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Tochigi K, Sakamoto H, Omura K, Kessoku H, Takeda T, Oguro R, Kojima H, Tanaka Y. Safety of cricotracheostomy with skin and tracheal membrane flaps for severe COVID-19 patients. Auris Nasus Larynx 2024; 51:583-587. [PMID: 38552421 DOI: 10.1016/j.anl.2024.03.003] [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: 06/12/2023] [Revised: 02/04/2024] [Accepted: 03/13/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Airway surgery is performed for COVID-19 patients who require long-term tracheal intubation and mechanical ventilation. Tracheostomy sometimes causes postoperative complications represented by bleeding at a relatively high rate in COVID-19 patients. As an alternative surgical procedure to tracheostomy, cricotracheostomy may reduce these complications, but few studies have examined its safety. METHODS Data were retrospectively collected for sixteen COVID-19 patients (11 underwent tracheostomy, 5 underwent modified cricotracheostomy). In addition to patients' backgrounds and blood test data, the frequency of complications and additional care required for postoperative complications were collected. Statistical analysis was conducted by the univariate analysis of Fischer analysis and Mann-Whitney U test. RESULTS Five cases experienced postoperative bleeding, four cases experienced peristomal infection, and one case experienced subcutaneous emphysema in the tracheostomy patients. These complications were not observed in the cricotracheostomy patients. The number of additional cares for postoperative complications was significantly lower in cricotracheostomy than in tracheostomy patients (p < 0.05). CONCLUSIONS Modified cricotracheostomy could be a safe procedure in airway surgery for patients with COVID-19 from the point of fewer postoperative complications and additional care. It might be necessary to select the cricotracheostomy depending on patients' background to reduce postoperative complications.
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Affiliation(s)
- Kosuke Tochigi
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hikaru Sakamoto
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuhiro Omura
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan; Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan.
| | - Hisashi Kessoku
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Teppei Takeda
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryoji Oguro
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiro Tanaka
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Wannitta Wong ET, Saniasiaya J, Tharek A, Sallehuddin NS. High-Riding Inominate Artery: Challenge During Tracheostomy. Indian J Otolaryngol Head Neck Surg 2023; 75:3878-3882. [PMID: 37974895 PMCID: PMC10645717 DOI: 10.1007/s12070-023-03944-6] [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: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 11/19/2023] Open
Abstract
An aberrant vessel presenting as a pulsatile neck mass poses a significant challenge intraoperatively if overlooked during the pre-operative period. We present a case of a high-riding innominate artery (HRIA) just above the suprasternal notch, with the right common carotid artery crossing the midline just inferior to the thyroid gland in a 72-year-old lady referred for tracheostomy. The surgeon operating on the anterior part of the neck must be aware of the HRIA and equipped with sufficient knowledge of interventions that may be adapted to prevent injury. We aim to highlight the importance of careful investigations of subtle signs which may lead to the diagnosis and treatment with a review of various interventions for this unusual condition.
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Affiliation(s)
- E-Ting Wannitta Wong
- Department of Otorhinolaryngology, Hospital Serdang, Jalan Puchong, Kajang, Selangor Darul Ehsan 43000 Malaysia
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Wilayah Persekutuan Kuala Lumpur, Kuala Lumpur, 50603 Malaysia
| | - Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Wilayah Persekutuan Kuala Lumpur, Kuala Lumpur, 50603 Malaysia
| | - Anas Tharek
- Department of Radiology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Seri Kembangan, Selangor 43400 Malaysia
| | - Nur Syazwani Sallehuddin
- Department of Otorhinolaryngology, Hospital Serdang, Jalan Puchong, Kajang, Selangor Darul Ehsan 43000 Malaysia
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3
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Zhou L, Xiaosan H, Jian C, Wang S. Successful endoscopic hemostatic treatment for endotracheal bleeding. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023. [PMID: 37732344 DOI: 10.17235/reed.2023.9821/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
A 42-year-old male patient experienced hemorrhagic shock after endotracheal intubation. Emergency gastroscopy showed no upper gastrointestinal bleeding, but active tracheal bleeding. After sedation, the tracheal bleeding was successfully stopped with gastroscopy. Post-intubation airway bleeding is a rare but fatal adverse event, and finding the exact bleeding site and quickly stopping the bleeding is the key to successful treatment.
