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Eskildsen SJ, Wessel I, Poulsen I, Hansen CA, Curtis DJ. Rehabilitative intervention for successful decannulation in adult patients with acquired brain injury and tracheostomy: a systematic review. Disabil Rehabil 2024; 46:2464-2476. [PMID: 37449332 DOI: 10.1080/09638288.2023.2233437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Tracheostomy and dysphagia are independently associated with increased complications and poorer functional outcome after acquired brain injury (ABI). The aim of this study was to identify and evaluate rehabilitation to restore functional swallowing ability and respiratory capacity during tracheal tube weaning. MATERIALS AND METHODS The review was conducted according to PRISMA guidelines. Any study design with adult patients with ABI and tracheostomy was eligible. The primary outcome was decannulation. RESULTS A total of 2647 records were identified and eight papers included. Four studies investigated pharyngeal electrical stimulation (PES), two explored Facial Oral Tract Therapy (F.O.T.T.), one respiratory physiotherapy (RPT), and one study investigated external subglottic air flow (ESAF). Two RCTs found a significant difference between intervention and control on successful decannulation and readiness for decannulation in favour of PES. Time from rehabilitation admission and tracheostomy to decannulation was significantly reduced after implementing an F.O.T.T.-based protocol. CONCLUSION Four interventions were identified, PES, F.O.T.T., RPT, and ESAF, all aimed at increasing oropharyngeal sensory input through stimulation. Due to heterogeneity of interventions, designs and outcome measures, effect could not be estimated. This review highlights the limited research on rehabilitative interventions and thus the limited evidence to guide clinical rehabilitation.
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Affiliation(s)
- Signe Janum Eskildsen
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, Aarhus University, Health, Aarhus, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Poulsen
- Department of Public Health, Aarhus University, Health, Aarhus, Denmark
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre Hospital, Hvidovre, Denmark
| | - Carrinna Aviaja Hansen
- Department of Orthopaedic Surgery, Zealand University Hospital, University of Copenhagen, Koege, Denmark
- Faculty of Health Sciences, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Derek John Curtis
- Department of Pediatric Rehabilitation, Children's Therapy Center, The Child and Youth Administration, Copenhagen, Denmark
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Formisano R, D'Ippolito M, Giustini M, Della Vedova C, Laurenza L, Matteis M, Menna C, Rendina EA. The impact of early surgical treatment of tracheal stenosis on neurorehabilitation outcome in patients with severe acquired brain injury. Brain Inj 2023; 37:74-82. [PMID: 36346363 DOI: 10.1080/02699052.2022.2143899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Acquired tracheal stenosis (TS) is a potentially life-threatening condition following prolonged intubation and/or tracheostomy in adult patients with severe Acquired Brain Injury (sABI), requiring a tracheal resection and reconstruction. METHODS We included 38 sABI adult patients with TS, admitted at a post-acute Neurorehabilitation Hospital. Disability Rating Scale (DRS) and other functional assessment measures were recorded at admission (t1), before TS surgical treatment (t2), and at discharge (t3). Patients were defined as 'improved' when they changed from a more severe to a less severe disability, between time t2 and time t3, and as "not improved" when they did not show any further improvement between t2 and t3, or they already exhibited a disability improvement since time interval t1-t2. RESULTS Time interval between the injury onset and TS surgical treatment (t2-t0) was associated with the patient's disability improvement, suggesting the t2-t0 time interval ≤ 115 days as a cutoff value for a possible functional recovery. A t2-t0 time interval ≤ 170 days is also associated to absence of persistent dysphagia. CONCLUSIONS Early TS surgical treatment within 115 days from the injury onset contributes to the improvement of the disability level in patients with sABI, optimizing their functional outcomes and recovery potential.
