1
|
Blackwell T, Alvi S, Curran NR, Germanwala A. Impact of Tracheostomy Timing Within the National Veterans Affairs Population. Laryngoscope 2024; 134:3555-3561. [PMID: 38501701 DOI: 10.1002/lary.31397] [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: 10/13/2023] [Revised: 01/25/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE There is a lack of a definitive study in the literature comparing early versus late tracheostomy and exploring the impact of tracheostomy timing on patient outcomes. This study may help guide treatment paradigms and contribute to a consensus for optimal tracheostomy timing. METHODS A retrospective review was performed comparing early versus late timing of tracheostomy placement and their respective outcomes. The authors used data provided by VA Informatics and Computing Infrastructure (VINCI) to find patients who received a tracheostomy at any VA Medical Center in the United States. There were a total of 25,334 tracheostomies in the database which satisfied our criteria. These occurred between the years 1999 and 2022. Propensity score matching assessed 17,074 tracheostomies, 8537 in either group. The median age of patients in the matched groups was 66 years, and approximately 97.4% of patients were male. Early tracheostomy timing was defined as the placement of the tracheostomy within 10 days of intubation. Outcomes included post-tracheostomy intensive care unit (ICU) days, post-tracheostomy hospital days, successful ventilator weaning, and all-cause mortality. RESULTS Early tracheostomy was associated with significantly fewer ICU days and hospital days, and the early group experienced higher rates of successful ventilator weaning. Survival analysis of data within 5 years of tracheostomy showed that early tracheostomy was associated with significantly lower hazard for all-cause mortality. CONCLUSION Our results add to the body of evidence that an earlier transition to mechanical ventilation by tracheostomy confers benefits in patient morbidity and mortality as well as resource utilization. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3555-3561, 2024.
Collapse
Affiliation(s)
- Thomas Blackwell
- Otolaryngology Section, Department of Surgery, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Otolaryngology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Suffia Alvi
- Otolaryngology Section, Department of Surgery, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Otolaryngology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | | | - Arpita Germanwala
- Otolaryngology Section, Department of Surgery, Jesse Brown VA Medical Center, Chicago, Illinois, USA
- Department of Otolaryngology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| |
Collapse
|
2
|
Alnemare AK. Age-Specific Differences in Laryngotracheal Trauma Characteristics: A Retrospective Study of Clinical Profiles, Outcomes, and Mortality Risk. J Clin Med 2024; 13:3508. [PMID: 38930037 PMCID: PMC11204626 DOI: 10.3390/jcm13123508] [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: 05/13/2024] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Laryngotracheal trauma is associated with a substantial risk of mortality. Age can be a critical factor in trauma management, as older adults often have diminished airway protective reflexes and preexisting respiratory conditions. Objective: This study aimed to characterize the clinical profiles and outcomes in different age groups of adult patients with laryngotracheal trauma using data from the National Trauma Data Bank (NTDB). Methods: We retrospectively analyzed the NTDB and included adult patients (aged ≥ 18 years) who had laryngotracheal fractures (closed or open) and were admitted directly after the injury. The patients were categorized into different age groups for analysis. A multivariate logistic regression analysis was performed to assess whether the elderly population (age ≥ 65 years) was predisposed to post-trauma death under care. Results: The study included 1171 patients, with the following age distributions: 13.7% aged 18-24 years, 21.6% aged 25-34 years, 55.2% aged 35-64 years, and 9.6% aged ≥ 65 years. Notable differences were observed in comorbidities, mechanisms, types of injuries, and associated injuries among age groups. There was no significant trend in airway surgical outcomes according to age. In-hospital mortality was highest among patients aged ≥ 65 years (22.3%), compared to 14.4% for those aged 18-24 years. Regression analysis indicated that age ≥ 65 was an independent mortality predictor. Conclusions: These findings underscore significant age-related differences in the presentation and outcomes of laryngotracheal trauma, emphasizing the need for age-specific treatment protocols, primarily to address the elevated risk among elderly patients.
Collapse
Affiliation(s)
- Ahmad K Alnemare
- Department of Otolaryngology, Faculty of Medicine, Majmaah University, Al-Majmaah 11952, Saudi Arabia
| |
Collapse
|
3
|
Lin H, Ainiwaer M, Jiang Z, Wang Z, Liu J, Chen F. Comparative evaluation of mechanical injury methods for establishing stable tracheal stenosis animal models. Sci Rep 2024; 14:2383. [PMID: 38287058 PMCID: PMC10824766 DOI: 10.1038/s41598-024-52230-0] [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: 08/25/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
The study aimed to assess the stability of various mechanical injury techniques in creating tracheal stenosis animal models using endoscopic assistance and investigate the viability of tracheal stoma in this process. Twenty-six healthy adult New Zealand white rabbits were randomly assigned to an experimental and control group. The experimental group underwent tracheal incision followed by steel brush scraping with endoscopic assistance, while the control group received nylon brush scraping. Within the control group, two subgroups were formed: Group A underwent scraping without tracheal stoma, and Group B underwent scraping followed by tracheal stoma. Additionally, a sham operation was performed on a separate group without subsequent scratching, resulting in no stenosis formation. Endoscopic observations were conducted at 7, 14, and 21 days post-scraping, followed by histological examinations of euthanized rabbits on the 21st day. Notably, all rabbits in the non-stoma group survived without complications, whereas Group B rabbits faced mortality post-operation. Histological assessments revealed inflammatory cell infiltration, fibroblast proliferation, and collagen fiber deposition in narrowed tracheal specimens. Steel brush scraping with endoscopic assistance proved more effective in inducing stable tracheal stenosis compared to nylon brush scraping. However, the survival challenges of rabbits with tracheal fistula require further investigation.
Collapse
Affiliation(s)
- Hongbin Lin
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- Head and Neck Surgical CenterWest China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- Department of Otolaryngology-Head and Neck Surgery, The Third People's Hospital of Sichuan Province, Chengdu, China
| | - Mailudan Ainiwaer
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- Head and Neck Surgical CenterWest China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zheng Jiang
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
- Head and Neck Surgical CenterWest China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zhenyan Wang
- Department of Otolaryngology-Head and Neck Surgery, The Third People's Hospital of Sichuan Province, Chengdu, China.
| | - Jun Liu
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
- Head and Neck Surgical CenterWest China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Fei Chen
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
- Head and Neck Surgical CenterWest China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| |
Collapse
|
4
|
Vahabzadeh‐Hagh AM, Marsh‐Armstrong BP, Patel SH, Lindenmuth L, Feng Z, Gong R, Lin Y, Pierce T, Loh KJ. Endotracheal tube forces exerted on the larynx and a novel support device to reduce it. Laryngoscope Investig Otolaryngol 2023; 8:989-995. [PMID: 37621270 PMCID: PMC10446261 DOI: 10.1002/lio2.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/08/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Endotracheal tubes (ETTs) are commonly associated with laryngeal injury that may be short lasting and temporary or more severe and life altering. Injury is believed to result from forces that these ETTs exert on the larynx. Here we quantify the forces of ETTs of various sizes on the laryngotracheal complex to gain a more quantitative understanding of these potential damaging forces. Here we also perform preclinical testing of a novel support device to offload these forces. Methods Endotracheal intubation was performed on a fresh human cadaver using various ETT sizes. A strain-sensitive graphene nanosheet sensor and a commercially available force sensing resistor were secured behind the larynx, anterior to the prevertebral fascia. The forces exerted on the larynx were measured for each of the commonly used ETTs. A novel support device, ETT clip (Endo Clip), was attached to the ETTs and changes in these forces were observed. Results Forces exerted on the laryngotracheal complex by various ETTs were observed to increase with increasing tube size. This pressure can be significantly reduced with a novel ETT clip. Conclusion Here we demonstrate the first quantitative measurement of forces that ETTs exert on the larynx. We demonstrate a novel device that can easily clip onto an ETT reducing pressure on the laryngotracheal complex. This preclinical test paves the way for a human clinical trial. Level of evidence 5.