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Affiliation(s)
- Lifeng Zhou
- Gastroenterology, Nanchong Central Hospital, China
| | - Hu Xiaosan
- Gastroenterology, Nanchong Central Hospital
| | - Chen Jian
- Gastroenterology, Nanchong Central Hospital
| | - Shanping Wang
- Gastroenterology, The Third Affiliated Hospital of Guangzhou Medical University
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Yagiz Agayarov O, Arslan IB, Gumussoy M, Guclu G, Cukurova I. The Impact of the COVID-19 Pandemic on Urgent Awake Tracheotomies in Adults. Cureus 2023; 15:e44015. [PMID: 37753000 PMCID: PMC10519441 DOI: 10.7759/cureus.44015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
Objective This study aims to investigate the impact of the COVID-19 pandemic on urgent awake tracheotomies (UATs) in adults in a reference center. Methodology During the pandemic (between March 2020 and May 2022) and before the pandemic (between January 2018 and March 2020), medical charts of patients who underwent UATs were reviewed. The analysis focused on demographic characteristics, indications, COVID-19 positivity status, surgical procedures, and complications. Results During the pandemic, 67 UATs (age 62.04 ± 11.9 years) were performed. Of the indications, 56 (83.5%) were malignancy. Before the pandemic, 22 UATs (age 63.86 ± 15.1 years) were performed, of which 14 UATs (63.6%) were due to malignancy. There was a significant increase in UATs and their indications in patients with head and neck malignancies (P < 0.05). Stay suture (65, 97%) and suture ligation of the thyroidal isthmus (61, 91%) were significantly performed during the pandemic (P < 0.05). Conclusions A significant increase in UAT was detected, especially in patients with advanced head and neck cancer. Pandemic conditions and the risk of viral transmission have led to more conservative UAT techniques.
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Affiliation(s)
- Ozlem Yagiz Agayarov
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Ilker Burak Arslan
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Murat Gumussoy
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Gulay Guclu
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
| | - Ibrahim Cukurova
- Department of Otolaryngology, Head and Neck Surgery, Tepecik Training and Research Hospital, Health Sciences University, Izmir, TUR
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5
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Stramiello JA, Friesen TL, Rao A, Ratnayaka K, Moore J, El-Said H, Brigger MT. Aortopulmonary collaterals: An etiology for pediatric tracheostomy hemorrhage. Int J Pediatr Otorhinolaryngol 2022; 158:111123. [PMID: 35483154 DOI: 10.1016/j.ijporl.2022.111123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To report a single-institution's experience of symptomatic aortopulmonary collaterals presenting as tracheostomy tube hemorrhage. STUDY DESIGN Retrospective case series and Contemporary Review. SETTING Tertiary care children's hospital. METHODS Retrospective review, from 2015 to 2020, of patients <18 years old who were treated for tracheostomy hemorrhage with endovascular embolization of aortopulmonary collateral (APC) vessels. RESULTS 4 patients were identified, 2 males and 2 females, ages 15 months-to 14 years-old, with a range of cyanotic congenital heart diseases. Direct laryngoscopy and bronchoscopy were necessary for excluding proximal airway sources. Chest computed tomography angiography did not localize pulmonary hemorrhage, but helped identify aortopulmonary collaterals. Cardiac catheterization was both diagnostic and therapeutic with use of endovascular embolization techniques by pediatric interventional cardiology and interventional radiology. Previously reported APC-related pulmonary hemorrhages occurred in significantly different settings compared to our patients, and evaluation by an otolaryngologist was key to rule out upper airway etiologies. CONCLUSION Symptomatic aortopulmonary collaterals is an important etiology in pediatric tracheostomy tube hemorrhage in patients with cyanotic congenital heart disease.
