1
|
Nguyen M, Amanian A, Wei M, Prisman E, Mendez-Tellez PA. Predicting Tracheostomy Need on Admission to the Intensive Care Unit-A Multicenter Machine Learning Analysis. Otolaryngol Head Neck Surg 2024. [PMID: 39077854 DOI: 10.1002/ohn.919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 06/12/2024] [Accepted: 07/06/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE It is difficult to predict which mechanically ventilated patients will ultimately require a tracheostomy which further predisposes them to unnecessary spontaneous breathing trials, additional time on the ventilator, increased costs, and further ventilation-related complications such as subglottic stenosis. In this study, we aimed to develop a machine learning tool to predict which patients need a tracheostomy at the onset of admission to the intensive care unit (ICU). STUDY DESIGN Retrospective Cohort Study. SETTING Multicenter Study of 335 Intensive Care Units between 2014 and 2015. METHODS The eICU Collaborative Research Database (eICU-CRD) was utilized to obtain the patient cohort. Inclusion criteria included: (1) Age >18 years and (2) ICU admission requiring mechanical ventilation. The primary outcome of interest included tracheostomy assessed via a binary classification model. Models included logistic regression (LR), random forest (RF), and Extreme Gradient Boosting (XGBoost). RESULTS Of 38,508 invasively mechanically ventilated patients, 1605 patients underwent a tracheostomy. The XGBoost, RF, and LR models had fair performances at an AUROC 0.794, 0.780, and 0.775 respectively. Limiting the XGBoost model to 20 features out of 331, a minimal reduction in performance was observed with an AUROC of 0.778. Using Shapley Additive Explanations, the top features were an admission diagnosis of pneumonia or sepsis and comorbidity of chronic respiratory failure. CONCLUSIONS Our machine learning model accurately predicts the probability that a patient will eventually require a tracheostomy upon ICU admission, and upon prospective validation, we have the potential to institute earlier interventions and reduce the complications of prolonged ventilation.
Collapse
Affiliation(s)
| | - Ameen Amanian
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Meihan Wei
- Department of Biomedical Engineering-Whiting School of Engineering, Johns Hopkins University, Baltimore, USA
| | - Eitan Prisman
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, Canada
| | - Pedro Alejandro Mendez-Tellez
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
2
|
Papaioannou M, Vagiana E, Kotoulas SC, Sileli M, Manika K, Tsantos A, Kapravelos N. Tracheostomy-related data from an intensive care unit for two consecutive years before the COVID-19 pandemic. World J Methodol 2024; 14:91868. [PMID: 38983661 PMCID: PMC11229867 DOI: 10.5662/wjm.v14.i2.91868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/24/2024] [Accepted: 04/12/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Tracheostomy is commonly used in intensive care unit (ICU) patients who are expected to be on long-term mechanical ventilation or suffer from emergency upper airway obstruction. However, some studies have conflicting findings regarding the optimal technique and its timing and benefits. AIM To provide evidence of practice, characteristics, and outcome concerning tracheostomy in an ICU of a tertiary care hospital. METHODS This was a retrospective cohort study including adult critical care patients in a single ICU for two consecutive years. Patients' demographic characteristics, severity of illness (APACHE II score), level of consciousness [Glasgow Coma Scale (GCS)], comorbidities, timing and type of tracheostomy procedure performed and outcome were recorded. We defined late as tracheostomy placement after 8 days or no tracheotomy. RESULTS Data of 660 patients were analyzed (median age of 60 years), median APACHE II score of 19 and median GCS score of 12 at admission. Tracheostomy was performed in 115 patients, of whom 63 had early and 52 late procedures. Early tracheostomy was mainly executed in case of altered level of consciousness and severe critical illness polyneuromyopathy, however there were no significant statistical results (47.6% vs 36.5%, P = 0.23) and (23.8% vs 19.2%, P = 0.55) respectively. Regarding the method selected, early surgical tracheostomy (ST) was conducted in patients with maxillofacial injuries (50.0% vs 0.0%, P = 0.033), whereas late surgical tracheostomy was selected for patients with goiter (44.4% vs 0.0% P = 0.033). Patients with early tracheostomy spent significantly fewer days on mechanical ventilation (15.3 ± 8.5 vs 22.8 ± 9.6, P < 0.001) and in ICU in general (18.8 ± 9.1 vs 25.4 ± 11.5, P < 0.001). Percutaneous dilatation tracheostomy (PDT) vs ST was preferable in older critical care patients in the case of Central Nervous System underlying cause of admission (62.5% vs 26.3%, P = 0.004). ST was the method of choice in compromised airway (31.6%, vs 7.3% P = 0.008). A large proportion of patients (88/115) with tracheostomy managed to wean from mechanical ventilation and were transferred out of the ICU (100% vs 17.4%, P < 0.001). CONCLUSION PDT was performed more frequently in our cohort. This technique did not affect mechanical ventilation days, ventilator-associated pneumonia (VAP), ICU length of stay, or survival. No complications were observed in the percutaneous or surgical tracheostomy groups. Patients undergoing early tracheostomy benefited in terms of mechanical ventilation days and ICU length of stay but not of discharge status, presence of VAP, or survival.