Collapse
Affiliation(s)
- Andrew M. Vahabzadeh‐Hagh
- Department of Otolaryngology/Head and Neck SurgeryUniversity of California, San DiegoLa JollaCaliforniaUSA
| | | | - Shiv H. Patel
- School of MedicineUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Luke Lindenmuth
- Jacobs School of EngineeringUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Zeyu Feng
- Jacobs School of EngineeringUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Rufu Gong
- Jacobs School of EngineeringUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Yun‐An Lin
- Department of Structural EngineeringUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Taylor Pierce
- Electrical & Computer EngineeringUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Kenneth J. Loh
- Department of Structural EngineeringUniversity of California, San DiegoLa JollaCaliforniaUSA
- Materials Science & EngineeringUniversity of California, San DiegoLa JollaCaliforniaUSA
| |
Collapse
|
5
|
Saggu JS, Farlow JL, Morrison RJ, Maile MD. Acute Cricoarytenoid Joint Fixation Following Routine Intubation: A Case Report. A A Pract 2023; 17:e01706. [PMID: 37471344 DOI: 10.1213/xaa.0000000000001706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Prolonged intubation is a common cause of injury to the posterior larynx often resulting in cricoarytenoid joint (CAJ) fixation and posterior glottic stenosis (PGS). We present a case of respiratory failure due to acute bilateral CAJ fixation and PGS following only 2 days of intubation for routine cardiac surgery. A tracheostomy was placed due to critical airway obstruction. Clinicians should remain vigilant for laryngeal injury presenting as CAJ fixation and PGS. Prompt surgical consultation is advised as early intervention is associated with reduced morbidity.
Collapse
Affiliation(s)
- Jay S Saggu
- From the Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan
| | - Janice L Farlow
- Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert J Morrison
- Department of Otolaryngology, Michigan Medicine, Ann Arbor, Michigan
| | - Michael D Maile
- From the Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan
| |
Collapse
|
6
|
Di Felice C, Machuzak MS, Shepherd RW. Use of Mitomycin-C in Laryngotracheal Stenosis: A Focused Clinical Review. J Bronchology Interv Pulmonol 2023; 30:223-231. [PMID: 37271867 DOI: 10.1097/lbr.0000000000000933] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Therapeutic options for managing laryngotracheal stenosis (LTS) are limited. Endoscopy is a minimally invasive approach to treating LTS, but carries a high risk of stenosis recurrence. Mitomycin C (MMC) is often used as an adjunct therapy to delay the time to symptomatic recurrence of LTS. This review synthesizes the current literature on the topic of MMC as an adjunct treatment strategy for LTS. METHODS A focused literature search was carried out from PubMed on June 12, 2022 using the terms "mitomycin c AND stenosis" in all fields with no date limitations. Evidence-based recommendations relevant to the clinical application of MMC as an adjunct therapy for LTS were formulated. Three questions were addressed: 1) efficacy of MMC, 2) single versus multiple application(s) of MMC, and 3) safety of MMC. The evidence rating and recommendation strength were guided by the GRADE system. RESULTS Twenty-nine studies were reviewed. The efficacy of MMC as an adjunct therapy for LTS varied across studies. Randomized controlled trials have not shown an outcome difference with MMC use, although methodologic flaws including underpowering were noted. A meta-analysis of observational studies with a comparator arm found the unadjusted probability of remaining symptom-free for > 1 year is greater with versus without MMC application (73% vs. 35%). Single versus multiple application(s) of MMC resulted in similar restenosis rates at long-term follow-up. Complications related to MMC use are rarely reported using conventional doses (0.4 mg/mL). Overall, the quality of evidence was low and the recommendation for intervention was weak. CONCLUSION The role for MMC as an adjunct therapy in LTS is uncertain. While safe in its application, the efficacy of MMC in reducing stenosis recurrence remains a matter of debate. Large, prospective studies are needed to inform future recommendations.
Collapse
Affiliation(s)
- Christopher Di Felice
- Department of Pulmonary and Critical Care Medicine, Louis Stokes Cleveland VA Medical Center
| | - Michael S Machuzak
- Department of Pulmonary, Allergy and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Ray W Shepherd
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Medical Center, Richmond, VA
| |
Collapse
|
7
|
Hong PY, Huang MH, Zhan FF, Lin YL, Qiu SZ, Zhang XB. Case series: Montgomery T-tube placement for subglottic tracheal stenosis: a report of 3 cases. Medicine (Baltimore) 2023; 102:e32680. [PMID: 36637935 PMCID: PMC9839252 DOI: 10.1097/md.0000000000032680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Subglottic tracheal stenosis is stenosis of the trachea between the vocal cords and the lower margin of the cricoid cartilage. The Montgomery T-tube is used as a tracheostomy tube and a combined tracheal stent to avoid postoperative tracheal stenosis. PATIENT CONCERNS Because the stenosis is close to the glottis, surgical treatment is complex, and many complications may arise. DIAGNOSES Subglottic tracheal stenosis. INTERVENTIONS The patients underwent endotracheal intubation or tracheotomy because of acute pancreatitis, laryngeal malignancy, or cerebral hemorrhage after endotracheal intubation or tracheotomy and presented with varying degrees of tracheal stenosis and dyspnea. We relieved airway stenosis and improved dyspnea in these 3 patients by placing a Montgomery T-tube. OUTCOMES None of the 3 patients had intraoperative complications. In 2 of the cases, airway secretions were stored after surgery. LESSONS Montgomery T-tube placement is safe and effective for patients with complex subglottic tracheal stenosis.
Collapse
Affiliation(s)
- Ping-Yang Hong
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, Fujian, China
| | - Mao-Hong Huang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, Fujian, China
| | - Feng-Fu Zhan
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, Fujian, China
| | - Yi-Li Lin
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, Fujian, China
| | - Shao-Zhao Qiu
- Department of Anesthesia, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University, Fujian, China
| | - Xiao-Bin Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, Fujian, China
- * Correspondence: Xiao-Bin Zhang, Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University; The Third Clinical College of Fujian Medical University; Key Clinical Specialty of Fujian Province, No.201, Hubin Nan Road, Siming District, Xiamen, Fujian Province 361004, China (e-mail: )
| |
Collapse
|
8
|
Orlandi R, Raveglia F, Calderoni M, Cassina EM, Cioffi U, Guttadauro A, Libretti L, Pirondini E, Rimessi A, Tuoro A, Passera E. Management of COVID-19 related tracheal stenosis: The state of art. Front Surg 2023; 10:1118477. [PMID: 36891547 PMCID: PMC9986964 DOI: 10.3389/fsurg.2023.1118477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
Tracheal stenosis (TS) is a debilitating disease promoted by pathologic narrowing of the trachea. The acute respiratory distress syndrome caused by COVID-19 has been demonstrated to trigger enhanced inflammatory response and to require prolonged invasive mechanical ventilation as well as high frequency of re-intubation or emergency intubation, thus increasing the rate and complexity of TS. The standard-of-care of COVID-19-related tracheal complications has yet to be established and this is a matter of concern. This review aims at collecting latest evidence on this disease, providing an exhaustive overview on its distinctive features and open issues, and investigating different diagnostic and therapeutic strategies to handle COVID-19-induced TS, focusing on endoscopic versus open surgical approach. The former encompasses bronchoscopic procedures: electrocautery or laser-assisted incisions, ballooning dilation, submucosal steroid injection, endoluminal stenting. The latter consists of tracheal resection with end-to-end anastomosis. As a rule, traditionally, the endoscopic management is restricted to short, low-grade, and simple TS, whereas the open techniques are employed in long, high-grade, and complex TS. However, the critical conditions or extreme comorbidities of several COVID-19 patients, as well as the marked inflammation in tracheal mucosa, have led some authors to apply endoscopic management also in complex TS, recording acceptable results. Although severe COVID-19 seems to be an issue of the past, its long-term complications are still unknown and considering the increased rate and complexity of TS in these patients, we strongly believe that it is worth to focus on it, attempting to find the best management strategy for COVID-19-related TS.
