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Hixson R, Jensen KS, Melamed KH, Qadir N. Device associated complications in the intensive care unit. BMJ 2024; 386:e077318. [PMID: 39137947 DOI: 10.1136/bmj-2023-077318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Invasive devices are routinely used in the care of critically ill patients. Although they are often essential components of patient care, devices such as intravascular catheters, endotracheal tubes, and ventilators are a common source of complications in the intensive care unit. Critical care practitioners who use these devices need to use strategies for risk reduction and understand approaches to management when adverse events occur. This review discusses the identification, prevention, and management of complications of vascular, airway, and mechanical support devices commonly used in the intensive care unit.
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Affiliation(s)
- Roxana Hixson
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Kristin Schwab Jensen
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Kathryn H Melamed
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
| | - Nida Qadir
- David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, CA, USA
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2
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Schneider H, Meis J, Klose C, Ratzka P, Niesen WD, Seder DB, Bösel J. Surgical Versus Dilational Tracheostomy in Patients with Severe Stroke: A SETPOINT2 Post hoc Analysis. Neurocrit Care 2024; 41:146-155. [PMID: 38291277 PMCID: PMC11335838 DOI: 10.1007/s12028-023-01933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Tracheostomy in mechanically ventilated patients with severe stroke can be performed surgically or dilationally. Prospective data comparing both methods in patients with stroke are scarce. The randomized Stroke-Related Early Tracheostomy vs Prolonged Orotracheal Intubation in Neurocritical Care Trial2 (SETPOINT2) assigned 382 mechanically ventilated patients with stroke to early tracheostomy versus extubation or standard tracheostomy. Surgical tracheostomy (ST) was performed in 41 of 307 SETPOINT2 patients, and the majority received dilational tracheostomy (DT). We aimed to compare ST and DT in these patients with patients. METHODS All SETPOINT2 patients with ST were compared with a control group of patients with stroke undergoing DT (1:2), selected by propensity score matching that included the factors stroke type, SETPOINT2 randomization group, Stroke Early Tracheostomy score, patient age, and premorbid functional status. Successful decannulation was the primary outcome, and secondary outcome parameters included functional outcome at 6 months and adverse events attributable to tracheostomy. Potential predictors of decannulation were evaluated by regression analysis. RESULTS Baseline characteristics were comparable in the two groups of patients with stroke undergoing ST (n = 41) and matched patients with stroke undergoing DT (n = 82). Tracheostomy was performed significantly later in the ST group than in the DT group (median 9 [interquartile range {IQR} 5-12] vs. 9 [IQR 4-11] days after intubation, p = 0.025). Patients with ST were mechanically ventilated longer (median 19 [IQR 17-24] vs.14 [IQR 11-19] days, p = 0.008) and stayed in the intensive care unit longer (median 23 [IQR 16-27] vs. 17 [IQR 13-24] days, p = 0.047), compared with patients with DT. The intrahospital infection rate was significantly higher in the ST group compared to the DT group (14.6% vs. 1.2%, p = 0.002). At 6 months, decannulation rates (56% vs. 61%), functional outcomes, and mortality were not different. However, decannulation was performed later in the ST group compared to the DT group (median 81 [IQR 66-149] vs. 58 [IQR 32-77] days, p = 0.004). Higher baseline Stroke Early Tracheostomy score negatively predicted decannulation. CONCLUSIONS In ventilated patients with severe stroke in need of tracheostomy, surgical and dilational methods are associated with comparable decannulation rate and functional outcome at 6 months. However, ST was associated with longer time to decannulation and higher rates of early infections, supporting the dilational approach to tracheostomy in ventilated patients with stroke.
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Affiliation(s)
- Hauke Schneider
- Department of Neurology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Medical Faculty, University of Dresden, Dresden, Germany.
| | - Jan Meis
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Peter Ratzka
- Department of Neurology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David B Seder
- Department of Critical Care Services, Maine Medical Center, Portland, ME, USA
| | - Julian Bösel
- University of Heidelberg, Heidelberg, Germany
- Johns Hopkins University Hospital, Baltimore, MD, USA
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3
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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.