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Affiliation(s)
- R Formisano
- Neurorehabilitation 2, Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - M D'Ippolito
- Neurorehabilitation 2, Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - M Giustini
- Environmental and Social Epidemiology Unit, National Institute of Health, Rome, Italy
| | - C Della Vedova
- Neurorehabilitation 2, Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - L Laurenza
- Neurorehabilitation 2, Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - M Matteis
- Neurorehabilitation 2, Post-Coma Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - C Menna
- Thoracic Surgery Department, Sant'Andrea Hospital, Rome, Italy
| | - E A Rendina
- Thoracic Surgery Department, Sant'Andrea Hospital, Rome, Italy
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Hakiki B, Draghi F, Pancani S, Portaccio E, Grippo A, Binazzi B, Tofani A, Scarpino M, Macchi C, Cecchi F. Decannulation After a Severe Acquired Brain Injury. Arch Phys Med Rehabil 2020; 101:1906-1913. [PMID: 32428445 DOI: 10.1016/j.apmr.2020.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify the effect of some clinical characteristics of severe acquired brain injury (sABI) patients on decannulation success during their intensive rehabilitation unit (IRU) stay. DESIGN Nonconcurrent cohort study. SETTING Don Gnocchi Foundation Institute. PARTICIPANTS Patients (N=351) with sABI and tracheostomy were retrospectively selected from the database of the IRU of the Don Gnocchi Foundation Institute. MAIN OUTCOME MEASURES Potential predictors of decannulation were screened from variables collected at admission during clinical examination, conducted by trained and experienced examiners. The association between clinical characteristics and decannulation status was investigated through a Cox regression model. Kaplan-Meier curves were then created for time-event analysis. RESULTS Among the patients (mean age, 64.1±15.5y), 54.1% were decannulated during their IRU stay. Absence of pulmonary infections (P<.001), sepsis (P=.001), tracheal alteration at the fibrobronchoscopy examination (P=.004) and a higher Coma Recovery Scale-Revised (CRS-R) score (P<.001) or a better state of consciousness at admission (P=.001) were associated with a higher probability of decannulation. CONCLUSIONS Fibrobronchoscopy assessment of patency of airways and accurate evaluation of the state of consciousness using the CRS-R are relevant in this setting of care to better identify patients who are more likely to have the tracheostomy tube removed. These results may help clinicians choose the appropriate timing and intensity of rehabilitation interventions and plan for discharge.
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Affiliation(s)
- Bahia Hakiki
- Don Carlo Gnocchi Foundation, IRCSS, Florence, Italy
| | | | | | - Emilio Portaccio
- SOC Neurology, San Giovanni di Dio Hospital, Firenze, AUSL Toscana Center, Florence, Italy
| | | | | | - Ariela Tofani
- Don Carlo Gnocchi Foundation, IRCSS, Florence, Italy
| | | | - Claudio Macchi
- Don Carlo Gnocchi Foundation, IRCSS, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Tsai SCS, Lin FCF. Surgical treatments for post-intubation laryngotracheal stenosis in patients with central nervous system injuries. Medicine (Baltimore) 2020; 99:e18628. [PMID: 32011442 PMCID: PMC7220156 DOI: 10.1097/md.0000000000018628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Post-intubation laryngotracheal stenosis is a complication commonly encountered in patients with central nervous system (CNS) injuries, often preventing decannulation. To date, no data is available in the literature focusing on this issue. Our objective was to describe surgical treatments for laryngotracheal stenosis and discuss factors associated with successful decannulation in this group of patients.Medical records of patients with CNS injury who received tracheal surgeries at our institution between 2009 and 2016 were retrospectively collected and analyzed.Data on 124 surgeries in 62 patients with CNS injury were collected. The total complication rate was 20.9% with no surgical mortality. The decannulation success rate was 85.5%. Argon laser surgeries (48), diode laser surgeries (22), tracheal resection and reconstructions (R&R) (9), and tracheal T-tube placements (67) were performed. The average times from the first bronchoscopy check up to surgery and surgery to decannulation were 0.7 and 8.2 months, accordingly. The mean post-decannulation follow-up time was 13.5 months. A shift from the use of rigid bronchoscopy in the initial surgeries to laryngeal mask in the latter surgeries yielded an average decrease of 3 days in hospital length of stay (LOS). A change from initial rigid bronchoscopic core out procedures and argon laser to interventional flexible bronchoscopic resections with diode laser also decreased LOS significantly.Surgical treatments for patients with CNS injury and laryngotracheal stenosis can be safely performed with low mortality, acceptable complications, and a high decannulation success rate. The majority of patients with laryngotracheal stenosis can be managed with laser endoscopic surgeries, though tracheal R&R might still be required in selected cases. The use of laryngeal mask to secure the airway and diode laser in the intra-luminal resections improved the surgical outcome and was therefore recommended for these patients suffering from post-intubation laryngotracheal stenosis.
