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Postintubation Injury

Michael A. Maddaus, F. Griffith Pearson, Maria Lucia L. Madariaga, Henning A. Gaissert

Key Points

  • Blood supply to the trachea is segmental.
  • Intubation may damage the airway at one or several levels: glottis, subglottis, trachea and main bronchi.
  • Postintubation injury, the most common cause of benign upper airway stenosis, can be the result of pressure on the posterior commissure or vocal folds, tube cuff, tube pressure at the tracheal stoma, confluent injury between cuff and stoma in the trachea, or injury from the tip of the endotracheal tube
  • Dyspnea on exertion with stridor is the usual symptom of airway stenosis. Patients are frequently misdiagnosed as having asthma.
  • Critical tracheal stenosis due to intubation is best managed by tracheal or laryngotracheal resection and reconstruction in appropriate candidates.
  • Repair of the arterial wall is contraindicated in acute tracheo-innominate artery fistula after tracheostomy.
  • Prior to single-stage repair of tracheoesophageal fistula with tracheal resection, esophageal closure and muscle interposition, nutrition should be optimized and ongoing respiratory aspiration prevented.

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Last updated: August 27, 2024