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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
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4
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Daou CAZ, Chahine EM, Barazi R. Assessment of Tracheostomy Tube Placement and Late Change Practices in an Academic Tertiary Care Center. Int Arch Otorhinolaryngol 2024; 28:e407-e414. [PMID: 38974638 PMCID: PMC11226274 DOI: 10.1055/s-0043-1776723] [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: 03/19/2023] [Accepted: 07/14/2023] [Indexed: 07/09/2024] Open
Abstract
Introduction The optimal time for tracheostomy changes is unknown. Most surgeons opt to wait until five to seven days postoperatively, while more recent studies suggest that changes occurring as early as two to three days postoperatively are also safe. Objective To evaluate the safety of changing the tracheostomy tube later than 14 days postoperatively. Methods The charts of patients who underwent tracheostomy placement and change at a tertiary care center from 2015 to 2019 were retrospectively reviewed, and the subjects were divided into 2 cohorts (late and very late), depending on the time of the first tracheostomy change. Results The study included 198 patients, 53 of whom aged between 0 and 18 years, and 145, aged > 18 years. The time until the first tracheostomy change was on average of 131.1 days. The most common indication for tracheostomy tube placement was prolonged intubation. Adverse events were observed in 30.8% of the cases (the most common being the formation of granulation tissue), a rate that does not differ much from the incidence reported in the literature (of 34% to 77%) when tracheostomy tubes are changed as early as 3 to 7 days postoperatively. There was no significant difference in the incidence of complications between patients undergoing late and very late changes ( p = 0.688), or between pediatric and adult subjects ( p = 0.36). There were no significant correlations regarding the time of the first or second change and the incidence of complications (r = -0.014; p = 0.84 for the first change; and r = -0.57; p = 0.64 for the second change). Conclusion The late first tracheostomy tube change was safe and could save resources and decrease the financial burden of frequent changes. It is always crucial to provide adequate information about home tracheostomy care for patients.
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Affiliation(s)
- Christophe Abi Zeid Daou
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Randa Barazi
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Yang M, Li H, Zhou Y, Li H, Wei H, Cheng Q. Airway collapse hinders recovery in bronchoscopy therapy for postintubation tracheal stenosis patients. Eur Arch Otorhinolaryngol 2024; 281:3061-3069. [PMID: 38582815 PMCID: PMC11065913 DOI: 10.1007/s00405-024-08602-3] [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: 12/27/2023] [Accepted: 03/05/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Expiratory central airway collapse (ECAC) following postintubation airway stenosis (PITS) is a rare phenomenon. The impact of airway malacia and collapse on the prognosis and the success rate of bronchoscopic interventional therapy in patients with PITS had been inadequately investigated. OBJECTIVE The aim of this research was to assess the influence of airway malacia and collapse on the efficacy of bronchoscopic interventional therapy in patients with PITS. DESIGN This retrospective analysis examined the medical documentation of individuals diagnosed with PITS who underwent bronchoscopic intervention at the tertiary interventional pulmonology center of Emergency General Hospital from 2014 to 2021. MAIN OUTCOME MEASURES Data pertaining to preoperative, perioperative, and postoperative stages were documented and subjected to analysis. RESULTS The patients in malacia and collapse group (MC group) exhibited a higher frequency of perioperative complications, including intraoperative hypoxemia, need for reoperation within 24 h, and postoperative intensive care unit admission rate (P < 0.05, respectively). Meanwhile, patients in group MC demonstrated significantly worse postoperative scores (higher mMRC score and lower KPS score) compared to those in pure stenosis group (P < 0.05, respectively), along with higher degrees of stenosis after treatment and a lower success rate of bronchoscopic intervention therapy cured (P < 0.05, respectively). Pearson analysis results showed that these terms were all significantly correlated with the occurrence of airway malacia and collapse in the airway (P < 0.05, respectively). CONCLUSION The presence of malacia or collapse in patients with PITS was associated with increased perioperative complications following bronchoscopic interventional therapy, and significantly reduced the long-term cure rate compared to patients with pure tracheal stenosis. Trial registration Chinese Clinical Trial Registry on 06/12/2021. REGISTRATION NUMBER ChiCTR2100053991.
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Affiliation(s)
- Mingyuan Yang
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China
| | - Hong Li
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China
| | - Yunzhi Zhou
- Department of Pulmonary and Critical Care Medicine, Emergency General Hospital, Beijing, China
| | - Hao Li
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China
| | - Huafeng Wei
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Qinghao Cheng
- Center of Anesthesiology and Pain, Emergency General Hospital, Beijing, 100028, China.