Collapse
Affiliation(s)
- Riccardo Orlandi
- Department of Thoracic Surgery, University of Milan, Milan, Italy
| | - Federico Raveglia
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Matteo Calderoni
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Angelo Guttadauro
- Department of Medicine and Surgery, School of Medicine and Surgery, Università degli Studi di Milano Bicocca, Monza, Italy
| | - Lidia Libretti
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Emanuele Pirondini
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Arianna Rimessi
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Antonio Tuoro
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Eliseo Passera
- Department of Thoracic Surgery, San Gerardo Hospital, ASST Monza, Monza, Italy
| |
Collapse
|
9
|
Dobrow S, Bartels H, Casale G, Strumpf A, Park S, Christophel JJ. Correlating the Bony Facial Trauma Score with Clinical Outcomes. Facial Plast Surg Aesthet Med 2023; 25:16-21. [PMID: 35254889 DOI: 10.1089/fpsam.2021.0322] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: In 2017, the Bony Facial Trauma Score (BFTS) was developed to quantify and describe bony trauma of the face. Objective: To compare BFTSs for the need of hospital admission, intensive care unit (ICU) admission, surgery, tracheostomy tube placement, cervical spine (c-spine) injury, and mortality. Methods: A retrospective review of patients sustaining bony facial trauma from January 1, 2017 to November 30, 2019 was done. Logistic regression modeling measured the association between BFTS and admission status, need for operative repair, tracheostomy, mortality, ICU admission, and c-spine injury. Results: Three hundred six patients were included for this analysis. Median BFTS was 3.5 (interquartile range, 5), while the average age was 45.0 years (standard deviation, 22.3). The most common mechanisms of injury were motor vehicle accident (44.8%) and ground-level fall (32.5%). BFTS was found to correlate with the following (p < 0.05): admission (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.01-1.13), mortality (OR 1.05, 1.00-1.10), tracheostomy (OR 1.11, 1.07-1.17), operative management (OR 1.16, 1.11-1.22), ICU (OR 1.07, 1.03-1.11), and c-spine injury (OR 1.05, 95% CI 1.03-1.11). Conclusion: A significant correlation was found between BFTS and all the outcomes investigated.
Collapse
Affiliation(s)
- Sebastian Dobrow
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Harrison Bartels
- Department of Otolaryngology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Garrett Casale
- Department of Otolaryngology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Andrew Strumpf
- Department of Otolaryngology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Stephen Park
- Department of Otolaryngology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - J Jared Christophel
- Department of Otolaryngology, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| |
Collapse
|
10
|
Exploring the Influence of Dysphagia and Tracheostomy on Pneumonia in Patients with Stroke: A Retrospective Cohort Study. Brain Sci 2022; 12:brainsci12121664. [PMID: 36552123 PMCID: PMC9775301 DOI: 10.3390/brainsci12121664] [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] [Received: 10/20/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Pneumonia is common in patients with tracheostomy and dysphagia. However, the influence of dysphagia and tracheostomy on pneumonia in patients with stroke remains unclear. The aim of this study was to explore the risk factors related to pneumonia, and the association between dysphagia, tracheostomy and pneumonia in patients with stroke was investigated. Methods: Patients with stroke who experienced tracheostomy and dysphagia were included and divided into two groups based on record of pneumonia at discharge. Clinical manifestations and physical examination were used to diagnose pneumonia, whereas clinical swallowing examination, and videofluoroscopy swallowing studies (VFSS) were used to evaluate swallowing function. Results: There were significant differences between the pneumonia group and the no pneumonia group in total tracheostomy time (6.3 ± 5.9 vs. 4.3 ± 1.7 months, p = 0.003), number of instances of ventilator support (0.41 ± 0.49 vs. 0.18 ± 0.38, p = 0.007), PAS score (5.2 ± 1.92 vs. 4.3 ± 1.79, p = 0.039), impaired or absent cough reflex (76.4 vs. 55.6%, p = 0.035), oropharyngeal phase dysfunction (60.6 vs. 40.8%, p = 0.047), length of hospital stay (36.0 ± 7.2 vs. 30.5 ± 11.7 days, p = 0.025) and direct medical costs (15,702.21 ± 14,244.61 vs. 10,923.99 ± 7250.14 United States dollar [USD], p = 0.042). Multivariate logistic regression showed that the total tracheostomy time (95% confidence interval [CI], 1.966−12.922, p = 0.001), impaired or absent cough reflex (95% CI, 0.084−0.695, p = 0.008), and oropharyngeal phase dysfunction (95% CI, 1.087−8.148, p = 0.034) were risk factors for pneumonia. Spearman’s correlation analysis demonstrated that PAS scores were significantly correlated with cough reflex dysfunction (r = 0.277, p = 0.03), oropharyngeal phase dysfunction (r = 0.318, p < 0.01) and total tracheostomy time (r = 0.178, p = 0.045). The oropharyngeal phase dysfunction was significantly correlated with cough reflex (r = 0.549, p < 0.001) and UES opening (r = 0.643, p < 0.01). Conclusions: Tracheostomy and dysphagia increased the risk of pneumonia in patients with stroke. Total tracheostomy time, duration of ventilator support, degree of penetration and aspiration, and oropharyngeal phase dysfunction are risk factors. Given this, we also found that there may be a correlation between tracheostomy and dysphagia.