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Affiliation(s)
- Joshua A Stramiello
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, 92037, USA
| | - Tzyynong L Friesen
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, 92037, USA; Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA
| | - Aparna Rao
- Division of Pulmonary/Respiratory Medicine, Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA
| | - Kanishka Ratnayaka
- Division of Cardiology, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92037, USA; Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA
| | - John Moore
- Division of Cardiology, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92037, USA; Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA
| | - Howaida El-Said
- Division of Cardiology, Department of Pediatrics, University of California San Diego, La Jolla, CA, 92037, USA; Division of Pediatric Cardiology, Department of Pediatrics, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA
| | - Matthew T Brigger
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, 92037, USA; Division of Pediatric Otolaryngology, Rady Children's Hospital San Diego, San Diego, CA, 92123, USA.
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6
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Tracheobronchial Thrombus in a Combat Wounded Patient With a New Tracheostomy. J Bronchology Interv Pulmonol 2021; 27:216-218. [PMID: 32574475 DOI: 10.1097/lbr.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abbott F, Ortega M, Bravo S, Basoalto R, Kattan E. Can we improve teaching and learning of percutaneous dilatational tracheostomy's bronchoscopic guidance? SAGE Open Med 2021; 9:20503121211002321. [PMID: 33796301 PMCID: PMC7983236 DOI: 10.1177/20503121211002321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
Percutaneous dilatational tracheostomy has become the technique of choice in multiple intensive care units. Among innovations to improve procedural safety and success, bronchoscopic guidance of percutaneous dilatational tracheostomy has been advocated and successfully implemented by multiple groups. Most published literature focuses on the percutaneous dilatational tracheostomy operator, with scarce descriptions of the bronchoscopic particularities of the procedure. In this article, we provide 10 suggestions to enhance specific procedural aspects of bronchoscopic guidance of percutaneous dilatational tracheostomy, and strategies to optimize its teaching and learning, in order to promote learners' competence acquisition and increase patient safety.
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Affiliation(s)
- Francisco Abbott
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Departamento de Enfermedades
Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Marcos Ortega
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Departamento de Enfermedades
Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Sebastian Bravo
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Roque Basoalto
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
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8
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O'Malley TJ, Jordan AM, Prochno KW, Saxena A, Maynes EJ, Ferrell B, Guy TS, Entwistle JW, Massey HT, Morris RJ, Abai B, Tchantchaleishvili V. Evaluation of Endovascular Intervention for Tracheo-Innominate Artery Fistula: A Systematic Review. Vasc Endovascular Surg 2021; 55:317-324. [PMID: 33529132 DOI: 10.1177/1538574420980625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While the standard of care for suspected tracheo-innominate artery fistula (TIF) necessitates sternotomy, perioperative mortality remains high. Endovascular interventions have been attempted, but reports have been anecdotal. The aim of this systematic review was to evaluate the outcomes of endovascular management of TIF by pooling the existing evidence. METHODS An electronic database search of Ovid MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Controlled Trials Register was performed to identify all studies examining endovascular treatment of TIF. Patients greater than 14 years of age who underwent endovascular intervention for TIF were included. 25 studies consisting of 27 patients met the inclusion criteria. RESULTS 48.1% (13/27) of patients were male and median age was 39.0 [IQR 16.0, 47.5] years. Tracheostomy was present in 96.3% (26/27) of cases. Median duration from tracheostomy to TIF presentation was 2.2 months [0.5, 42.5]. On presentation, 84.6% (22/26) had tracheal hemorrhage, and 22.8% (6/27) were hemodynamically unstable. 96.3% (26/27) underwent covered stent graft placement while 1 patient (3.8%) had coil embolization. 18.5% (5/27) of patients required repeat endovascular intervention for recurrent bleeding, while 11.1% (3/27) required rescue sternotomy. Median hospital length of stay was 30 days [16.0, 46.5], and overall mortality was 29.6% (8/27) with a median follow-up time of 5 months [1.2, 11.5]. CONCLUSION While uncommon, endovascular treatment of TIF may be a feasible alternative to sternotomy. The approach may be useful in those who are unable to undergo surgery or are likely to have adhesions from prior chest operations.