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Tekin P, Bulut A. Tracheostomy Timing in Unselected Critically Ill Patients with Prolonged Intubation: A Prospective Cohort Study. J Clin Med 2024; 13:2729. [PMID: 38792271 PMCID: PMC11121849 DOI: 10.3390/jcm13102729] [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: 04/07/2024] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Tracheostomy procedures are performed in the intensive care unit (ICU) for prolonged intubation, unsuccessful weaning and infection prevention through either percutaneous or surgical techniques. This study aimed to outline the impact of tracheostomy timing in the ICU on mortality, need for mechanical ventilation, and complications. Methods: Patients were included in the study on the day of tracheostomy. Demographic information, tracheostomy timing, technique, complications, sedation requirement and need for mechanical ventilation at discharge were recorded by an anesthesiologist, including the pre-tracheostomy period. Results: Tracheostomy was performed on 33 patients during the first 14 days of intubation and on 54 patients on the 15th day and beyond. There was no significant difference between the tracheostomy timing and mortality, sedation requirement, or weaning from the ventilator. We observed that patients who underwent tracheostomy with the surgical technique experienced more complications, but there was no significant difference. Tracheostomy performed after the 14th day was shown to be associated with prolonged hospital stay. Conclusions: Early tracheostomy does not have any influence on the need for mechanical ventilation, sedation and mortality. The optimal timing for tracheostomy is still controversial. We are of the opinion that randomized controlled trials involving patient groups with similar survival expectations are needed.
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Affiliation(s)
| | - Azime Bulut
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Giresun University, 28100 Giresun, Türkiye;
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Taeger J, Goncalves M, Duong Dinh TA, Ilgner J, Michels G, Hackenberg S. [Management of ear, nose and throat emergencies]. Med Klin Intensivmed Notfmed 2024; 119:236-248. [PMID: 38441579 DOI: 10.1007/s00063-024-01114-2] [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: 09/06/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 04/05/2024]
Abstract
Emergency situations involving the ears, nose, and throat (ENT) area can pose considerable challenges for clinicians and often require an interdisciplinary approach due to the involvement of different organ systems. To avoid damage to highly relevant sensory and perception organs and life-threatening bleeding or respiratory complications, strategies that are as quick and targeted as possible are necessary. This article aims to provide an overview of ENT emergency management strategies. The entire spectrum from simple conservative to highly complex surgical measures plays a role here, both diagnostically and therapeutically. Aspects such as bleeding, respiratory problems, inflammation, hearing disorders, vertigo, facial palsy and injuries to the head and neck area are discussed. In addition, important topics such as preventive measures and possible complications are also addressed to ensure optimal patient care.
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Affiliation(s)
- J Taeger
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - M Goncalves
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - T A Duong Dinh
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - J Ilgner
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - G Michels
- Notfallzentrum, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
| | - S Hackenberg
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Würzburg, Deutschland
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8
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Alvi S, Blackwell T, Curran NR, Germanwala A. Comparative impact of COVID-19 infection on tracheostomy patients. Am J Otolaryngol 2024; 45:104112. [PMID: 38039914 DOI: 10.1016/j.amjoto.2023.104112] [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: 09/07/2023] [Accepted: 10/29/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE We study outcomes after tracheostomy in COVID-19 positive patients versus COVID-19 negative patients who underwent tracheostomy during the same time frame in an effort to better understand the influence of COVID-19 despite variances in virus strain and treatment practices. MATERIALS AND METHODS This is a retrospective cohort study of all Veterans Affairs centers nationwide, using data provided by the Veterans Affairs Informatics and Computing Infrastructure. Our cohort consisted of veteran patients who underwent tracheostomy between March 2020 and September 2022. Patients who tested positive for COVID-19 within three months prior to tracheostomy were compared to patients who had never tested positive for COVID-19. RESULTS 956 patients were included in the analysis, and nearly 96 % of these patients were male. The COVID-19 positive group spent one more week on the ventilator and experienced lower rates of successful ventilator weaning (hazard ratio 0.74, 95 % confidence interval [0.62, 0.88], P < 0.001). Survival curves were non-proportional, and while the COVID-19 positive group had higher 30-day mortality (relative risk 1.37, 95 % confidence interval [1.09, 1.73], P = 0.007), the COVID-19 negative group had higher long-term mortality. CONCLUSIONS Our findings suggest that while infection with COVID-19 has a significant effect on short-term outcomes after tracheostomy, chronic comorbidities seem to have the more enduring impact. In spite of prolonged ventilation and higher short-term mortality, tracheostomy in COVID-19 can be a positive intervention that does not necessarily predestine patients to the same level of long-term morbidity and mortality of typical tracheostomies.