Collapse
|
11
|
Tokunaga K, Ejima T, Nakashima T, Kuwahara M, Narimatsu N, Sagishima K, Mizumoto T, Sakagami T, Yamamoto T. A novel technique for assessment of post-extubation airway obstruction can successfully replace the conventional cuff leak test: a pilot study. BMC Anesthesiol 2022; 22:38. [PMID: 35105303 PMCID: PMC8807367 DOI: 10.1186/s12871-022-01576-x] [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: 10/19/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Post-extubation airway obstruction is an important complication of tracheal intubation. The cuff leak test is traditionally used to estimate the risk of this complication. However, the cuff leak test parameters are not constant and may depend on the respiratory system and ventilator settings. Furthermore, deflating the cuff also be a risk factor for patient-ventilator asynchrony and ventilator-associated pneumonia. Instead of using the cuff leak test, we measured the pressure of the leak to the upper airway through the gap between the tube and glottis with a constant low flow from the lumen above the cuff without deflating the cuff and called it "pressure above the cuff." The purpose of this study was to investigate whether pressure above the cuff can be used as an alternative to the cuff leak volume. Methods This prospective observational study was conducted at Kumamoto University Hospital after obtaining approval from the institutional review board. The pressure above the cuff was measured using an endotracheal tube with an evacuation lumen above the cuff and an automated cuff pressure modulation device. We pumped 0.16 L per minute of air and measured the steady-state pressure using an automated cuff pressure modulation device. Then, the cuff leak test was performed, and the cuff leak volume was recorded. The cuff leak volume was defined as the difference between the expiratory tidal volume with the cuff inflated and deflated. The relationship between the pressure above the cuff and cuff leak volume was evaluated. The patient-ventilator asynchrony during each measurement was also examined. Results The pressure above the cuff was measured, and the cuff leak volume was assessed 27 times. The pressure above the cuff was significantly correlated with the cuff leak volume (r = -0.76, p < 0.001). Patient-ventilator asynchrony was detected in 37% of measurements during the cuff leak test, but not during the pressure above the cuff test. Conclusions This study suggests that pressure above the cuff measurement may be a less complicated alternative to the conventional cuff leak test for evaluation of the risk of post-extubation airway obstruction. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN000039987; March 30, 2020). https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000044604
Collapse
Affiliation(s)
- Kentaro Tokunaga
- Department of Intensive Care Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan. .,Department of Respiratory Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
| | - Tadashi Ejima
- Department of Intensive Care Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Takuro Nakashima
- Department of Intensive Care Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Manami Kuwahara
- Department of Intensive Care Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Noriko Narimatsu
- Department of Anesthesiology, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro-shi, Kumamoto, 866-8533, Japan
| | - Katsuyuki Sagishima
- Department of Intensive Care Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Teruhiko Mizumoto
- Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Takuro Sakagami
- Department of Respiratory Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| | - Tatsuo Yamamoto
- Department of Intensive Care Medicine, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan
| |
Collapse
|
12
|
Mani GS, Mathews SS, Victor P, Peter JV, Yadav B, Albert RRA. Laryngeal Dysfunction in Acute Organophosphorus and Carbamate Poisoning. Indian J Crit Care Med 2022; 26:167-173. [PMID: 35712737 PMCID: PMC8857705 DOI: 10.5005/jp-journals-10071-24096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Organophosphorus (OP) and carbamate pesticides are widely used for crop protection. We describe the spectrum of laryngeal abnormalities in patients admitted to the intensive care unit (ICU) with acute OP and carbamate poisoning as there is limited information on it. Materials and methods Consecutive patients admitted to the ICU with acute OP and carbamate poisoning over 20 months (December 2014–July 2016) were recruited. Patients were followed up post-discharge if they had undergone tracheostomy or developed hoarseness of voice or stridor following extubation. Asymptomatic individuals who consented underwent laryngoscopy after ICU discharge. The primary outcome was the development of laryngeal dysfunction. Other outcomes included length of stay, need for ventilation, mortality, tracheostomy, and time to decannulation of tracheostomy. Results Of the 136 patients recruited, 71 (52%) underwent laryngoscopy. The overall mortality rate was 9.6%. Of the 71 patients who underwent laryngoscopy, 18 had abnormal findings, which included unilateral or bilateral vocal cord paresis or palsy (n = 14) and/or aspiration (n = 9), subglottic stenosis (n = 1), tracheal stenosis (n = 1), or arytenoid granuloma (n = 1). Laryngeal dysfunction was associated with the ingestion of a dimethyl OP compound (p = 0.04) and quantum consumed (p <0.001). Patients with laryngeal dysfunction had significantly (p = 0.004) longer hospital stay (19.1 ± 10.7 vs 11.8 ± 8.3 days). Conclusion Laryngeal dysfunction is not uncommon in OP and carbamate poisoning and is associated with the ingestion of larger quantity of a dimethyl OP compound and longer hospital stay. Otorhinolaryngologists could be involved early to help identify these abnormalities and initiate an appropriate treatment to ensure a functional voice and good airway. How to cite this article Mani GS, Mathews SS, Victor P, Peter JV, Yadav B, Albert RRA. Laryngeal Dysfunction in Acute Organophosphorus and Carbamate Poisoning. Indian J Crit Care Med 2022;26(2):167–173.
Collapse
Affiliation(s)
- Gajalakshmi S Mani
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suma S Mathews
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
| | - Punitha Victor
- Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - John V Peter
- Department of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India
| | - Bijesh Yadav
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rita RA Albert
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India
- Rita RA Albert, Department of ENT, Christian Medical College, Vellore, Tamil Nadu, India, Phone: +91 9994308432, e-mail:
| |
Collapse
|
13
|
Amadi N, Trivedi R, Ahmed N. Timing of tracheostomy in mechanically ventilated COVID-19 patients. World J Crit Care Med 2021; 10:345-354. [PMID: 34888160 PMCID: PMC8613720 DOI: 10.5492/wjccm.v10.i6.345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
According to the World Health Organization as of September 16, 2021, there have been over 226 million documented cases of coronavirus disease 2019 (COVID-19), which has resulted in more than 4.6 million deaths and approximately 14% develop a more severe disease that requires respiratory assistance such as intubation. Early tracheostomy is recommended for patients that are expected to be on prolonged mechanical ventilation; however, supporting data has not yet been provided for early tracheostomies in COVID-19 patients. The aim of this study was to explore established guidelines for performing tracheostomies in patients diagnosed with COVID-19. Factors considered were patient outcomes such as mortality, ventilator-associated pneumonia, intensive care unit length of stay, complications associated with procedures, and risks to healthcare providers that performed tracheostomies. Various observational studies, meta-analyses, and systematic reviews were collected through a PubMed Database search. Additional sources were found through Google. The search was refined to publications in English and between the years of 2003 and 2021. The keywords used were “Coronavirus” and/or “guidelines'' and/or “tracheostomy” and/or “intensive care”. Twenty-three studies were retained. Due to the complex presentation of the respiratory virus COVID-19, previously established guidelines for tracheostomies had to be reevaluated to determine if these guidelines were still applicable to these critically ill ventilated patients. More specifically, medical guidelines state benefits to early tracheostomies in critically ill ventilated non-COVID-19 patients. However, after having conducted this review, the assumptions about the benefits of early tracheostomies in critically ill ventilated patients may not be appropriate for COVID-19 patients.
