the patients who died succumbed to causes other than airway obstruction. In both cases in which no relief was obtained, the patients had undergone left pneu- mectomy and presented compressive obstruction of the remaining main stem bronchus. When intubation was attempted as a desperate “last resort,” both patients were in acute respiratory distress (one with 02 saturation below 45 percent). Despite successful intubation, these patients died—one on the day of the procedure and the other three days later. tadacip 20 mg
Tolerance was excellent. No patient complained of pain or discomfort. In fact, most patients reported no foreign body sensation at all. No infection due to the presence of the prosthesis was observed. To prevent infection, two precautions should be taken: the prosthesis should be carefully sterilized before insertion, and antibiotics should be administered for the first few days after insertion.
Obstruction of the prosthesis by dried secretions was recorded in two patients. In one patient with diffuse tracheobronchial amyloidosis, the prosthesis was cleared by aspiration and left in place. The other case involving a tracheostomized patient was more serious since the prosthesis was totally obstructed by dried secretions and had to be removed.
Granulomas were observed in ten cases. All these cases occurred early in the series and were probably due to the excessive rigidity and sharp edges of the makeshift prosthesis used at that time. No granulomas have been observed since we began using our new dedicated tracheobronchial prosthesis which is made of a more flexible material and has a carefully smoothed surface. Granulomas may be resected with the laser, but the prosthesis must be removed first because there is the danger of igniting the prosthesis and because a defective prosthesis must be replaced to prevent recurrence.
Migration of the prosthesis occurred 12 times. In seven of these 12 cases an early, poorly designed prototype tracheal stent had been used. This prototype had two serious defects, ie, overrigidity and short studs. These defects have since been corrected. In the other five cases, migration resulted because the prosthesis did not fit snugly. Indeed, choosing the right diameter is the key to preventing migration. In all cases, endoscopy was performed and the prosthesis was removed and replaced by a properly fitting one.
In two cases, injury to vocal cords with resulting aphonia occurred during insertion. One of these patients recovered his voice after one week but in the other aphonia is ongoing at two months due to luxation of an arythenoid. viagra plus
The long prosthesis designed to extend from the trachea into a main stem bronchus was used in only two cases. Placement of this type of prosthesis was difficult in both cases and results were not very good. In one case, the prosthesis had to be removed after two months because granulomas formed on the side opening to the right lung. In the other case, migration occurred after only five days. Based on these results it appears safer and technically easier to stack stents than to use the long prosthesis alone.