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Affiliation(s)
- Thomas J O'Malley
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew M Jordan
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Kyle W Prochno
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Abhiraj Saxena
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Brandon Ferrell
- 12230Georgetown University School of Medicine, Washington, DC, USA
| | - T Sloane Guy
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - John W Entwistle
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - H Todd Massey
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Rohinton J Morris
- Division of Cardiac Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
| | - Babak Abai
- Division of Vascular and Endovascular Surgery, 6529Thomas Jefferson University, Philadelphia, PA, USA
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9
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Bathula SS, Srikantha L, Patrick T, Stern NA. Immediate Postoperative Complications in Adult Tracheostomy. Cureus 2020; 12:e12228. [PMID: 33381358 PMCID: PMC7757757 DOI: 10.7759/cureus.12228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective Tracheostomy is one of the oldest operations for the management of airway obstruction. With time, indications expanded to prolonged mechanical ventilation, and currently, the majority of tracheostomies are done for this reason. There are several techniques used in a tracheostomy procedure, depending on surgeon preference. Immediate complications such as bleeding, pneumothorax, pneumomediastinum, airway fire, and posterior tracheal wall perforation with esophageal injury are rare, although they do occur, and must be managed accordingly. This study aimed to assess differences in types and rates of immediate postoperative complications in patients undergoing tracheostomy when performed under general anesthesia and local anesthesia (awake tracheostomies) at a large academic institution. This is a continuing ongoing literature reporting tracheostomy adverse events. Methods A retrospective chart review was performed to identify patients who underwent tracheostomy placement between January 1, 2013 and December 31, 2019 at the Detroit Medical Center, USA. Postoperative complications such as bleeding, pneumothorax, pneumomediastinum, airway fire, and posterior tracheal perforation were collected along with gender, age, and revision tracheostomy status. IBM SPSS Statistics (IBM Inc., Armonk, USA) was used for statistical analysis with the statical significance defined as a p<0.05. Results A total of 1,469 patient charts were reviewed. Of these, 1,342 met the inclusion and exclusion criteria, of which, males were 57.2% (n=768), and females were 42.8% (n=574). The age range was 18 years to 96 years (mean=58.03; SD= 15.97), and BMI range was 12-83 (mean=28.77; SD=7.885). Multinomial logistic regression was performed to determine whether age, BMI, sex, and revision tracheostomies were represented across both general and awake tracheostomy groups proportionally to their numbers in the total sample. It showed non-significant value for age (χ2=0.776, p=0.378), BMI (χ2=0.004, p=0.947), but significant value for sex (χ2=4.645, p=0.031), revision tracheostomy (χ2=18.282, p<0.001), indicating that males and revision tracheostomies over-represented in awake tracheostomies. Next, Pearson correlation analysis was performed to determine any significant linear relationship between age, sex, and tracheostomy complications. It showed a significant positive correlation between age and tracheal stomal infection [r(1,340)=0.062, p=0.022]. An independent sample t-test showed a statistically significant difference between the mean pneumothorax and pneumomediastinum of general (n=1,277, mean=0.01, SD=0.088) and awake tracheostomies (n=65, mean=0.08, SD=0.269, t=2.069, p=0.043). Pneumothorax pneumomediastinum complications between the general tracheostomy and awake tracheostomy odds ratio (OR)-6.22, indicates the chance of pneumothorax /pneumomediastinum complication is 6.22 times more in awake tracheostomy than general tracheostomy. Based on the above statistical analysis, we rejected the null hypothesis. Conclusions Tracheostomy is the procedure of choice to relieve the upper airway obstruction and treat patients requiring prolonged mechanical ventilation. A slightly higher number of Immediate postoperative complications in awake tracheostomy were noticed in patients with more surgically challenging revision tracheostomies.