Collapse
Affiliation(s)
- Maria Papaioannou
- 1st Intensive Care Unit, G Papanikolaou General Hospital, Exohi, Thessaloniki 57010, Greece
| | - Evdoxia Vagiana
- 2nd Intensive Care Unit, G Papanikolaou General Hospital, Exohi, Thessaloniki 57010, Greece
| | | | - Maria Sileli
- 2nd Intensive Care Unit, G Papanikolaou General Hospital, Exohi, Thessaloniki 57010, Greece
| | - Katerina Manika
- Department of Pulmonary, Medical School, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Exohi, Thessaloniki 57010, Greece
| | - Alexandros Tsantos
- 2nd Department of Internal Medicine, General Hospital of Thessaloniki “Ippokration”, Thessaloniki 54642, Greece
| | - Nikolaos Kapravelos
- 2nd Intensive Care Unit, G Papanikolaou General Hospital, Exohi, Thessaloniki 57010, Greece
| |
Collapse
|
3
|
Keirns DL, Rajan AK, Wee SH, Govardhan IS, Eitan DN, Dilsaver DB, Ng I, Balters MW. Tracheal Stenosis in Open Versus Percutaneous Tracheostomy. Cureus 2024; 16:e57075. [PMID: 38681475 PMCID: PMC11052640 DOI: 10.7759/cureus.57075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE This study aims to investigate if there is an increased risk of developing tracheal stenosis after tracheostomy with an open versus percutaneous tracheostomy. METHODS The patient cohort included patients receiving open or percutaneous tracheostomies at Catholic Health Initiatives Midwest facilities from January 2017 to June 2023. The primary aim was to compare the differences in the risk of developing tracheal stenosis between open and percutaneous tracheostomy techniques. Between-technique differences in the risk of developing tracheal stenosis were assessed via a Cox proportional hazard model. To account for death precluding patients from developing tracheal stenosis, death was considered a competing risk. RESULTS A total of 828 patients met inclusion criteria (61.7% open, 38.3% percutaneous); 2.5% (N = 21) developed tracheal stenosis. The median number of days to develop tracheal stenosis was 84 (interquartile range: 60 to 243, range: 6 to 739). Tracheal stenosis was more frequent in patients who received a percutaneous tracheostomy (percutaneous: 3.5% vs. open: 2.0%); however, the risk of developing tracheal stenosis was statistically similar between open and percutaneous techniques (HR: 2.05, 95% CI: 0.86-4.94, p = 0.108). CONCLUSIONS This study demonstrates no significant difference in the development of tracheal stenosis when performing an open versus a percutaneous tracheostomy. Tracheal stenosis is a long-term complication of tracheostomy and should not influence the decision about the surgical technique used.