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Affiliation(s)
- Suffia Alvi
- Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, IL, United States of America; University of Illinois at Chicago College of Medicine, Chicago, IL, United States of America
| | - Thomas Blackwell
- Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, IL, United States of America; University of Illinois at Chicago College of Medicine, Chicago, IL, United States of America
| | - Nicholas R Curran
- University of Cincinnati Medical Center, Cincinnati, OH, United States of America
| | - Arpita Germanwala
- Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, IL, United States of America; University of Illinois at Chicago College of Medicine, Chicago, IL, United States of America.
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Erickson EL, Katta J, Sun S, Shan L, Lemeshow S, Schofield ML. Retrospective review of acute post-tracheostomy complications and contributing risk factors. Clin Otolaryngol 2024; 49:277-282. [PMID: 38095241 DOI: 10.1111/coa.14131] [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: 09/23/2022] [Revised: 11/01/2023] [Accepted: 11/18/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Tracheostomy is performed for various indications ranging from prolonged ventilation to airway obstruction. Many factors may play a role in the incidence of complications in the immediate post-operative period including patient-related factors. Chronic obstructive pulmonary disease and asthma are some of the most common pulmonary pathologies in the United States. The relationship between obstructive pulmonary diseases and acute post-tracheostomy complications has been incompletely studied. DESIGN A retrospective chart review was designed in order to answer these objectives. Medical records were reviewed for the technique used, complications, and contributing patient factors. Post-operative complications were defined as any tracheostomy-related adverse event occurring within 14 days. SETTING The study took place at an academic comprehensive cancer. PARTICIPANTS Inclusion criteria included patients from January 2017 through December 2018 who underwent a tracheostomy. Exclusion criteria included presence of stomaplasty, total laryngectomy, and tracheostomies performed at outside hospitals. MAIN OUTCOME MEASURES Patient factors examined included demographics, comorbidities, and body mass index with the primary outcome measured being the rate of tracheostomy complications. RESULTS The most common indication for tracheostomy among the 321 patients that met inclusion criteria was airway obstruction or a head and neck cancer surgical procedure. Obstructive sleep apnea was associated with acute complications in bivariate analysis (29.4% complications, p = .003). Chronic obstructive pulmonary disease and asthma were not associated with acute complications in bivariate analysis (11.6% complications, p = .302). Among the secondary outcomes measured, radiation was associated with early complications occurring in post-operative days 0-6 (1.1%, p = .029). CONCLUSION Patients with obstructive sleep apnea may have a higher risk of acute post-tracheostomy complications that might be due to the patient population at risk for obstructive sleep apnea. Patients with obstructive pulmonary pathologies such as asthma or chronic obstructive pulmonary disorder did not have an elevated risk of complications which is clinically significant when considering the utility of ventilation and tracheostomy in the management of acute respiratory failure secondary to these conditions.
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Affiliation(s)
| | - Juhi Katta
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Shuai Sun
- The Ohio State University Department of Public Health, Columbus, Ohio, USA
| | - Lingpeng Shan
- The Ohio State University Department of Public Health, Columbus, Ohio, USA
| | - Stanley Lemeshow
- The Ohio State University Department of Public Health, Columbus, Ohio, USA
| | - Minka L Schofield
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Umstot R, Samanta D, Umstot E, Area SA, Richmond BK, Jarrouj A. Ten-Year Review of Tracheostomy Techniques and Related Complications. Am Surg 2024; 90:225-230. [PMID: 37608524 DOI: 10.1177/00031348231198115] [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: 08/24/2023]
Abstract
BACKGROUND Tracheostomy is a frequently performed procedure that allows for definitive airway access in critically ill patients. Complications associated with tracheostomy have been well documented in the literature. This study aims to examine if different tracheostomy techniques were associated with specific complications. Secondary objectives were to determine the rate and commonality of post-tracheostomy complications. METHODS This was a descriptive retrospective study of patients who underwent tracheostomy between June 2009 and June 2019. Patients included in the study were ≥18 years and were admitted to a rural tertiary care hospital system. RESULTS Overall procedure complication rate was 34.3% with pneumonia (18.6%), obstruction (6.2%), bleeding (4.0%), and accidental tube decannulation (3.8%) being the most common. Rate of complications was not associated with the timing of the tracheostomy, the incision type, tube location, tracheostomy technique, and securing technique. However, tube size significantly differed between patients with or without complications (P = .016). Tube size 8 Shiley was most commonly used in both groups and was significantly associated with reduced complication rate (72.0% vs 78.8%, P = .002). CONCLUSION Tracheostomy technique should be guided by proceduralist experience and patient clinical picture to determine the best approach. However, the association of post-tracheostomy complication with tube size perhaps will guide clinicians with tube size selection.