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Affiliation(s)
- Samba Siva Bathula
- Otolaryngology, Michigan State University Detroit Medical Center, Detroit, USA
| | - Luxman Srikantha
- Otolaryngology, Michigan State University Detroit Medical Center, Detroit, USA
| | - Tyler Patrick
- Otolaryngology, Michigan State University Detroit Medical Center, Detroit, USA
| | - Noah A Stern
- Otolaryngology, Michigan State University Detroit Medical Center, Detroit, USA
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10
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Endlich Y, Beckmann LA, Choi SW, Culwick MD. A prospective six-month audit of airway incidents during anaesthesia in twelve tertiary level hospitals across Australia and New Zealand. Anaesth Intensive Care 2020; 48:389-398. [PMID: 33104443 DOI: 10.1177/0310057x20945325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This audit of airway incidents was conducted over six months in 12 tertiary level hospitals across Australia and New Zealand. During that time, 131,233 patients had airway management and 111 reports were submitted (incidence 0.08%). The airway incidents included a combination of difficult airway management (83), oxygen desaturation (58), aspiration (19), regurgitation (14), laryngospasm (16), airway bleeding (10), bronchospasm (5) and dental injury (4), which gave a total of 209 events in 111 reports. Most incidents occurred during general anaesthesia (GA; 83.8%) and normal working hours (81.1%). Forty-three percent were associated with head and neck surgery and 12.6% with upper abdominal procedures. Of these patients, 52% required further medical treatment or additional procedures and 16.2% required unplanned admission to an intensive care unit or a high dependency unit. A total of 31.5% of patients suffered from temporary harm and 1.8% from permanent harm. There was one death. The factors associated with a high relative risk (RR) of an airway incident included American Society of Anesthesiologists Physical Status (ASA PS) (ASA PS 2 versus 1, RR 1.75; ASA PS 3 versus 1, RR 3.56; ASA PS 4 versus 1, RR 6.1), and emergency surgery (RR 2.16 compared with elective). Sedation and monitored anaesthesia care were associated with lower RRs (RR 0.49 and RR 0.73 versus GA, respectively). Inadequate airway assessment, poor judgement and poor planning appeared to be contributors to these events. Future teaching and research should focus on these areas to further improve airway management and patient safety.
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Affiliation(s)
- Yasmin Endlich
- Department of Anaesthesia, University of Adelaide, Adelaide, Australia
| | - Linda A Beckmann
- Department of Anaesthesia, University of Queensland, Brisbane, Australia
| | - Siu-Wai Choi
- Department of Oral and Maxillofacial Surgery, University of Hong Kong, Hong Kong SAR
| | - Martin D Culwick
- Department of Anaesthesia, Royal Brisbane and Women's Hospital, Brisbane, Australia.,The Australian and New Zealand Tripartite Anaesthetic Data Committee
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Abstract
Life-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 15% cases of hemoptysis are LTH and need urgent life-saving intervention. Understanding of pulmonary vascular anatomy is of paramount importance to manage LTH. The goal of treatment lies in airway protection, appropriate oxygenation, and prevention of exsanguination. Once the airway is stabilized, a quick diagnosis and control of bleeding site is targeted. This chapter highlights current practices and approach to LTH including medical management, bronchoscopic approach, and advanced therapies such as bronchial artery embolization and surgical resection. We review situations, such as bronchiectasis, vascular malformation, diffuse alveolar hemorrhage, and tracheostomy bleed and specific approach to management of these conditions in a systematic and evidence-based manner.
