Treatment of postoperative tracheal granulation tissue with inhaled budesonide in congenital tracheal stenosis.

Abstract

PURPOSE:

Tracheal obstruction by granulation tissue can compromise the postoperative course in congenital tracheal stenosis (CTS). Balloon dilatation and stenting may be required. Budesonide is a corticosteroid with topical anti-inflammatory effects. In 2008, we used inhaled budesonide for treatment of postoperative granulation tissue for the first time in CTS, resulting in significant improvement. The aim of this study was to evaluate the efficacy of inhaled budesonide for treatment of postoperative granulation tissue in CTS.

METHODS:

Retrospective chart review was conducted. From 2004 through 2011, we performed 39 tracheoplasties. Forced stenting ± balloon dilatation (S/B) was required when airway obstruction with tissue granulation was life-threatening. We compared the requirement for S/B between the early group without budesonide (2004-Nov. 2008, Early) and the late group with budesonide (Dec. 2008-2011, Late). Statistical analysis was performed using Fisher's Exact test.

RESULTS:

Eleven of 22 in Early and 8 of 17 in Late were successfully extubated, never having had life-threatening tissue granulation. The remaining patients in each group (11 in Early and 9 in Late) required tracheostomies due to postoperative complication. Ten in Early and 5 in Late with tracheostomies developed granulation tissue. Of these patients, the 10 in Early required S/B, while none of the 5 in Late required S/B (P=.0003). Bronchoscopy demonstrated significant regression of granulation tissue in all cases treated with inhaled budesonide.

CONCLUSION:

Inhaled budesonide is effective for treatment of tracheal granulation tissue in patients with tracheostomies after repair of CTS.

• Authors: Akiko Yokoi, Makoto Nakao, Yuko Bitoh, Hiroshi Arai, Yoshihiro Oshima, Eiji Nishijima
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 49 Issue 2 Pg. 293-5; discussion 295 (Feb 2014) ISSN: 1531-5037 [Electronic] United States
• PMID: 24528970 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Inflammatory Agents
• Budesonide

Topics

• Administration, Inhalation
• Angioplasty, Balloon
• Anti-Inflammatory Agents (administration & dosage)
• Bronchoscopy
• Budesonide (administration & dosage)
• Child
• Female
• Granulation Tissue (pathology)
• Humans
• Male
• Postoperative Complications (drug therapy)
• Retrospective Studies
• Stents
• Tracheal Stenosis (drug therapy, etiology)
• Treatment Outcome