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The Journal of Thoracic and Cardiovascular Surgery, Vol 83, 414-417, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
S Westaby, JW Jackson and FG Pearson
Though the techniques for surgical treatment after postintubation tracheal
stenoses are well defined, the management of major airway obstruction by
tracheal tumor, external compression, or diffuse intrinsic tracheal disease
below the thoracic inlet still presents a difficult problem. Existing
methods do not provide safe and effective relief at the level of the distal
trachea, carina, and main bronchi. This report describes a bifurcated
silicone rubber stent initially designed to preserve patency of the airways
in a patient after severe and diffuse scalding injury to the trachea and
main bronchi. This stent has since been used to provide relief from airway
obstruction by tracheal or mediastinal tumors below the thoracic inlet. The
method for insertion by tracheostomy with guide bougies passed under direct
bronchoscopic vision past the obstructing lesion is described in detail and
illustrated by reference to two patients with tracheobronchial obstruction.
Once the tube is in place, the patient breathes normally through the mouth
and nose and can speak, cough, or clear his own airway by suction if
necessary. This method has proved a safe and effective means to restore
patency of the major airways and provide relief from asphyxia while further
treatment is planned or healing ensues. Our initial experience indicates
that the tube may be allowed to remain in position for several months
without adverse effects.
ARTICLES
A bifurcated silicone rubber stent for relief of tracheobronchial obstruction
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