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12
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Karunakaran V, Nair NP, Alexander A, Munuswamy H, Rajan N, Ganesan S. Tracheo-innominate Artery Fistula in a Complicated Penetrating Neck Trauma: A Successfully Managed Rare Complication of Low Tracheotomy. Turk Arch Otorhinolaryngol 2020; 58:127-129. [PMID: 32783041 DOI: 10.5152/tao.2020.5006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/08/2020] [Indexed: 11/22/2022] Open
Abstract
Tracheo-innominate artery fistula is a rare complication of tracheotomy with very high mortality rate. Only a few patients survive this complication as reported in the literature. Here we report the case of a 54-year-old gentleman who presented to the emergency department with a history of penetrating neck trauma following a road traffic accident. Neck exploration and tracheotomy were done to secure the airway. After two weeks, the patient had an episode of massive stomal bleed for which he was taken to the operating room and re-explored. A tracheo-innominate artery fistula was detected, and right side aorto-carotid and right side aorto-subclavian anastomoses were done using reversed saphenous vein graft with interruption of flow. Following a successful surgery, the patient was decannulated later, and now lives a healthy normal life. Early diagnosis and immediate intervention are the key in managing this complication. Bedside management also plays a vital role.
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Affiliation(s)
- Vignesh Karunakaran
- Department of Otorhinolaryngology, Jawaharlal Institute of Post Graduation Education and Research (JIPMER), Pondicherry, India
| | - Nithin Prakasan Nair
- Department of Otorhinolaryngology, Jawaharlal Institute of Post Graduation Education and Research (JIPMER), Pondicherry, India
| | - Arun Alexander
- Department of Otorhinolaryngology, Jawaharlal Institute of Post Graduation Education and Research (JIPMER), Pondicherry, India
| | - Hemachandren Munuswamy
- Department of Cardio Thoracic Vascular Surgery, Jawaharlal Institute of Post Graduation Education and Research (JIPMER), Pondicherry, India
| | - Nikhil Rajan
- Department of Otorhinolaryngology, Jawaharlal Institute of Post Graduation Education and Research (JIPMER), Pondicherry, India
| | - Sivaraman Ganesan
- Department of Otorhinolaryngology, Jawaharlal Institute of Post Graduation Education and Research (JIPMER), Pondicherry, India
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Brenner MJ, Pandian V, Milliren CE, Graham DA, Zaga C, Morris LL, Bedwell JR, Das P, Zhu H, Lee Y. Allen J, Peltz A, Chin K, Schiff BA, Randall DM, Swords C, French D, Ward E, Sweeney JM, Warrillow SJ, Arora A, Narula A, McGrath BA, Cameron TS, Roberson DW. Global Tracheostomy Collaborative: data-driven improvements in patient safety through multidisciplinary teamwork, standardisation, education, and patient partnership. Br J Anaesth 2020; 125:e104-e118. [PMID: 32456776 DOI: 10.1016/j.bja.2020.04.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/17/2020] [Accepted: 04/17/2020] [Indexed: 01/15/2023] Open
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Donaldson L, Raper R. Successful emergency management of a bleeding tracheoinnominate fistula. BMJ Case Rep 2019; 12:12/12/e232257. [PMID: 31852691 DOI: 10.1136/bcr-2019-232257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In this case, we describe a novel approach to achieving temporary haemostasis in acute massive haemorrhage from a bleeding tracheoinnominate fistula. We report the case of a 42-year-old man admitted to hospital after suffering 80% body surface area burns. Thirty days following the percutaneous insertion of a tracheostomy, spontaneous massive haemorrhage occurred via the tracheostomy stoma, the tracheostomy tube and the mouth. After hyperinflation of the tracheostomy cuff which controlled airway contamination, effective tamponade was achieved using a hyperinflated balloon on a Foley catheter that was introduced by direct laryngoscopy into the upper larynx above the tracheotomy stoma. This provided temporary control of the bleeding until definitive management through ligation of the innominate artery via median sternotomy.