Collapse
Affiliation(s)
- Darby L Keirns
- Department of Surgery, Creighton University School of Medicine, Phoenix, USA
| | - Ajay K Rajan
- Department of Surgery, Creighton University School of Medicine, Phoenix, USA
| | - Shirline H Wee
- Department of Surgery, Creighton University School of Medicine, Phoenix, USA
| | - Isheeta S Govardhan
- Department of Surgery, Creighton University School of Medicine, Phoenix, USA
| | - Dana N Eitan
- Department of Surgery, Creighton University School of Medicine, Phoenix, USA
| | - Danielle B Dilsaver
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, USA
| | - Ian Ng
- Department of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, USA
| | - Marcus W Balters
- Department of Surgery, Creighton University School of Medicine, Omaha, USA
| |
Collapse
|
4
|
Sissoko C, Walker V, Dion GR. Biomechanical Evaluation of Tracheal Needle Puncture Forces: Comparative Analysis of Annular Ligaments and Tracheal Cartilage. J Biomech Eng 2024; 146:011008. [PMID: 37851532 DOI: 10.1115/1.4063821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023]
Abstract
Percutaneous tracheotomies (PCT) are commonly performed minimally invasive procedures involving the creation of an airway opening through an incision or puncture of the tracheal wall. While the medical intervention is crucial for critical care and the management of acute respiratory failure, tracheostomy complications can lead to severe clinical symptoms due to the alterations of the airways biomechanical properties/structures. The causes and mechanisms underlaying the development of these post-tracheotomy complications remain largely unknown. In this study, we aimed to investigate the needle puncture process and its biomechanical characteristics by using a well establish porcine ex vivo trachea to simulate the forces involved in accessing airways during PCT at varying angular approaches. Given that many procedures involve inserting a needle into the trachea without direct visualization of the tracheal wall, concerns have been raised over the needle punctures through the cartilaginous rings as compared to the space between them may result in fractured cartilage and post-tracheostomy airway complications. We report a difference in puncture force between piercing the cartilage and the annular ligaments and observe that the angle of puncture does not significantly alter the puncture forces. The data collected in this study can guide the design of relevant biomechanical feedback system during airway access procedures and ultimately help refine and optimize PCT.
Collapse
Affiliation(s)
- Cheick Sissoko
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0528, Cincinnati, OH 45267
| | - Victoria Walker
- University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0528, Cincinnati, OH 45267
| | - Gregory R Dion
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0528, Cincinnati, OH 45267
| |
Collapse
|
5
|
Bódis F, Orosz G, Tóth JT, Szabó M, Élő LG, Gál J, Élő G. Percutaneous tracheostomy: Comparison of three different methods with respect to tracheal cartilage injury in cadavers—Randomized controlled study. Pathol Oncol Res 2023; 29:1610934. [PMID: 37123534 PMCID: PMC10135429 DOI: 10.3389/pore.2023.1610934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
Background: Performing tracheostomy improves patient comfort and success rate of weaning from prolonged invasive mechanical ventilation. Data suggest that patients have more benefit of percutaneous technique than the surgical procedure, however, there is no consensus on the percutaneous method of choice regarding severe complications such as late tracheal stenosis. Aim of this study was comparing incidences of cartilage injury caused by different percutaneous dilatation techniques (PDT), including Single Dilator, Griggs’ and modified (bidirectional) Griggs’ method.Materials and methods: Randomized observational study was conducted on 150 cadavers underwent post-mortem percutaneous tracheostomy. Data of cadavers including age, gender and time elapsed from death until the intervention (more or less than 72 h) were collected and recorded. Primary and secondary outcomes were: rate of cartilage injury and cannula malposition respectively.Results: Statistical analysis revealed that method of intervention was significantly associated with occurrence of cartilage injury, as comparing either standard Griggs’ with Single Dilator (p = 0.002; OR: 4.903; 95% CI: 1.834–13.105) or modified Griggs’ with Single Dilator (p < 0.001; OR: 6.559; 95% CI: 2.472–17.404), however, no statistical difference was observed between standard and modified Griggs’ techniques (p = 0.583; OR: 0.748; 95% CI: 0.347–1.610). We found no statistical difference in the occurrence of cartilage injury between the early- and late post-mortem group (p = 0.630). Neither gender (p = 0.913), nor age (p = 0.529) influenced the rate of cartilage fracture. There was no statistical difference between the applied PDT techniques regarding the cannula misplacement/malposition.Conclusion: In this cadaver study both standard and modified Griggs’ forceps dilatational methods were safer than Single dilator in respect of cartilage injury.