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Affiliation(s)
- Stella Chin-Shaw Tsai
- Department of Otolaryngology, Tungs’ Taichung MetroHarbor Hospital
- Department of Nutrition, Providence University
| | - Frank Cheau-Feng Lin
- School of Medicine, Chung Shan Medical University
- Department of Thoracic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
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Kieninger M, Windorfer M, Eissnert C, Zech N, Bele S, Zeman F, Bründl E, Graf B, Künzig H. Impact of bedside percutaneous dilational and open surgical tracheostomy on intracranial pressure, pulmonary gas exchange, and hemodynamics in neurocritical care patients. Medicine (Baltimore) 2019; 98:e17011. [PMID: 31464959 PMCID: PMC6736110 DOI: 10.1097/md.0000000000017011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim was to compare the impact of bedside percutaneous dilational tracheostomy (PDT) and open surgical technique (ST) on intracranial pressure (ICP), pulmonary gas exchange and hemodynamics.We retrospectively analyzed data of 92 neurocritical care patients with invasive ICP monitoring during either PDT (43 patients) or ST (49 patients).Peak ICP levels were higher during PDT (22 [17-38] mm Hg vs 19 [13-27] mm Hg, P = .029). Mean oxygen saturation (SpO2) and end-tidal carbon dioxide partial pressure (etCO2) did not differ. Episodes with relevant desaturation (SpO2 < 90%) or hypercapnia (etCO2 > 50 mm Hg) occurred rarely (5/49 during ST vs 3/43 during PDT for SpO2 < 90%; 2/49 during ST vs 5/43 during PDT for hypercapnia). Drops in mean arterial pressure (MAP) below 60 mm Hg were seen more often during PDT (8/43 vs 2/49, P = .026). Mean infusion rate of norepinephrine did not differ (0.52 mg/h during ST vs 0.45 mg/h during PDT). No fatal complications were observed.Tracheostomy can be performed as ST and PDT safely in neurocritical care patients. The impact on ICP, pulmonary gas exchange and hemodynamics remains within an unproblematic range.
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Affiliation(s)
| | | | | | | | | | - Florian Zeman
- Centre for Clinical Studies, University Hospital Regensburg, Germany
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Management of tracheostomized patients after poor grade subarachnoid hemorrhage: Disease related and pulmonary risk factors for failed and delayed decannulation. Clin Neurol Neurosurg 2019; 184:105419. [PMID: 31306892 DOI: 10.1016/j.clineuro.2019.105419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Tracheostomy is often indicated in patients with spontaneous subarachnoid hemorrhage (sSAH). Decannulation is a major goal of neurorehabilitation, but cannot be achieved in all patients. The aim of this study was to describe the course of decannulation and to identify associated risk factors in a single-center collective. PATIENTS AND METHODS We retrospectively reviewed 87 sSAH patients with WFNS (World Federation of Neurosurgical Societies) grade III-IV, who received tracheostomy. Decannulation events and the time from tracheostomy to decannulation were recorded in a 200-days follow-up. Variables analyzed were: age, sex, WFNS grade, Fisher grade, the presence of intracerebral or intraventricular hematoma, acute hydrocephalus, aneurysm location, aneurysm obliteration (surgical vs. endovascular), treatment related complications, decompressive craniectomy, symptomatic cerebral vasospasm, vasospasm-related infarction and timing of tracheostomy. Further risk factors analyzed were preexisting chronic lung disease and pneumonia. Functional outcome was assessed by the modified Rankin Scale (mRS). RESULTS The rate of successful decannulation was 84% after a median of 47 days. A higher WFNS grade and pneumonia were associated with both a prolonged time to decannulation (TTD) and decannulation failure (DF). Older age (> 60 years) and necessity for decompressive craniectomy were only associated with prolonged TTD. Outcome analysis revealed that patients with DF show a significantly (p < 0.01) higher rate of unfavorable outcome (mRS 3-6). CONCLUSION Successful decannulation is possible in the majority of sSAH patients and particularly, in all patients with WFNS grade III. WFNS grading, age, the necessity for decompressive craniectomy and pneumonia are significantly associated with the TTD. WFNS grade and pneumonia are significantly associated with DF. The mean cannulation time of sSAH patients is shorter in relation to stroke patients.