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Affiliation(s)
- Lachlan Donaldson
- Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Raymond Raper
- Department of Intensive Care Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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15
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Lewith H, Athanassoglou V. Update on management of tracheostomy. BJA Educ 2019; 19:370-376. [PMID: 33456860 DOI: 10.1016/j.bjae.2019.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- H Lewith
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
| | - V Athanassoglou
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
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16
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Zapata-Contreras L, Hoyos-Cuervo CE, Florián-Pérez MC. Open tracheostomy in patients with dual platelet aggregation inhibitors. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2019. [DOI: 10.1097/cj9.0000000000000113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Nicosia D, Federico A, Vigna I, Iozzo P, Misseri G, Cortegiani A. Use of low dose of rFVIIa (recombinant Factor VII activated) to control late bleeding after percutaneous dilational tracheostomy. Clin Case Rep 2019; 7:665-667. [PMID: 30997059 PMCID: PMC6452479 DOI: 10.1002/ccr3.2061] [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: 08/31/2018] [Revised: 11/12/2018] [Accepted: 01/29/2019] [Indexed: 11/26/2022] Open
Abstract
In our case, the use of a low intravenous bolus dose of rFVIIa (recombinant factor VII activated; 15-20 mcg/kg) was effective and uneventful in controlling late postprocedural PDT bleeding associated with thrombocytopenia that cannot be corrected and after all other treatments failed.
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Affiliation(s)
- Dario Nicosia
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Antonino Federico
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Ivan Vigna
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Pasquale Iozzo
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Giovanni Misseri
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo GiacconeUniversity of PalermoPalermoItaly
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19
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Bobinskas AM, Kanatas AN, Law MB, Fabbroni G. Simple method of securing an airway while accessing a bleeding tracheostomy site when nasal or oral endotracheal intubation is not feasible. Br J Oral Maxillofac Surg 2016; 54:1042-1043. [PMID: 27162085 DOI: 10.1016/j.bjoms.2016.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 02/08/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - Anastasios N Kanatas
- Consultant Head and Neck Surgeon / Senior Lecturer, Leeds Teaching Hospitals and St James Institute of Oncology.
| | - Matthew B Law
- Consultant in Anaesthetics & Honorary Senior Lecturer, Leeds General Infirmary & University of Leeds.
| | - Gillon Fabbroni
- Consultant Oral and Maxillofacial surgeon, Leeds Teaching Hospitals and St James Institute of Oncology.
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20
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Dave VJ, Upadhya IB. Aberrant innominate artery may complicate a potentially safe surgery. BMJ Case Rep 2016; 2016:bcr-2015-213910. [PMID: 26795742 DOI: 10.1136/bcr-2015-213910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Surgeries of the anterior neck include thyroid surgery, open or percutaneous dilatational tracheotomy, bronchoscopy, mediastinoscopy and oesophagoscopy. These are potentially safe surgeries with mortality rates less than 1%. Today, the most common cause of death following a tracheotomy is haemorrhage and, following thyroid surgery, the causes are haemorrhage, giant goitres and upper airway complications. Bronchoscopies and mediastinoscopies are almost never fatal. While operating around the trachea, no major vessel is encountered in the surgical field. We report a case in which an aberrant innominate artery was encountered crossing anterior to the trachea just below the thyroid isthmus. As it is an uncommon finding, even minor complacency can lead to torrential bleeding culminating in death. Thus, we recommend surgeons to be vigilant for any aberrant artery in the surgical field rather than finding it accidentally; thereby preventing any complications in a potentially safe surgery.
