Stenosis Trakea Distal Jinak Berat Pasca Trakeostomi dengan Gagal Napas Hiperkapnik: Dilatasi Bougie Terpandu Bronkoskopi dan Trakeostomi Distal Terarah
DOI:
https://doi.org/10.35790/ecl.v14i2.65878Keywords:
stenosis trakea; bronkoskopi; trakeostomi; gagal napas hiperkapnikAbstract
Abstract: Tracheal stenosis is a progressive upper-airway obstruction, most commonly occurring after intubation or tracheostomy in adults. We reported a 24-year-old man with a history of tracheostomy and prior bronchoscopy presented with acute worsening dyspnea and inspiratory stridor. Pre-intubation arterial blood gas demonstrated compensated hypercapnia (pH 7.347; pCO₂ 80 mmHg) despite oxygen saturation of 100%. Chest X-ray showed no significant parenchymal abnormality, and neck CT excluded external compression, while bronchoscopy revealed benign granulation tissue occluding >90% of the distal tracheal lumen, consistent with severe distal tracheal stenosis (Cotton–Myer grade 3–4) complicated by hypercapnic respiratory failure. Management consisted of emergency airway stabilization with orotracheal intubation and ICU care, followed by bronchoscopic bougie dilatation and targeted tracheostomy distal to the stenosis. This case highlights the need for high clinical suspicion and a multidisciplinary, stepwise approach to secure ventilation and bridge to definitive therapy.
Keywords: tracheal stenosis; bronchoscopy; tracheostomy; hypercapnic respiratory failure
Abstrak: Stenosis trakea merupakan obstruksi jalan napas atas yang dapat progresif dan pada pasien dewasa paling sering terjadi pasca-intubasi atau pasca-trakeostomi. Kami melaporkan seorang laki-laki 24 tahun dengan riwayat trakeostomi dan bronkoskopi sebelumnya, datang dengan sesak mendadak memberat disertai stridor inspirasi dan rasa tercekik. AGD pra-intubasi menunjukkan hiperkapnia terkompensasi (pH 7,347; pCO₂ 80 mmHg) dengan saturasi oksigen 100%. Foto toraks tidak menunjukkan kelainan parenkim bermakna dan CT colli tidak menemukan kompresi eksternal, sedangkan bronkoskopi memperlihatkan jaringan granulasi jinak yang menutup >90% lumen trakea distal. Pasien didiagnosis stenosis trakea distal jinak derajat berat setara Cotton–Myer 3–4 dengan gagal napas hiperkapnik. Tata laksana dilakukan secara bertahap melalui intubasi darurat dan stabilisasi di ICU, dilatasi bougie terpandu bronkoskopi, serta trakeostomi terarah distal dari lesi, sudah sesuai dengan prinsip penatalaksanaan obstruksi jalan napas sentral. Pendekatan ini berhasil menstabilkan ventilasi, namun pasien tetap memerlukan tindak lanjut berupa rujukan untuk terapi definitif seperti pemasangan stent trakea. Kasus ini menekankan pentingnya kewaspadaan klinis dan pendekatan multidisiplin untuk stabilisasi jalan napas serta pemantauan restenosis sebagai jembatan menuju terapi definitif.
Kata kunci: stenosis trakea; bronkoskopi; trakeostomi; gagal napas hiperkapnik
References
1. American College of Chest Physicians (CHEST). Management of central airway obstruction: an American College of Chest Physicians guideline and expert panel report. Chest. 2024;165(3):e123–e145. Doi: https://doi.org/10.1016/j.chest.2023.10.012
2. Gulilat D, Genetu A, Kejela S, Kassa S, Bekele A, Tizazu A, et al. Nonmalignant tracheal stenosis: presentation, management and outcome in limited resources setting. J Cardiothorac Surg. 2024;19(1):21. Doi:10.1186/s13019-024-02480-w.