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Ringrose H, Brown M, Walton K, Sivan M. Association between Paroxysmal Sympathetic Hyperactivity and tracheostomy weaning in Traumatic Brain Injury. NeuroRehabilitation 2018; 42:207-212. [PMID: 29562563 DOI: 10.3233/nre-172276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rehabilitation following severe Traumatic Brain Injury (TBI) often involves the use of temporary tracheostomies. Tracheostomy weaning is influenced by physiological parameters, which are abnormal in the concomitant complication of Paroxysmal Sympathetic Hyperactivity (PSH). OBJECTIVE To investigate the association between PSH and tracheostomy weaning in severe TBI. METHODS This was a retrospective cohort study of consecutive patients with TBI and tracheostomy admitted to a Hyper-Acute Neurorehabilitation Unit over a 34-month period. Duration of tracheostomy wean and influencing characteristics were statistically compared between those with and without PSH. RESULTS Fifty-one patients admitted with TBI required a tracheostomy. Of these, 10 patients were also diagnosed with PSH. The mean tracheostomy wean in the PSH group was longer compared to the non-PSH group (72.3, SD 61.0 versus 30.0 days, SD 16.2). This difference was statistically significant (p = 0.007, using Mann Whitney U test). The PSH group had more respiratory and oral secretions, but this was not statistically significant (p = 0.16 and 0.29). CONCLUSIONS This is the first study to demonstrate that PSH is associated with prolonged tracheostomy weaning in severe TBI. Awareness of this association should enable those planning rehabilitation to set realistic goals for a patient's tracheostomy weaning programme.
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Affiliation(s)
- Hollie Ringrose
- Department of Rehabilitation Medicine (Neurology), Salford Royal Hospital, Salford, UK.,Rakehead Rehabilitation Centre, Burnley General Hospital, Burnley, UK
| | - Mary Brown
- Department of Rehabilitation Medicine (Neurology), Salford Royal Hospital, Salford, UK
| | - Krystyna Walton
- Department of Rehabilitation Medicine (Neurology), Salford Royal Hospital, Salford, UK
| | - Manoj Sivan
- Department of Rehabilitation Medicine (Neurology), Salford Royal Hospital, Salford, UK.,Institute of Brain Behaviour and Mental Health, University of Manchester, Manchester, UK.,Academic Department of Rehabilitation Medicine, University of Leeds, Leeds, UK
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Perin C, Meroni R, Rega V, Braghetto G, Cerri CG. Parameters Influencing Tracheostomy Decannulation in Patients Undergoing Rehabilitation after severe Acquired Brain Injury (sABI). Int Arch Otorhinolaryngol 2017; 21:382-389. [PMID: 29018503 PMCID: PMC5629091 DOI: 10.1055/s-0037-1598654] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/21/2016] [Indexed: 11/06/2022] Open
Abstract
Introduction
Tracheostomy weaning in patients who suffered a severe acquired brain injury is often a challenge and decannulation failures are not uncommon.
Objective
Our study objective is to describe the decannulation failure rate in patients undergoing rehabilitation following a severe acquired brain injury (sABI); to describe the factors associated with a successful tube weaning.
Methods
We conduct a retrospective analysis of charts, consecutively retrieved considering a 3-year window. Variables analyzed were: age, sex, body mass index (BMI), Glasgow Coma Scale (GCS), cause of hospitalization (stroke, trauma, cardiac arrest), date of the pathological event, gap between the index event and the first day of hospitalization, duration of Neurorehabilitation Ward hospitalization, comorbidities, chest morphological alteration, kind of tracheostomy tube used (overall dimension, cap, fenestration), SpO2, presentation and quantification of pulmonary secretion, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), respiratory frequency and pattern, cardiac frequency, presence of spontaneous cough, cough strength, and blood gas analysis.
Results
We analyzed 45 tracheostomised sABI patients following stroke, trauma, or cardiac arrest. The weaning success percentage was higher in Head Trauma patients and in patients presenting positive spontaneous cough. Failures seem to be associated with presence of secretions and anoxic brain damage. GCS seemed not related to the decannulation outcome.