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Affiliation(s)
- Richard Umstot
- Department of Surgery, West Virginia University School of Medicine-Charleston Division, Charleston, WV, USA
| | - Damayanti Samanta
- Institute for Academic Medicine, Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, WV, USA
| | - Emma Umstot
- Department of Professional Nursing-Surgical Trauma Intensive Care Unit, Charleston Area Medical Center, Charleston, WV, USA
| | - Scott A Area
- Institute for Academic Medicine, Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, WV, USA
| | - Bryan K Richmond
- Department of Surgery, West Virginia University School of Medicine-Charleston Division, Charleston, WV, USA
| | - Aous Jarrouj
- Institute for Academic Medicine, Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, WV, USA
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11
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Ibraheem A, Al Khayer A. Tracheal pouch in a child with SMA type 1 after prolonged ventilation via tracheostomy tube. Pediatr Pulmonol 2024; 59:213-214. [PMID: 37787426 DOI: 10.1002/ppul.26711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
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12
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Liu Y, Zhou C, Wu Y, Deng S, Chen Y, Zhou J. Tracheostomy tube changes in patients with tracheostomy: A quality improvement project. Nurs Crit Care 2023. [PMID: 38146628 DOI: 10.1111/nicc.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Tracheostomy tube changes are a considerable part of the management of patients with tracheostomy and are necessary for preventing aspiration pneumonia, especially in patients with long-term tracheostomy. The process of tracheostomy tube changes in many patients may not be timely, safe or efficient. OBJECTIVE The objectives were to implement a quality improvement intervention that reduces the incidence of aspiration pneumonia in patients with tracheostomy, improve staff knowledge about tracheostomy tube changes and improve staff adherence to documentation. METHODS A pre-post intervention design was used in this quality improvement project. We created a change strategy bundle that included identification of the need for and observation determination of the timing of tube changes timing, change assessments, identification of the person and location, preparation, co-operation and maintenance. A tracheostomy tube change workflow was also created. Then, the intervention was implemented in the clinic after staff training. The incidence of aspiration pneumonia, staff knowledge and staff adherence were compared before and after the intervention. RESULTS Two hundred and 20 patients were enrolled (105 in the preintervention group; 115 in the postintervention group) with 88 tracheostomy tube change episodes (23 in the preintervention group; 65 in the postintervention group). Thirty-five staff members completed the training and surveys. The incidence of pneumonia decreased from 43.8% to 27.8% after the intervention (p = .013). The knowledge score of staff increased from 46.57 ± 11.10 to 88.14 ± 6.76, and the implementation rate of the audit increased to 67.32%-100%. CONCLUSIONS This quality improvement project regarding tracheostomy changes reduced the incidence of pneumonia, increased staff knowledge about tracheostomy tube changes and improved staff adherence. RELEVANCE TO CLINICAL PRACTICE A standardized tracheostomy tube change bundle, education, interprofessional collaboration and culture changes were important to ensure the best outcomes in this quality improvement project. These factors improved the timeliness, efficiency and safety of tracheostomy tube changes.