Collapse
Affiliation(s)
- Fruzsina Bódis
- Department of Otorhinolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
- *Correspondence: Fruzsina Bódis,
| | - Gábor Orosz
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - József T. Tóth
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Marcell Szabó
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - László Gergely Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Gábor Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| |
Collapse
|
6
|
Shahparonyan RG, Poghosyan AY, Minasyan AM, Bablumyan AY, Malkhasyan IE, Gnuni AS, Matosyan KH, Sargsyan AM, Tadevosyan AE, Muradyan AA. Evaluation of post-tracheostomy scars and their impact on persons' quality of life: A case-control study. Int Wound J 2022; 20:372-380. [PMID: 35801258 PMCID: PMC9885458 DOI: 10.1111/iwj.13885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/14/2022] [Accepted: 06/25/2022] [Indexed: 02/03/2023] Open
Abstract
Tracheostomy is one of the more commonly performed procedures in critically ill patients under mechanical ventilation. Postoperative scarring is one of the bothersome sequelae of tracheostomies. Scars distort physical appearance, especially when found on the head and neck, which could have a negative impact on quality of life. The aim of this study was to evaluate and assess the impact of post-tracheostomy scars on quality of life according to the tracheostomy method. A prospective, single-center, observational, case-control study was conducted. One hundred fifty-six persons with a post-tracheostomy surgical scar for more than four months were observed using the Patient and Observer Scar Assessment Scale and Dermatology Life Quality Index questionnaire. Persons were divided into two groups depending on the method of tracheostomy, and the duration of the cannulated period was considered in both groups. Statistical analyses were performed using SPSS ver. 16.0 (SPSS Inc., Chicago, IL, USA), and P values of <0.05 were considered significant. The patients who had a tracheostomic tube cannulation period of fewer than 15 days had better cosmetic results than those who had tracheostomic tubes for more than 15 days, regardless of the tracheostomy method: 6.64 ± 0.082 versus 16.15 ± 0.096 (P < 0.001) in the surgical tracheostomy group and 7.26 ± 0.211 versus 14.17 ± 0.379 (P < 0.05) in the percutaneous dilatational group. The Dermatology Life Quality Index scores had a mean value of 0.6 ± 0.01, which means that post-tracheostomy scarring in the present study had no effect on the person's quality of life. The aesthetic outcomes of post-tracheostomy scars after the open surgical tracheostomy technique did not significantly differ from those of the percutaneous dilatational technique in the present study. Persons with a long duration of tracheostomic tube ventilation showed worse aesthetic outcomes than those with short-term tracheostomic cannulation, which was not dependent on the tracheostomy technique. The Dermatology Life Quality Index showed that post-ttracheostomy scarring in the present study had no effect on the person's quality of life.
Collapse
Affiliation(s)
- Rafik G. Shahparonyan
- ENT and Maxillofacial Surgery Department, Yerevan State Medical University"Heratsi" №1 University HospitalYerevanArmenia
| | - Anna Yu Poghosyan
- ENT and Maxillofacial Surgery Department, Yerevan State Medical University"Heratsi" №1 University HospitalYerevanArmenia
| | - Armen M. Minasyan
- Administrative DepartmentYerevan State Medical UniversityYerevanArmenia
| | - Aren Yu Bablumyan
- Administrative DepartmentYerevan State Medical UniversityYerevanArmenia
| | - Irina E. Malkhasyan
- Department of Anesthesiology and Intensive CareYerevan State Medical UniversityYerevanArmenia
| | - Anatoly S. Gnuni
- Department of Anesthesiology and Intensive CareYerevan State Medical UniversityYerevanArmenia
| | - Khachatur H. Matosyan
- ENT and Maxillofacial Surgery Department, Yerevan State Medical University"Heratsi" №1 University HospitalYerevanArmenia
| | - Ani M. Sargsyan
- ENT and Maxillofacial Surgery Department, Yerevan State Medical University"Heratsi" №1 University HospitalYerevanArmenia
| | - Artashes E. Tadevosyan
- Department of Public Health and HealthcareYerevan State Medical UniversityYerevanArmenia
| | - Armen A. Muradyan
- Administrative DepartmentYerevan State Medical UniversityYerevanArmenia
| |
Collapse
|
7
|