Collapse
Affiliation(s)
- Nwonukwuru Amadi
- Division of Trauma, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
| | - Radhika Trivedi
- Division of Trauma, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
| | - Nasim Ahmed
- Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Nepune, NJ 07754, United States
| |
Collapse
|
14
|
Johnson RF, Bradshaw S, Jaffal H, Chorney SR. Estimations of Laryngotracheal Stenosis After Mechanical Ventilation: A Cross-Sectional Analysis. Laryngoscope 2021; 132:1723-1728. [PMID: 34542167 DOI: 10.1002/lary.29866] [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: 05/25/2021] [Revised: 07/29/2021] [Accepted: 09/01/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To estimate the incidence of laryngotracheal stenosis among adults after intubation. STUDY DESIGN Cross-sectional analysis. METHODS We used the Nationwide Readmission Database to examine adult patients readmitted within 45 days after admission for mechanical ventilation. Those with a diagnosis of laryngotracheal stenosis or tracheostomy dependence on their index admission were excluded. Patient demographics, associated comorbidities, and intubation lengths were compared among those with and without a diagnosis of airway stenosis at readmission. RESULTS An estimated 624,918 patients met inclusion with a mean age of 59 years (standard error = 0.2). There were 1,230 patients readmitted within 45 days and diagnosed with laryngeal (N = 362) or tracheal stenosis (N = 920) estimating an incidence of 1.98 per 1,000 discharges. Compared with those without a diagnosis of airway stenosis, those with stenosis were younger (57 vs. 59 years, P < .001), more often female (62% vs. 45%, P < .001) and frequently intubated for >96 hours (47% vs. 32%, P < .001). Additionally, a history of respiratory failure, pneumonia, obesity, gastroesophageal reflux disease, and chronic steroid use were also more common among patients with stenosis. Multiple logistic regression analysis identified a decreased risk of stenosis with advancing age while an increased risk was associated strongest for females (odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.58-2.44, P < .001) and those with chronic steroid use (OR: 2.69, 95% CI: 1.80-4.02, P < .001). CONCLUSION The incidence of laryngotracheal stenosis after intubation in adults is rare but is associated with female gender and younger age. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
Collapse
Affiliation(s)
- Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.,Department of Pediatric Otolaryngology, Children's Medical Center, Dallas, Texas, U.S.A
| | - Stanley Bradshaw
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Hussein Jaffal
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Stephen R Chorney
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.,Department of Pediatric Otolaryngology, Children's Medical Center, Dallas, Texas, U.S.A
| |
Collapse
|
15
|
Bhatt NK, Huang VP, Bertelsen C, Gao WZ, Reder LS, Johns MM, O'Dell K. Pulmonary Function Tests May Better Predict Dyspnea-Severity in Patients with Subglottic Stenosis Compared to Clinician-Reported Stenosis. Ann Otol Rhinol Laryngol 2021; 131:791-796. [PMID: 34496642 DOI: 10.1177/00034894211045266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patients with subglottic stenosis (SGS) present with varied degree of breathing complaints. The dyspnea index (DI) is a 10-question patient-reported outcome measure designed to measure the severity of upper airway obstruction. We set out to determine whether pulmonary function tests or clinician-reported degree of stenosis best predicted DI scores. METHODS Thirty patients with SGS were retrospectively reviewed over a 6-year period. One visit from each patient was included. Data including peak expiratory flow rate (PEFR), body-mass index (BMI), clinician-reported degree of stenosis, and DI scores were reviewed. Multiple linear regression was performed to determine how degree of stenosis and PEFR % predicted the variation in DI score. RESULTS PEFR % better predicted DI scores compared to degree of stenosis (partial correlation -0.32 vs 0.17). After stepwise elimination, PEFR % remained in the regression and was significantly associated with DI scores (F[1, 29] = 9.38, P = .005). BMI did not demonstrate a linear relationship with DI scores and was not included in the regression (r = -.02). The PEFR % unstandardized coefficient was -0.25 (95% CI: -0.42 to -0.08, P = .005). The model predicts that a 4% increase in the PEFR % results in a 1-point decrease in the DI score (95% CI: -1.68 to -0.32). CONCLUSION This study suggests that pulmonary function tests may be a better in-office measure to substantiate the severity of symptoms in patients with SGS.
Collapse
Affiliation(s)
- Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Washington, St Louis, MO, USA
| | - Valerie P Huang
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | | | - William Z Gao
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC, USA
| | - Lindsay S Reder
- Southern California Permanente Medical Group, Kaiser Permanente Baldwin Park, Baldwin Park, CA, USA
| | - Michael M Johns
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Karla O'Dell
- Tina and Rick Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
16
|
Gheorghe DC, Ilie A, Niculescu AG, Grumezescu AM. Preventing Biofilm Formation and Development on Ear, Nose and Throat Medical Devices. Biomedicines 2021; 9:1025. [PMID: 34440229 PMCID: PMC8394763 DOI: 10.3390/biomedicines9081025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/10/2021] [Accepted: 08/14/2021] [Indexed: 12/17/2022] Open
Abstract
Otorhinolaryngology is a vast domain that requires the aid of many resources for optimal performance. The medical devices utilized in this branch share common problems, such as the formation of biofilms. These structured communities of microbes encased in a 3D matrix can develop antimicrobial resistance (AMR), thus making it a problem with challenging solutions. Therefore, it is of concern the introduction in the medical practice involving biomaterials for ear, nose and throat (ENT) devices, such as implants for the trachea (stents), ear (cochlear implants), and voice recovery (voice prosthetics). The surface of these materials must be biocompatible and limit the development of biofilm while still promoting regeneration. In this respect, several surface modification techniques and functionalization procedures can be utilized to facilitate the success of the implants and ensure a long time of use. On this note, this review provides information on the intricate underlying mechanisms of biofilm formation, the large specter of implants and prosthetics that are susceptible to microbial colonization and subsequently related infections. Specifically, the discussion is particularized on biofilm development on ENT devices, ways to reduce it, and recent approaches that have emerged in this field.
Collapse
Affiliation(s)
- Dan Cristian Gheorghe
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “M.S. Curie” Clinical Emergency Hospital for Children, 077120 Bucharest, Romania
| | - Andrei Ilie
- Faculty of Engineering in Foreign Languages, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.I.); (A.-G.N.)
| | - Adelina-Gabriela Niculescu
- Faculty of Engineering in Foreign Languages, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.I.); (A.-G.N.)
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
- Academy of Romanian Scientists, 3 Ilfov Street, 50044 Bucharest, Romania
| |
Collapse
|
17
|
Carratola M, Hart CK. Pediatric tracheal trauma. Semin Pediatr Surg 2021; 30:151057. [PMID: 34172217 DOI: 10.1016/j.sempedsurg.2021.151057] [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: 10/21/2022]
Abstract
Tracheal trauma is an uncommon but potentially serious cause of airway injury in children. Presentation may be acute in cases of blunt or penetrating trauma, or delayed in cases of chronic irritation or indwelling endotracheal tubes. Symptoms include dyspnea, progressive respiratory distress, neck and chest swelling and ecchymosis, and dysphonia. Workup is pursued as allowed by the patient's clinical status and may include plain radiography, computed tomography, and endoscopy. Accuracy and efficiency of diagnosis is paramount for those at risk of rapid decompensation. Treatment may include observation, elective and strategic intubation, or primary surgical repair.