3. Mu G, Wang F, Li Q, Yu X, Lu B. Reevaluating 30 cmH2O endotracheal tube cuff pressure: risks of airway mucosal damage during prolonged mechanical ventilation. Front Med (Lausanne). 2024;11:1468310. Doi: https://doi.org/10.3389/fmed.2024.1468310
4. Myer CM 3rd, O’Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol. 1994;103(4 Pt 1):319–23. Doi: https://doi.org/10.1177/000348949410300410
5. Jagpal N, Shabbir N. Subglottic Stenosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563265/
6. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on management of the difficult airway. Anesthesiology. 2022;136(1):31–81. Doi: https://doi.org/10.1097/ALN.0000000000004002
7. Fanucchi O, Di Santo A, Franceschi E, Gozzi G, Pignotti F, Peretti G, et al. The role of bronchoscopy in benign airway stenosis: literature review of a central procedure guiding multidisciplinary care and therapeutic approach for improving patient outcomes. J Vis Surg. 2025;11:2. Doi: https://doi.org/10.21037/jovs-24-29
8. Ravikumar N, Ho E, Eapen G, Mahajan A, Murgu S. The role of bronchoscopy in the multidisciplinary approach to benign tracheal stenosis. J Thorac Dis. 2023;15:ePub ahead of print. Doi: https://doi.org/10.21037/jtd-22-1579
9. Wright CD, Li S, Geller AD, Lanuti M, Gaissert HA, Muniappan A. Postintubation tracheal stenosis: management and results 1993 to 2017. Ann Thorac Surg. 2019;108(5):1471–7. Doi: https://doi.org/10.1016/j.athoracsur.2019.05.041
10. Galluccio G, Lucantoni G, Battistoni P, Paone G, Batzella S, Lucifora V, et al. Interventional endoscopy in the management of benign tracheal stenoses: definitive treatment at long-term follow-up. Eur J Cardiothorac Surg. 2009;35(3):429–33. Doi: https://doi.org/10.1016/j.ejcts.2008.10.041
11. Guo Q, An Q, Zhao L, Wu M, Wang Y, Guo Z. Safety and efficacy of dexmedetomidine for bronchoscopy: a systematic review and meta-analysis. J Clin Med. 2023;12(3):852. Doi: https://doi.org/10.3390/jcm12030852
12. Pertzov B, Krasulya I, Gelb A, Shteinberg M, Fridel L, Rosengarten D, et al. Dexmedetomidine versus propofol sedation in flexible bronchoscopy: a randomized controlled trial. BMC Pulm Med. 2022;22(1):87. Doi: https://doi.org/10.1186/s12890-022-01880-9
13. Apostolos F, Karvounis H, Koulouris NG, Maltezou HC, Triantafillidou C, et al. Dexmedetomidine–ketamine combination versus fentanyl–midazolam for patient sedation during flexible bronchoscopy: a prospective, single-blind, randomized trial. BMC Pulm Med. 2024;24(1):298. Doi: https://doi.org/10.1186/s12890-024-02988-w
14. Almanzar A, Mancho JP. Laryngotracheal stenosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554561/
15. Filauro M, Mazzola F, Missale F, Canevari FR, Peretti G. Endoscopic preoperative assessment, classification of stenosis, decision-making. Front Pediatr. 2020;7:532. Doi: https://doi.org/10.3389/fped.2019.00532
16. Chen DF, Chen YH, Wu CY, Liu YH, Hsu CI, Wu YC. Long-term efficacy and safety of the Dumon stent for benign tracheal stenosis: a meta-analysis. J Thorac Dis. 2021;13(1):192–203. Doi: https://doi.org/10.21037/jtd-20-2327
17. Lim SY, Kim H, Jeon K, Um SW, Koh WJ, Suh GY, et al. Prognostic factors for endotracheal silicone stenting in the management of inoperable post-intubation tracheal stenosis. Yonsei Med J. 2012;53(3):565–70. Doi: https://doi.org/10.3349/ymj.2012.53.3.565
18. Feng YG, Wu J, Peng T, Liu H, Li S, Zhang Q, et al. Surgical treatment of severe benign tracheal stenosis. J Cardiothorac Surg. 2023;18:173. Doi: https://doi.org/10.1186/s13019-023-02369-0
19. Karambelkar A, Lara J, Beattie JA, Parikh MS, Swenson KE, Majid A, et al. Procedure-free survival after therapeutic bronchoscopy in patients with central airway obstruction: a real-world analysis. Respir Med. 2025;244:108156. Doi: https://doi.org/10.1016/j.rmed.2025.108156
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