Kristinsdottir EA, Sigvaldason K, Karason S, Jonasdottir RJ, Bodvarsdottir R, Olafsson O, Tryggvason G, Gudbjartsson T, Sigurdsson MI. Utilization and outcomes of tracheostomies in the intensive care unit in Iceland in 2007-2020: A descriptive study. Acta Anaesthesiol Scand 2022; 66:996-1002. [PMID: 35704855 DOI: 10.1111/aas.14105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tracheostomies are commonly utilized in ICU patients due to prolonged mechanical ventilation, upper airway obstruction, or surgery in the face/neck region. However, practices regarding the timing of placement and utilization vary. This study provides a nationwide overview of tracheostomy utilization and outcomes in the ICU over a 14-year period. METHODS A retrospective study including all patients that received a tracheostomy during their ICU stay in Iceland between 2007 and 2020. Data were retrieved from hospital records on admission cause, comorbidities, indication for tracheostomy insertion, duration of mechanical ventilation before and after tracheostomy placement, extubation attempts, complications, length of ICU and hospital stay and survival. Descriptive statistics were provided, and survival analysis was performed using Cox regression. RESULTS A total of 336 patients (median age 64 years, 33% females) received a tracheostomy during the study period. The most common indication for tracheostomy insertion was respiratory failure, followed by neurological disorders. The median duration of mechanical ventilation prior to tracheostomy insertion was 9 days and at least one extubation had been attempted in 35% of the cases. Percutaneous tracheostomies were 32%. The overall rate of complications was 25% and the most common short-term complication was bleeding (5%). In-hospital mortality was 33%. The one- and five-year survival rate was 60% and 44%, respectively. CONCLUSIONS We describe a whole-nation practice of tracheostomies. A notable finding is the relatively low rate of extubation attempts prior to tracheostomy insertion. Future work should focus on standardization of assessing the need for tracheostomy and the role of extubation attempts prior to tracheostomy placement.
Collapse
Affiliation(s)
- Eyrun A Kristinsdottir
- Division of Anaesthesia and Intensive Care, Perioperative Services at Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Kristinn Sigvaldason
- Division of Anaesthesia and Intensive Care, Perioperative Services at Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Sigurbergur Karason
- Division of Anaesthesia and Intensive Care, Perioperative Services at Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Rannveig J Jonasdottir
- Division of Anaesthesia and Intensive Care, Perioperative Services at Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Regina Bodvarsdottir
- Division of Anaesthesia and Intensive Care, Perioperative Services at Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Oddur Olafsson
- Division of Anaesthesia and Intensive Care, Perioperative Services at Akureyri Hospital, Akureyri, Iceland
| | - Geir Tryggvason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Otorhinolaryngology at Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Tomas Gudbjartsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Cardiothoracic Surgery at Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland
| | - Martin I Sigurdsson
- Division of Anaesthesia and Intensive Care, Perioperative Services at Landspitali, the National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
8
|
An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management. CURRENT PULMONOLOGY REPORTS 2022; 11:29-38. [PMID: 35261874 PMCID: PMC8892813 DOI: 10.1007/s13665-022-00286-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 12/27/2022]
|
9
|
Sandu K. Laryngotracheal Complications in Intubated COVID-19 Patients. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211020590. [PMID: 34104030 PMCID: PMC8165861 DOI: 10.1177/11795476211020590] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022]
Abstract
During the current COVID-19 pandemic, several emerging cases of laryngotracheal stenosis
following prolonged intubation and tracheostomy are being reported. The patients’
pre-existing comorbidities, the disease itself and the pronation maneuvers increase the
risk for endolaryngeal and tracheal damage. In this commentary, we report 4 such patients
with acquired severe laryngotracheal stenosis. We describe their airway lesions, the
surgical treatment they received, and the outcomes.