Collapse
Affiliation(s)
- Maria Carratola
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229, USA.
| |
Collapse
|
18
|
Jahshan F, Abu Ammar A, Ertracht O, Eisenbach N, Daoud A, Sela E, Atar S, Zussman E, Fichtman B, Harel A, Gruber M. Local Delivery of Mometasone Furoate from an Eluting Endotracheal Tube Reduces Airway Morbidity Following Long-Term Animal Intubation. ACS APPLIED BIO MATERIALS 2021; 4:4131-4139. [PMID: 35006827 DOI: 10.1021/acsabm.0c01526] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND upper airway complications are common sequelae of endotracheal tube (ETT) intubation, and systemic corticosteroids are considered a mainstay treatment for this problem. Drug-eluting ETT may present an attractive option for topical steroid delivery while avoiding systemic side effects and improving the therapeutic outcome. The objective of the present study is to evaluate the reduction of tube-related tracheal morbidity via a self-designed steroid-eluting ETT with controlled sustained release properties in an animal model. METHODS steroid-eluting ETTs were coated by poly(lactic-co-glycolic acid) -electrospun nanofibers loaded with mometasone furoate (MF) as a model drug. Animals were randomly assigned into three equal groups: non-intubated, blank-ETT, and loaded-ETT. The intubation interval was 1 week. Specimens were analyzed by histology, specific fibrosis staining, and scanning electron microscopy (SEM). RESULTS the blank-ETT group exhibited a significant increase in tracheal mucosal thickness compared to the loaded-ETT and control groups. Average tracheal mucosal thickness was 112 ± 34, 242 ± 49, and 113 ± 43 μm in the control, blank-ETT, and loaded-ETT groups, respectively. The blank-ETT group exhibited a significant increase in tracheal fibrosis compared to the loaded-ETT and control groups. Relative fibrosis values were 0.07 ± 0.05, 0.154 ± 0.1, and 0.0984 ± 0.084% for the control, blank-ETT, and loaded-ETT groups, respectively. While SEM imaging showed normal surface structures in the control group, intubated blank-ETT rats showed severe surface structural damage, whereas only mild damage was observed in the loaded-ETT group. CONCLUSIONS local sustained release of MF via a self-designed drug-eluting ETT is a potential therapeutic approach which may significantly reduce tube-related upper airway morbidity.
Collapse
Affiliation(s)
- Forsan Jahshan
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Aiman Abu Ammar
- Department of Pharmaceutical Engineering, Azrieli College of Engineering Jerusalem, Jerusalem 9103501, Israel
| | - Offir Ertracht
- Eliachar Research Laboratory, Galilee Medical Center, Nahariya 2210001, Israel
| | - Netanel Eisenbach
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Amani Daoud
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Eyal Sela
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel
| | - Shaul Atar
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Eyal Zussman
- NanoEngineering Group, Department of Mechanical Engineering, Technion, Israel Institute of Technology, Haifa 3200003, Israel
| | - Boris Fichtman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Amnon Harel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Maayan Gruber
- Department of Otolaryngology-Head and Neck Surgery, Galilee Medical Center, Nahariya 2210001, Israel.,Eliachar Research Laboratory, Galilee Medical Center, Nahariya 2210001, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| |
Collapse
|
19
|
Hong S, Wang H, Tian Y, Qiao L. The roles of noninvasive mechanical ventilation with helmet in patients with acute respiratory failure: A systematic review and meta-analysis. PLoS One 2021; 16:e0250063. [PMID: 33857228 PMCID: PMC8049716 DOI: 10.1371/journal.pone.0250063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To compare the safety and effectiveness between helmet and face mask noninvasive mechanical ventilation (NIMV) in patients with acute respiratory failure (ARF). Methods English databases included PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science. Chinese databases involved Wanfang Data, China Knowledge Resource Integrated Database and Chinese Biological Medicine Database. Randomized controlled trials (RCTs) comparing helmet and face mask NIMV for patients with ARF were searched. Meta-analysis was performed using Review manager 5.1.0. Results Twelve trials with a total of 569 patients were eligible. Our meta-analysis showed that, comparing with face mask, helmet could significantly decrease the incidences of intolerance [risk ratio (RR) 0.19; 95% confidence interval (CI) 0.09−0.39], facial skin ulcer (RR 0.19; 95% CI 0.08−0.43) and aerophagia (RR 0.15; 95% CI 0.06−0.37), reduce respiratory rate [mean difference (MD) -3.10; 95% CI -4.85 to -1.34], intubation rate (RR 0.39; 95% CI 0.26−0.59) and hospital mortality (RR 0.62; 95% CI 0.39−0.99) in patients with ARF, and improve oxygenation index in patients with hypoxemic ARF (MD 55.23; 95% CI 31.37−79.09). However, subgroupanalysis for hypercapnic ARF revealed that PaCO2 was significantly reduced in face mask group compared with helmet group (MD 5.34; 95% CI 3.41−7.27). Conclusion NIMV with helmet can improve the patient’s tolerance, reduce adverse events, increase oxygenation effect, and decrease intubation rate and hospital mortality comparing to face mask. However, the low number of patients from included studies may preclude strong conclusions. Large RCTs are still needed to provide more robust evidence.
Collapse
Affiliation(s)
- Shukun Hong
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
- * E-mail:
| | - Hongye Wang
- Department of Obstetrics and Gynecology, Shengli Oilfield Central Hospital, Dongying, China
| | - Yonggang Tian
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Lujun Qiao
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| |
Collapse
|
20
|
Piro R, Casalini E, Livrieri F, Fontana M, Ghidoni G, Taddei S, Facciolongo N. Interventional pulmonology during COVID-19 pandemic: current evidence and future perspectives. J Thorac Dis 2021; 13:2495-2509. [PMID: 34012596 PMCID: PMC8107537 DOI: 10.21037/jtd-20-2192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
COVID-19, caused by SARS-CoV-2 infection, has become increasingly prevalent worldwide, reaching a pandemic stage in March 2020. The organization of health care services had to change because of this new disease, with the need to reallocate staff and materials, besides changing management protocols. A very important challenge is not to expose patients and health care workers to the risk of infection and not to waste personal protective equipment (PPE). In the field of interventional pulmonology, various aspects related to COVID-19 must be taken into great consideration. Although bronchoscopy is not a first-line test for patients with suspected SARS-CoV-2 infection, it has a role in selected cases and it can be useful for differential diagnosis. However, bronchoscopy is an aerosol-generating procedure, that’s why its unjustified use could contribute to propagate the virus. For this reason, the utility of each procedure must be carefully evaluated, the patient has to be properly investigated before the procedure, which has to be performed with specific precautions, including adequate PPE. In this review, we summarize the knowledge and the principal statements about endoscopic activity in COVID-19 period, in both diagnosis of COVID-19 and management of patients. How to safely perform both bronchoscopic and pleural-related procedures (thoracoscopy, pleural biopsy and drainage of pleural effusions) is described with the aim to help the staff to decide when and how performing a procedure. We also highlight how interventional pulmonology could help in matter of complications related to COVID-19.
Collapse
Affiliation(s)
- Roberto Piro
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Eleonora Casalini
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Francesco Livrieri
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Matteo Fontana
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Giulia Ghidoni
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Sofia Taddei
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Nicola Facciolongo
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| |
Collapse
|
21
|
Maurizi G, Vanni C, Rendina EA, Ciccone AM, Ibrahim M, Andreetti C, Venuta F, D'Andrilli A. Surgery for laryngotracheal stenosis: Improved results. J Thorac Cardiovasc Surg 2020; 161:845-852. [PMID: 33451851 DOI: 10.1016/j.jtcvs.2020.12.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Laryngotracheal resection is still considered a challenging operation and few high-volume institutions have reported large series of patients in this setting. During the 5 years, novel surgical techniques as well as new trends in the intra- and postoperative management have been proposed. We present results of our increased experience with laryngotracheal resection for benign stenosis. METHODS Between 1991 and May 2019, 228 consecutive patients underwent laryngotracheal resection for subglottic stenosis. One hundred eighty-three (80.3%) were postintubation, and 45 (19.7%) were idiopathic. Most of them (58.7%) underwent surgery during the past 5 years. At the time of surgery, 139 patients (61%) had received tracheostomy, laser, or laser plus stenting. The upper limit of the stenosis ranged between actual involvement of the vocal cords to 1.5 cm from the glottis. RESULTS There was no perioperative mortality. Two hundred twenty-two patients underwent resection and anastomosis according to the Pearson technique; 6 patients with involvement of thyroid cartilage underwent resection and reconstruction with the laryngofissure technique. Airway resection length ranged between 1.5 and 8 cm (mean, 3.8 ± 0.8 cm) and it was >4.5 cm in 19 patients. Airway complication rate was 7.8%. Overall success of airway complication treatment was 83.3%. Definitive success was achieved in 98.7% of patients. Patients presenting with idiopathic stenosis or postcoma patients showed no increased failure rate. CONCLUSIONS Laryngotracheal resection for benign subglottic stenosis is safe and effective, and provides a very high rate of success. Careful intra- and postoperative management is crucial for a successful outcome.
