A bifurcated silicone rubber stent for relief of tracheobronchial obstruction

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.