Collapse
Affiliation(s)
- Kishore Sandu
- Department of Otolaryngology, Lausanne University Hospital CHUV, Switzerland
| |
Collapse
|
10
|
Bertini P, Forfori F, Bruschini L, Corradi F, Ribechini A, Brogi E, Guarracino F. Percutaneous Tracheostomy in COVID-19 Critically Ill Patients: Experience from 30 Consecutive Procedures. Int Arch Otorhinolaryngol 2021; 25:e135-e140. [PMID: 33552294 PMCID: PMC7851370 DOI: 10.1055/s-0040-1718528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/08/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction Percutaneous tracheostomy (PT) in the intensive care unit (ICU) is a well-established practice that shows a reduced risk of wound infection compared with surgical tracheostomy, thus facilitating mechanical ventilation, nursing procedures, reduction in sedation and early mobilization. Objective This is an observational case-control study that compares the results of PT in ICU patients with coronavirus disease 2019 (COVID-19) prospectively enrolled to a similar group of subjects, retrospectively recruited, without COVID-19. Methods Ninety-eight consecutive COVID-19 patients admitted to the ICU at Pisa Azienda Ospedaliero Universitaria Pisana between March 11th and May 20 th , 2020 were prospectively studied. Thirty of them underwent PT using different techniques. Another 30 non-COVID-19 ICU patients were used as a control-group. The main outcome was to evaluate the safety and feasibility of PT in COVID-19 patients. We measured the rate of complications. Results Percutaneous tracheostomy was performed with different techniques in 30 of the 98 COVID-19 ICU patients admitted to the ICU. Tracheostomy was performed on day 10 (mean 10 ± 3.3) from the time of intubation. Major tracheal complications occurred in 5 patients during the procedure. In the control group of 30 ICU patients, no differences were found with regards to the timing of the tracheostomy, whereas a statistically significant difference was observed regarding complications with only one tracheal ring rupture reported. Conclusion Percutaneous tracheostomy in COVID-19 patients showed a higher rate of complications compared with controls even though the same precautions and the same expertise were applied. Larger studies are needed to understand whether the coronavirus disease itself carries an increased risk of tracheal damage.
Collapse
Affiliation(s)
- Pietro Bertini
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesco Forfori
- Department of Anesthesia and Critical Care Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Università di Pisa, Pisa, Italy
| | - Luca Bruschini
- ENT Audiology and Phoniatric Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, Università di Pisa, Pisa, Italy
| | - Francesco Corradi
- Department of Anesthesia and Critical Care Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Università di Pisa, Pisa, Italy
| | - Alessandro Ribechini
- Thoracic Endoscopy Unit, Cardiothoracic and vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Etrusca Brogi
- Department of Anesthesia and Critical Care Medicine, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Università di Pisa, Pisa, Italy
| | - Fabio Guarracino
- Cardiothoracic and Vascular Anesthesia and Intensive Care, Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| |
Collapse
|
11
|
Ultrasound guided percutaneous dilatation tracheotomy (US-PDT) to prevent potentially life-threatening complications: A case report. Int J Surg Case Rep 2020; 77S:S125-S128. [PMID: 32972890 PMCID: PMC7876924 DOI: 10.1016/j.ijscr.2020.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/05/2020] [Indexed: 11/20/2022] Open
Abstract
Percutaneous dilatation tracheotomy enables non-surgeons to perform tracheotomies at patients bedside. Bleeding is a common complication of percutaneous dilatation tracheotomies. Performing a pre-operative neck ultrasound can help identifying aberrant vessels and reduce the risk of periprocedural bleeding.
Introduction Percutaneous dilatation tracheotomy (PDT) is a relatively recent technique that enables non surgeons to perform tracheotomies at bedside reducing operation rooms schedules. It is burdened by a moderate risk of postoperative bleeding. Presentation of case The patient was a 57 years old with a temporal intraparenchymal hematoma, submitted to percutaneous dilatation tracheotomy. Despite the favorable anatomical features, a pre-procedural US was performed, identifying a pulsating vessel with an arterial pattern, 2 cm above the hollow. The procedure was then considered at high risk, an operation room was required for the technique and an on-call surgeon was alerted. The procedure was ended safely and any bleeding was avoided because the technique was practiced with the best precautions. Discussion PDT strength is the possibility for non surgeons to perform tracheotomies in selected patients at bedside, reducing operation rooms congestion. Such technique though is a “blind” technique, and postoperative bleedings can occur and represent a feared complication. Conversely, the surgical tracheotomy permits a better control of hemorrhages, but needs the involvement of a surgeon and availability of an operation room. Performing a PDT guided by a neck ultrasound is useful to identify eventual aberrant vessel whose course could complicate the tracheotomy, it is part of PDT guidelines of some States. Conclusion US-PDT could help reducing procedure related complications selecting those high risk patients still in need of operating room and surgical assistance. US-PDT feasibility combined to its easy availability and low costs encourage its introduction into everyday practice.