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Affiliation(s)
- Varun Jitendra Dave
- Department of MS ENT, Government Medical College, Surat, Mumbai, Maharashtra, India
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21
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Wang XL, Xu ZG, Tang PZ, Yu Y. Tracheo-innominate artery fistula: Diagnosis and surgical management. Head Neck 2013; 35:1713-8. [PMID: 23345194 DOI: 10.1002/hed.23211] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2012] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tracheo-innominate artery fistula (TIF) is a rare and fatal complication after tracheostomy. The diagnosis, treatment, and possible prevention of this disease are discussed in this study. METHODS From 1976 to 2008, 14 patients with TIF were studied retrospectively. RESULTS All patients underwent open surgical tracheostomy. Before TIF, herald events occurred in 10 patients (8 had slight hemoptysis and 2 had innominate artery exposure). When TIF occurred, bedside aid was administered, and 5 patients lived long enough to reach the operating room. Four patients accepted median sternotomy and ligation of innominate arteries. After surgery, mediastinal infection caused the rebleeding and death of 3 patients. In conducting follow-up for 11 months, the last patient was still alive without neurological complications. The survival rate was only 7.1%. CONCLUSION Prompt diagnosis and surgical intervention can save the life of a patient with TIF. Prevention is vital because of the high mortality of this disease.
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Affiliation(s)
- Xiao-lei Wang
- Department of Head and Neck Surgery, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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22
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Townsley RB, Florea CD, Clark LJ. The adult tracheostomy: a guide for the hospital at night doctor. Br J Hosp Med (Lond) 2012; 73:C152-5. [PMID: 23124199 DOI: 10.12968/hmed.2012.73.sup10.c152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R B Townsley
- Department of Ear, Nose and Throat Surgery, Royal Alexandra Hospital, Paisley, UK.
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23
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Otchwemah R, Defosse J, Wappler F, Sakka SG. Percutaneous dilatation tracheostomy in the critically ill: use of ultrasound to detect an aberrant course of the brachiocephalic trunk. J Cardiothorac Vasc Anesth 2012; 26:e72-3. [PMID: 22818498 DOI: 10.1053/j.jvca.2012.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Indexed: 11/11/2022]
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McGrath BA, Bates L, Atkinson D, Moore JA. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia 2012; 67:1025-41. [DOI: 10.1111/j.1365-2044.2012.07217.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Veelo DP, Vlaar AP, Dongelmans DA, Binnekade JM, Levi M, Paulus F, Berends F, Schultz MJ. Correction of subclinical coagulation disorders before percutaneous dilatational tracheotomy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2012; 10:213-20. [PMID: 22337277 PMCID: PMC3320783 DOI: 10.2450/2012.0086-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 09/21/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is evidence that percutaneous dilatational tracheotomy (PDT) can be safely performed in patients with severe coagulation disorders if these are carefully corrected immediately before the procedure. However, it is currently unclear whether PDT can be performed safely in patients in an Intensive Care Unit (ICU) with uncorrected mild coagulation disorders. MATERIALS AND METHODS In a randomised controlled trial we determined the effect of correction of mild coagulation disorders on bleeding during and after PDT. ICU patients planned for bedside PDT with: (i) a prothrombin time (PT) between 14.7-20.0 seconds, (ii) a platelet count between 40-100×10(9)/L and/or (iii) active treatment with acetylsalicylic acid were randomised to receive infusion with fresh-frozen plasma (FFP) and/or platelets ("correction") versus no transfusion ("no correction") before PDT. RESULTS We randomised 35 patients to the "correction" group and 37 patients to the "no correction" group. In patients who received FFP, the decrease in PT was marginal (mean decrease 0.40±0.56 seconds); the median increase in platelet counts after transfusion of platelets was 35 [11-47]x10(9)/L. The median blood loss was 3 [IQR: 1-6] grams in the "correction" group and 3 [IQR: 2-6] grams in the "no correction" group (P=0.96). DISCUSSION Bleeding during and after bedside PDT in ICU patients with mild coagulation disorders is rare in our setting. Correction of subclinical coagulation disorders by transfusion of FFP and/or platelets does not affect bleeding.
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Affiliation(s)
- Denise P Veelo
- Department of Intensive Care Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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