Conclusions
Parameters that could be used as positive predictors of weaning are: mean expiratory pressure, presence of spontaneous cough, and cough strength. Provoked cough and GCS were not predictive of weaning success.
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Affiliation(s)
- Cecilia Perin
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
| | - Roberto Meroni
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
| | - Vincenzo Rega
- Riabilitazione Neurologica, Gruppo Ospedaliero San Donato Ringgold Standard Institution, Milano, Lombardia, Italy
| | - Giacomo Braghetto
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
| | - Cesare Giuseppe Cerri
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
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Gardizi E, Hanks RA, Millis SR, Figueroa MJ. Comorbidity and Insurance as Predictors of Disability After Traumatic Brain Injury. Arch Phys Med Rehabil 2014; 95:2396-401. [DOI: 10.1016/j.apmr.2014.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/23/2014] [Accepted: 06/06/2014] [Indexed: 11/25/2022]
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Blondonnet R, Chabanne R, Godet T, Pascal J, Pereira B, Kauffmann S, Perbet S. Trachéotomies en réanimation et devenir des patients : enquête déclarative nationale. ACTA ACUST UNITED AC 2014; 33:227-31. [DOI: 10.1016/j.annfar.2014.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/29/2014] [Indexed: 11/26/2022]
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Shamim MS, Qadeer M, Murtaza G, Enam SA, Farooqi NB. Emergency department predictors of tracheostomy in patients with isolated traumatic brain injury requiring emergency cranial decompression. J Neurosurg 2011; 115:1007-12. [DOI: 10.3171/2011.7.jns101829] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Patients with severe traumatic brain injury (TBI) frequently require a tracheostomy for prolonged mechanical ventilation and/or pulmonary toilet. It is now proven that the earlier the procedure is done, the more beneficial it is to the patient. The present study was carried out to determine if the requirement of a tracheostomy can be predicted on arrival of a patient to the emergency department. The prediction can potentially aid in combining the procedure with cranial decompression. In this study, the authors' aim was to determine the emergency department predictors of tracheostomy in patients with isolated TBI requiring emergency cranial decompression.
Methods
The authors performed a retrospective chart review of all patients who underwent surgery for isolated TBI and required more than 4 days of mechanical ventilation. Multivariate logistic regression analysis was used for predictive indicators.
Results
In patients with isolated severe TBI, a patient age of 31–50 years, the presence of preexisting medical comorbid conditions, a delay in emergency department arrival exceeding 1.5 hours, an abnormal pupil response on arrival, and a preoperative neurological worsening during hospital stay were independent predictors of the requirement for tracheostomy. These findings were validated in a small cohort of patients and were found to be significant.
Conclusions
Requirement of a tracheostomy can be predicted in patients with severe TBI on arrival to the emergency department. These results were validated in a small cohort of patients, and it was found that the positive predictive value of requirement of tracheostomy was directly proportional to the number of predictors present. Larger prospective studies with appropriate control groups are further recommended to validate the authors' findings.
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Ledl C, Mertl-Roetzer M. Tracheal and Tracheostomal Hypergranulation and Related Stenosis in Long-Term Cannulated Patients: Does the Tracheostomy Procedure Make a Difference? Ann Otol Rhinol Laryngol 2009; 118:876-80. [DOI: 10.1177/000348940911801208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Long-term cannulated patients are at risk of developing tracheal and tracheostomal hypergranulation. This study evaluated the incidence of hypergranulation and related tracheal stenosis in long-term cannulated patients. The relation between hypergranulation, specific tracheostomy techniques, and the duration of cannulation was investigated. Methods: A prospective observational study was conducted to analyze tracheostomal and tracheal hypergranulation in long-term cannulated patients. We compared complication rates in 344 postacute patients. Tracheas and tracheostomas were inspected visually and endoscopically at admission and at regular tube changes every 2 weeks until decannulation or discharge. Results: Hypergranulation appeared 3 times as often in the tracheostoma (n = 338) as in the trachea (n = 109). There was no influence of the tracheostomy procedure on the frequency (p = 0.931), location (tracheostoma, p = 0.947; trachea, p = 0.918), or severity (stenoses grade I, p = 0.910; grade II, p = 0.649; grade III, p = 0.304) of the hypergranulation. The main factors to account for hypergranulation were the duration of cannulation (p < 0.001) and age (p = 0.033). Conclusions: There was no influence of tracheostomy techniques on hypergranulation. Its development depends on the duration of cannulation. It is recommended to keep the duration of cannulation as short as possible with respect to the underlying neurologic impairment.