Collapse
|
12
|
Zhao C, Viana A, Wang Y, Wei HQ, Yan AH, Capasso R. Otolaryngology during COVID-19: Preventive care and precautionary measures. Am J Otolaryngol 2020; 41:102508. [PMID: 32345446 PMCID: PMC7195080 DOI: 10.1016/j.amjoto.2020.102508] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/18/2020] [Indexed: 01/08/2023]
Abstract
Since the outbreak of novel coronavirus disease (COVID-19) in December 2019, it has spread to various regions and countries, forming a global pandemic. Reducing nosocomial infection is a new issue and challenge for all healthcare systems. Otolaryngology is a high-risk specialty as it close contact with upper respiratory tract mucous, secretions, droplets and aerosols during procedures and surgery. Therefore, infection prevention and control measures for this specialty are essential. Literatures on the epidemiology, clinical characteristics and infection control measures of COVID-19 were reviewed, practical knowledge from first-line otolaryngologists in China, the United States, and Brazil were reviewed and collated. It was recommended that otolaryngology professionals should improve screening in suspected patients with relevant nasal and pharyngeal symptoms and signs, suspend non-emergency consultations and examinations in clinics, and rearrange the working procedures in operating rooms. The guidelines of personal protective equipment for swab sampling, endoscopy and surgery were listed. Indications for tracheotomy during the pandemic should be carefully considered to avoid unnecessary airway opening and aerosol-generation; precautions during surgery to reduce the risk of exposure and infection were illustrated. This review aimed to provide recommendations for otolaryngologists to enhance personal protection against COVID-19 and reduce the risk of nosocomial infection.
Collapse
Affiliation(s)
- Chen Zhao
- Department of Otolaryngology, the First Affiliated Hospital of China Medical University, Shenyang, China.
| | - Alonço Viana
- Department of Otorhinolaryngology, Marcílio Dias Naval Hospital, Rio de Janeiro, Brazil; Graduate Program of Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Yan Wang
- Department of Otolaryngology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Hong-Quan Wei
- Department of Otolaryngology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ai-Hui Yan
- Department of Otolaryngology, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Robson Capasso
- Department of Otolaryngology - Head & Neck Surgery, Stanford University Medical Center, Stanford, CA, United States of America
| |
Collapse
|
13
|
Long-term intubation and high rate of tracheostomy in COVID-19 patients might determine an unprecedented increase of airway stenoses: a call to action from the European Laryngological Society. Eur Arch Otorhinolaryngol 2020; 278:1-7. [PMID: 32506145 PMCID: PMC7275663 DOI: 10.1007/s00405-020-06112-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The novel Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, may need intensive care unit (ICU) admission in up to 12% of all positive cases for massive interstitial pneumonia, with possible long-term endotracheal intubation for mechanical ventilation and subsequent tracheostomy. The most common airway-related complications of such ICU maneuvers are laryngotracheal granulomas, webs, stenosis, malacia and, less commonly, tracheal necrosis with tracheo-esophageal or tracheo-arterial fistulae. MATERIALS AND METHODS This paper gathers the opinions of experts of the Laryngotracheal Stenosis Committee of the European Laryngological Society, with the aim of alerting the medical community about the possible rise in number of COVID-19-related laryngotracheal stenosis (LTS), and the aspiration of paving the way to a more rationale concentration of these cases within referral specialist airway centers. RESULTS A range of prevention strategies, diagnostic work-up, and therapeutic approaches are reported and framed within the COVID-19 pandemic context. CONCLUSIONS One of the most important roles of otolaryngologists when encountering airway-related signs and symptoms in patients with previous ICU hospitalization for COVID-19 is to maintain a high level of suspicion for LTS development, and share it with colleagues and other health care professionals. Such a condition requires specific expertise and should be comprehensively managed in tertiary referral centers.
Collapse
|