Incidence Rate of Post-Intubation Tracheal Stenosis in Patients Admitted to Five Intensive Care Units in Iran
نویسندگان
1 Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran,
2 Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran,
3 Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran,
4 Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran,
5 Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
6 Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran,
doi
چکیده
Tracheal stenosis is one of the worst complications associated with endotracheal intubation and it is the most commonreason for reconstructive airway surgeries. Due to various local risk factors, the incidence rate of tracheal stenosis may varyin different countries. In order to estimate the incidence rate of post-intubation tracheal stenosis (PITS) in patients admitted to anintensive care unit (ICU), a follow-up study was planned. As there was no similar methodological model in the literature, a feasibilitystep was also designed to examine the whole project and to enhance the follow-up rate.Objectives: To estimate the PITS incidence rate in patients admitted to ICUs, as well as to evaluate the feasibility of the study.Methods: This prospective cohort study was conducted in five hospitals in two provinces (Tehran and Arak) of Iran from November2011 to March 2013. All patients admitted to ICUs who underwent more than 24 hours of endotracheal intubation were included.Upon their discharge from the ICUs, the patients received oral and written educational materials intended to ensure a more successfulfollow-up. The patients were asked to come back for follow-up three months after their extubation, or sooner in case of anysymptoms developing. Those with dyspnea or stridor underwent a bronchoscopy. The asymptomatic patients were given a spirometryand then they underwent a bronchoscopy if the flow-volume loop suggested airway stenosis.Results: Some seventy-three patients (70% men) were included in the study. Multiple trauma secondary to motor vehicle accidents(52%)wasthemostcommoncause of intubation. Follow-ups were completed in only 14 (19.2%, CI=0.109 - 0.300) patients. Onepatient(7%, CI = 0.007 - 0.288) developed symptomatic tracheal stenosis that was confirmed by bronchoscopy. The barriers to a successfulfollow-up were assessed on three levels: ineffective oral education upon discharge, improper usage of educational materials, anddifficulties to attending follow-up visits. There were also some important obstacles in terms of human, time, material, and costresources, as well as data management.Conclusions: To enhance the follow-up rate, three strategies were proposed: patient-focused strategies such as emphasizing patienteducation upon discharge and providing rewards; structural-focused strategies such as scheduling home visits and uploadingquestionnaires onto the research center’s website; and provider-focused strategies such as selecting coordinators with goodcommunication skills. All necessary resources should also be re-arranged for a multicenter national study.