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Panerari AD, Costa HO, de Souza FC, Castro M, da Silva L, de Sousa Neto OM. Tracheal inflammatory response to bacterial cellulose dressing after surgical scarification in rabbits. Braz J Otorhinolaryngol 2008; 74:512-22. [PMID: 18852976 PMCID: PMC9442072 DOI: 10.1016/s1808-8694(15)30597-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 01/07/2008] [Indexed: 11/25/2022] Open
Abstract
Exuberant scarring tissue formation is among the failure causes of tracheal stenosis surgery. Dressings that could avoid such reaction could be very helpful in these cases. Bacterial cellulose, produced by acetobacter xylinun can be useful in these cases. There are no studies in the laryngotracheal region. Aim to assess subglottic tissue response in rabbits after scarification and placement of cellulose dressing, and comparing it to a control group. Study design experimental. Materials and Methods 26 rabbits underwent laryngotracheal scarification, received the dressing and were compared to the control group. We established four follow up periods. Laryngotracheal specimens underwent histological exam and the results were statistically assessed. Results the study group had statistically similar results when compared to the control group in the following parameters: vascular congestion, purulent oozing, acute inflammation, epithelial integrity, fibrous proliferation and granulous proliferation. Conclusion we did not observe differences between the study and control groups as far as inflammation and scarring are concerned. There were no inflammatory signs associated with the use of the cellulose membrane that did no occur because of surgery.
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Mackiewicz-Nartowicz H, Mackiewicz-Milewska M, Bilewicz R, Laskowska K. [Tracheocoele--a complication after decanniulation]. Otolaryngol Pol 2008; 61:990-3. [PMID: 18546949 DOI: 10.1016/s0030-6657(07)70567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A case of tracheocoele as a complication after decanniulation in a patient after brain trauma is presented. Within twelve months after decanniulation patient was operated three times to close the tracheocutaneous fistula without good effect. A pretracheal air cyst was recognized after the radiological examinations. Tracheocoele was evacuated with its tract. No recurrences were observed.
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Aissaoui Y, Azendour H, Balkhi H, Haimeur C, Kamili Drissi N, Atmani M. [Timing of tracheostomy and outcome of patients requiring mechanical ventilation]. ACTA ACUST UNITED AC 2007; 26:496-501. [PMID: 17521853 DOI: 10.1016/j.annfar.2007.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 03/26/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess the impact of tracheostomy timing on outcome of critically ill patients requiring mechanical ventilation (MV). STUDY DESIGN Retrospective clinical study in a twelve beds intensive care unit (ICU). PATIENTS AND METHODS From January 2001 to June 2005, patients under MV who received tracheostomy were divided into 2 groups: early tracheostomy group when tracheostomy was performed before or on day 7 and late tracheostomy group when it was performed thereafter. We compared prevalence of nosocomial pneumonia, length of sedation, lengths of MV, length of stay in ICU, weaning from MV and mortality rates between the 2 groups. RESULTS During this period of 4 years and half, 112 patients underwent tracheostomy, 62 of whom had early tracheostomy and 50 had late tracheostomy. Early tracheostomy was associated with significant reduction of length of sedation (10+/-3 vs 17+/-5 days, P<0.001), length of MV (21+/-19 vs 29+/-17 days, P=0.02) and length of stay in ICU (33+/-22 vs 42+/-18 days, P=0.042). There were no differences in prevalence of pneumonia (21% for early tracheostomy group vs 31% for late tracheostomy group, P=0, 13), weaning from MV (50 vs 36%, P=0.19), and mortality rates between the 2 groups (38 vs 54%, P=0.15). CONCLUSION This study demonstrated that early tracheostomy (< or =7 days), was associated with shorter length of sedation, shorter duration of MV and shorter ICU length of stay, without affecting weaning from MV, prevalence of nosocomial pneumonia or survival.
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Affiliation(s)
- Y Aissaoui
- Service de réanimation, département d'anesthésie-réanimation et urgences, hôpital militaire d'instruction des armées Mohammed-V, Rabat, Morocco
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