Post-intubation tracheal stenosis (PITS) is a medically-origin disease in which the trachea has experienced different degrees of ischemic or transmural damage to the tissues from the mucous membranes to the cartilage after treatment with tracheal intubation or tracheotomy, leading to scarring healing of the trachea (4,5). Epidemiological statistics indicate that the incidence of PITS is roughly 4.9 cases per million population annually (6). Stenosis frequently occurs at the site of trocar pressure during tracheal intubation and is formed mostly 3 to 6 weeks after extubation (7, 8). Dry cough, inspiratory wheezing, and progressive dyspnea are frequent symptoms of TS and are most likely to be clinically misinterpreted as asthma disease (9). This highlights the significance of a comprehensive medical history, specifically regarding the quantity of tracheal incisions or intubations, the length of the intubation, a history of airway surgery, or a genetic history of airway disease. All of these details provide the physician with crucial information for the diagnosis and treatment of TS.
Cervical chest CT and bronchoscopy are the "gold standard" for the diagnosis or evaluation of tracheal stenosis, and pulmonary function tests can be an indirect adjunct to the diagnosis (10–12). In clinical practice, the McCaffrey and Cotton-Meyer staging method is frequently employed to evaluate the severity of TS (13, 14). For the treatment of TS, open surgery, endoscopic surgery, and stenosis injection of steroids are the main options. Steroid injection for TS is a hot topic in current research, but most experts have not yet reached a consensus on the exact treatment strategy. Further research has shown that injectable steroids alone or in combination with steroid medication injections given following endoscopic dilatation can yield meaningful therapeutic outcomes to help treat TS (15–17).
In complicated and severe cases of TS, surgical stenosis excision or airway reconstruction remains the preferred treatment of choice. PITS is typically caused by tracheal injuries that affect the pharynx or the trachea's cartilaginous tissues, resulting in a stenosis that is more widely distributed, more severely blocked, and lower in position. The most successful way to treat PITS is surgery; however, endoscopic dilatation is less intrusive, has a lower rate of complications, is generally effective, and may need to be repeated (18–21). Prospective investigations into methods like tracheal replacement or transplantation, tracheal stent implantation, endotracheal skin grafting, or endoscopic scar removal might potentially provide novel developments in the management of PITS (22–24).
Another typical characteristic of critically ill patients with respiratory or neurological diseases is acquired airway injuries. When a patient needs to be intubated after evaluation, the proper and efficient placement of an endotracheal tube is essential to preventing PITS. According to research on effective PITS prevention, the following strategies can be used (25–27): The ideal location for the tracheal tube is three to five centimeters above the bifurcation bulge, as identified by imaging. In addition to lowering the risk of aspirating secretions from the airways, using tracheal intubation with a high-capacity, low-pressure balloon and keeping its pressure between 20 and 30 cmH2O successfully minimizes acquired airway damage and the development of distant stenosis. For less than seven days, tracheal intubation and mechanical ventilation should be administered. During this time, the trocar pressure should be regularly checked, the intubation trocar should be relaxed, and in critically ill patients who need prolonged mechanical ventilation, an early tracheotomy should be done.