Collapse
Affiliation(s)
- Giulio Maurizi
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Camilla Vanni
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Ciccone
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudio Andreetti
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Federico Venuta
- Division of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio D'Andrilli
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
22
|
Berard D, Navarro JD, Bascos G, Harb A, Feng Y, De Lorenzo R, Hood RL, Restrepo D. Novel expandable architected breathing tube for improving airway securement in emergency care. J Mech Behav Biomed Mater 2020; 114:104211. [PMID: 33285451 DOI: 10.1016/j.jmbbm.2020.104211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/30/2020] [Accepted: 11/15/2020] [Indexed: 11/17/2022]
Abstract
Life-saving interventions utilize endotracheal intubation to secure a patient's airway, but performance of the clinical standard of care endotracheal tube (ETT) is inadequate. For instance, in the current COVID-19 crisis, patients can expect prolonged intubation. This protracted intubation may produce health complications such as tracheal stenosis, pneumonia, and necrosis of tracheal tissue, as current ETTs are not designed for extended use. In this work, we propose an improved ETT design that seeks to overcome these limitations by utilizing unique geometries which enable a novel expanding cylinder. The mechanism provides a better distribution of the contact forces between the ETT and the trachea, which should enhance patient tolerability. Results show that at full expansion, our new ETT exerts pressures in a silicone tracheal phantom well within the recommended standard of care. Also, preliminary manikin tests demonstrated that the new ETT can deliver similar performance in terms of air pressure and air volume when compared with the current gold standard ETT. The potential benefits of this new architected ETT are threefold, by limiting exposure of healthcare providers to patient pathogens through streamlining the intubation process, reducing downstream complications, and eliminating the need of multiple size ETT as one architected ETT fits all.
Collapse
Affiliation(s)
- David Berard
- University of Texas at San Antonio, Department of Mechanical Engineering, San Antonio, TX, USA
| | - Juan David Navarro
- University of Texas at San Antonio, Department of Mechanical Engineering, San Antonio, TX, USA
| | - Gregg Bascos
- University of Texas at San Antonio, Department of Biomedical Engineering, San Antonio, TX, USA
| | - Angel Harb
- University of Texas at San Antonio, Department of Biomedical Engineering, San Antonio, TX, USA
| | - Yusheng Feng
- University of Texas at San Antonio, Department of Mechanical Engineering, San Antonio, TX, USA
| | - Robert De Lorenzo
- University of Texas Health Science Center at San Antonio, Department of Emergency Medicine, San Antonio, TX, USA
| | - R Lyle Hood
- University of Texas at San Antonio, Department of Mechanical Engineering, San Antonio, TX, USA; University of Texas at San Antonio, Department of Biomedical Engineering, San Antonio, TX, USA; University of Texas Health Science Center at San Antonio, Department of Emergency Medicine, San Antonio, TX, USA
| | - David Restrepo
- University of Texas at San Antonio, Department of Mechanical Engineering, San Antonio, TX, USA.
| |
Collapse
|
23
|
Pandian V, Morris LL, Brodsky MB, Lynch J, Walsh B, Rushton C, Phillips J, Rahman A, DeRose T, Lambe L, Lami L, Wu SPM, Garza FP, Maiani S, Zavalis A, Okusanya KA, Palmieri PA, McGrath BA, Pelosi P, Sole ML, Davidson P, Brenner MJ. Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach. Am J Crit Care 2020; 29:e116-e127. [PMID: 32929453 DOI: 10.4037/ajcc2020561] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed. A global interdisciplinary team analyzed and prioritized findings via electronic communications and video conferences to develop consensus recommendations. RESULTS Aerosol-generating procedures are commonly performed by nurses and other health care workers, most notably during suctioning, tracheostomy tube changes, and stoma care. Patient repositioning, readjusting circuits, administering nebulized medications, and patient transport also present risks. Standard personal protective equipment includes an N95/FFP3 mask with or without surgical masks, gloves, goggles, and gown when performing aerosol-generating procedures for patients with known or suspected COVID-19. Viral testing of bronchial aspirate via tracheostomy may inform care providers when determining the protective equipment required. The need for protocols to reduce risk of transmission of infection to nurses and other health care workers is evident. CONCLUSION Critical care nurses and multidisciplinary teams often care for patients with a tracheostomy who are known or suspected to have COVID-19. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of infectious transmission.
Collapse
Affiliation(s)
- Vinciya Pandian
- Vinciya Pandian is associate professor, Department of Nursing Faculty, and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland
| | - Linda L Morris
- Linda L. Morris is associate professor, Northwestern University Feinberg School of Medicine; Shirley Ryan AbilityLab, Chicago, Illinois
| | - Martin B Brodsky
- Martin B. Brodsky is associate professor, Department of Physical and Rehabilitation, Division of Critical Care and Pulmonary and OACIS Research Group, Johns Hopkins University
| | - James Lynch
- James Lynch is advanced critical care practitioner, Acute Intensive Care Unit, Manchester University National Health Services Foundation Trust, and National Tracheostomy Safety Project, Manchester, United Kingdom
| | - Brian Walsh
- Brian Walsh is professor, Department of Health Sciences, Liberty University, Lynchburg, Virginia
| | - Cynda Rushton
- Cynda Rushton is professor, Johns Hopkins University Anne and George L. Bunting Berman Institute of Bioethics, Department of Nursing Faculty, Johns Hopkins School of Nursing, and Department of Pediatrics, Johns Hopkins School of Medicine; and adjunct professor, University of Technology of Sydney, Sydney, New South Wales, Australia
| | - Jane Phillips
- Jane Phillips is professor of Palliative Nursing, and director IMPACCT, University of Technology Sydney
| | - Alphonsa Rahman
- Alphonsa Rahman is critical care clinical nurse specialist, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Troy DeRose
- Troy DeRose is nurse practitioner, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Leah Lambe
- Leah Lambe is nursing clinical coordinator, Rapid Response Team, Hospital of the University of Pennsylvania, Phila-delphia, Pennsylvania
| | - Lionel Lami
- Lionel Lami, University of Hospital of Toulouse, and University Cancer Institute of Toulouse Oncopole, Toulouse, France
| | - Sarah Pui Man Wu
- Sarah Pui Man Wu, advance practice nurse, Department of Otolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Hong Kong
| | - Francisco Paredes Garza
- Francisco Paredes Garza is critical care nurse, Hospital Universitario La Paz, Madrid, Spain
| | - Simona Maiani
- Simona Maiani is head nurse, Anesthesiology and Intensive Care, San Martino Policlinico Hospital, and IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Andrea Zavalis
- Andrea Zavalis is critical care nurse, Enfermeira Intensivista, Manaus, Brazil
| | - Kafilat Ajoke Okusanya
- Kafilat Ajoke Okusanya is critical care nurse, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Patrick A Palmieri
- Patrick A. Palmieri is vice chancellor for research, Universidad Norbert Wiener; and director of Centro de Salud Basada en Evidencia de Sudamérica: A Joanna Briggs Affiliated Group, Lima, Perú
| | - Brendan A McGrath
- Brendan A. McGrath is anesthesiology consultant, University of Manchester, National Health Service Foundation Trust, National Tracheostomy Safety Project, Manchester, United Kingdom
| | - Paolo Pelosi
- Paolo Pelosi is with Anesthesiology and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Genoa, Italy
| | - Mary Lou Sole
- Mary Lou Sole is dean of College of Nursing, Orlando Health Endowed Chair in Nursing, and University of Central Florida Pegasus Professor, University of Central Florida, Orlando, Florida
| | - Patricia Davidson
- Patricia Davidson is professor and dean, Department of Nursing Faculty, Johns Hopkins University
| | - Michael J Brenner
- Michael J. Brenner is associate professor, Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan; president, Global Tracheostomy Collaborative, Raleigh, North Carolina
| |
Collapse
|
24
|
Tara A, Kumaraswami S, Berzofsky C. From Tracheal Stenosis to Tracheostomy Displacement: A Case Report on a Seemingly Never-Ending Difficult Airway. A A Pract 2020; 14:e01185. [PMID: 32224697 DOI: 10.1213/xaa.0000000000001185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of undiagnosed tracheal stenosis that culminated in acute respiratory failure in an inpatient unit. After failed intubation attempts, the placement of a supraglottic airway resulted in successful ventilation and was followed by a tracheostomy in the operating room. Postoperatively, the tracheostomy tube became accidentally dislodged necessitating emergency measures with eventual reinsertion of a longer tracheostomy tube. We present this case to highlight life-saving airway strategies that may be considered in such emergency situations and propose 2 simple algorithms to guide anesthesiologists in managing similar airway emergencies.
Collapse
Affiliation(s)
| | | | - Craig Berzofsky
- Otolaryngology, New York Medical College, Westchester Medical Center, Valhalla, New York
| |
Collapse
|
25
|
Dhasmana A, Singh A, Rawal S. Biomedical grafts for tracheal tissue repairing and regeneration "Tracheal tissue engineering: an overview". J Tissue Eng Regen Med 2020; 14:653-672. [PMID: 32064791 DOI: 10.1002/term.3019] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/23/2022]
Abstract
Airway system is a vital part of the living being body. Trachea is the upper respiratory portion that connects nostril and lungs and has multiple functions such as breathing and entrapment of dust/pathogen particles. Tracheal reconstruction by artificial prosthesis, stents, and grafts are performed clinically for the repairing of damaged tissue. Although these (above-mentioned) methods repair the damaged parts, they have limited applicability like small area wounds and lack of functional tissue regeneration. Tissue engineering helps to overcome the above-mentioned problems by modifying the traditional used stents and grafts, not only repair but also regenerate the damaged area to functional tissue. Bioengineered tracheal replacements are biocompatible, nontoxic, porous, and having 3D biomimetic ultrastructure with good mechanical strength, which results in faster and better tissue regeneration. Till date, the bioengineered tracheal replacements studies have been going on preclinical and clinical levels. Besides that, still many researchers are working at advance level to make extracellular matrix-based acellular, 3D printed, cell-seeded grafts including living cells to overcome the demand of tissue or organ and making the ready to use tracheal reconstructs for clinical application. Thus, in this review, we summarized the tracheal tissue engineering aspects and their outcomes.
Collapse
Affiliation(s)
- Archna Dhasmana
- Department of Biotechnology, School of Applied and Life Sciences, Uttaranchal University, Dehradun, India
| | - Atul Singh
- Department of Biotechnology, School of Applied and Life Sciences, Uttaranchal University, Dehradun, India
| | - Sagar Rawal
- Department of Biotechnology, School of Applied and Life Sciences, Uttaranchal University, Dehradun, India
| |
Collapse
|
26
|
Huddleston SJ, Brown R, Rudser K, Goswami U, Tomic R, Lemke NT, Shaffer AW, Soule M, Hertz M, Shumway S, Kelly R, Loor G. Need for tracheostomy after lung transplant predicts decreased mid- and long-term survival. Clin Transplant 2019; 34:e13766. [PMID: 31815320 DOI: 10.1111/ctr.13766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/30/2019] [Accepted: 12/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tracheostomy is an important adjunct for lung transplant patients requiring prolonged ventilation. We explored the effects of post-transplant tracheostomy on survival and bronchiolitis obliterans syndrome after lung transplant. METHODS A retrospective, single center analysis was performed on all lung transplant recipients during the Lung Allocation Score (LAS) era. Risk factors for post-transplant tracheostomy or death within 30 days were assessed. Kaplan-Meier estimates and Cox proportional hazards models were used to examine the association between tracheostomy within 30 days after transplant and survival at 1 and 3 years. A total of 403 patients underwent single or bilateral lung transplant between May 2005 and February 2016 with complete data for 352 cases, and 35 patients (9.9%) underwent tracheostomy or died (N = 10, 2.8%) within 30 days. RESULTS In adjusted analyses, primary graft dysfunction grade 3 (PGD3) was associated with a composite end point of tracheostomy or death within 30 days (HR 3.11 (1.69, 5.71), P-value < .001). Tracheostomy within 30 days was associated with decreased survival at 1(HR 4.25 [1.75, 10.35] P-value = .001) and 3 years (HR 2.74 [1.30, 5.76], P-value = .008), as well as decreased bronchiolitis obliterans (BOS)-free survival at 1 (HR 1.87 [1.02, 3.41] P-value = .042) and 3 years (HR 2.15 [1.33, 3.5], P-value = .002). CONCLUSION Post-transplant tracheostomy is a marker for advanced lung allograft dysfunction with significant reduction in long-term overall and BOS-free survival.
Collapse
Affiliation(s)
- Stephen J Huddleston
- Division of Cardiothoracic Surgery, Department of a Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Roland Brown
- Divison of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Kyle Rudser
- Divison of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Umesh Goswami
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Rade Tomic
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Nicholas T Lemke
- Division of Cardiothoracic Surgery, Department of a Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Andrew W Shaffer
- Division of Cardiothoracic Surgery, Department of a Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Matthew Soule
- Division of Cardiothoracic Surgery, Department of a Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Marshall Hertz
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sara Shumway
- Division of Cardiothoracic Surgery, Department of a Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Rose Kelly
- Division of Cardiothoracic Surgery, Department of a Surgery, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Gabriel Loor
- Division of Cardiothoracic Transplantation and Circulatory Support, Texas Heart Institute, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
27
|
Abstract
Airway narrowing can be idiopathic or can occur as a result of airway tumors, hematomas, infections, and other pathologic conditions. Endoscopic management variously involves balloon dilatation, stent placement, laser vaporization of pathologic tissue, microdebridement, and other interventions, using either a rigid or a flexible bronchoscope. Jet ventilation is frequently used in such settings, especially when the presence of an endotracheal tube would interfere with the procedure. In desperate cases, extracorporeal membrane oxygenation may be used in managing the critical airway.
Collapse
|