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Affiliation(s)
- Yu Liu
- Rehabilitation Department, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Chunlan Zhou
- Nursing Department, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Yanni Wu
- Nursing Department, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Shuijuan Deng
- Rehabilitation Department, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Ying Chen
- Rehabilitation Department, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Jungui Zhou
- Rehabilitation Department, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
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Amien B, Harky A, Hill A, Mediratta N. Foreign Body Misdiagnosed as Mucus Plugging After Percutaneous Tracheostomy. Cureus 2023; 15:e49147. [PMID: 38130555 PMCID: PMC10733609 DOI: 10.7759/cureus.49147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
We report a case of a 59-year-old male who presented with a persistent cough for a year after being discharged from critical care following a subarachnoid haemorrhage. As part of his initial critical care management and in order to allow full neurological assessment, the patient required a period of prolonged mechanical ventilation, which necessitated a percutaneous tracheostomy. Following recovery and subsequent discharge, the patient presented on multiple occasions with cough, undergoing serial computed tomography (CT) scans which reported mucus plugging as a possible cause of the cough. As his symptoms continued to worsen, a flexible bronchoscopy was carried out, which identified a foreign body in the trachea. This object was later recognised as a retained part of the guiding catheter, part of the percutaneous tracheostomy tube dilator. After the object was retrieved, the patient reported a complete resolution of symptoms. Percutaneous tracheostomy is a common procedure within critical care units, and early complications such as bleeding or airway obstruction are typically recognised immediately after insertion. This report documents a late complication caused by the retention of a foreign object from insertion, which was misdiagnosed on serial CT scans, leading to persistent cough over a period of months.
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Affiliation(s)
- Bothayna Amien
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Amer Harky
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Amy Hill
- Anaesthesia and Critical Care, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Neeraj Mediratta
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
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14
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Marc MS, Rosca D, Bratosin F, Fira-Mladinescu O, Oancea C, Pescaru CC, Velescu D, Wellmann N, Motofelea AC, Ciuca IM, Saracin K, Manolescu D. The Effect of Comorbidities and Complications on COVID-19 Mortality: A Detailed Retrospective Study in Western Romania. J Pers Med 2023; 13:1552. [PMID: 38003867 PMCID: PMC10672588 DOI: 10.3390/jpm13111552] [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: 09/25/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
COVID-19 continues to impact global health systems even after being declared over, with some patients exhibiting severe complications linked to pre-existing conditions. This study aimed to investigate the association between comorbidities, complications, and survival outcomes among COVID-19 survivors in Western Romania. Our hypothesis posited that comorbidities and complications significantly influence survival rates. We conducted a retrospective analysis of 1948 COVID-19 survivors admitted from January to December 2021, with 192 selected for detailed analysis based on inclusion and exclusion criteria. The severity of COVID-19 was classified according to WHO guidelines, and conditions like hypertension and obesity were defined using criteria from the European Society of Hypertension (ESH), the European Society of Cardiology (ESC), and WHO, respectively. Among the 192 patients, 33 had mild, 62 had moderate, and 97 had severe COVID-19. The median age across the severity groups was 63.2 years. Patients undergoing tracheostomy had a mortality rate of 83.3% versus 22.2% for non-tracheostomy patients (p < 0.001) and presented with significantly higher lung injury, hospitalization duration, and complications. Remarkably, tracheostomized patients were 17.50 times more likely to succumb to the disease (95% CI 4.39-116.91, p < 0.001). Furthermore, pneumothorax increased the mortality risk significantly (OR 22.11, 95% CI 5.72-146.03, p < 0.001). Intriguingly, certain conditions like grade I hypertension and grade II obesity showed a protective effect against mortality, whereas type 2 diabetes mellitus increased mortality risk (univariate OR 2.89, p = 0.001). The presence of certain comorbidities and complications significantly impacts the survival rates of COVID-19 patients in Western Romania. Notably, tracheostomy, pneumothorax, and T2DM were associated with increased mortality. This study underscores the importance of personalized patient care and provides insights for healthcare policymakers in Western Romania to improve clinical management strategies.
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Affiliation(s)
- Monica Steluta Marc
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Daniela Rosca
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (N.W.)
| | - Felix Bratosin
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (N.W.)
- Discipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ovidiu Fira-Mladinescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Camelia Corina Pescaru
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Diana Velescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Norbert Wellmann
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (N.W.)
| | - Alexandru Catalin Motofelea
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Ioana Mihaiela Ciuca
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Pediatric Pulmonology Unit, Clinical County Hospital, Evliya Celebi 1-3, 300226 Timisoara, Romania
| | - Karina Saracin
- Emergency County Hospital Craiova, Strada Tabaci 1, 200642 Craiova, Romania;
| | - Diana Manolescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Radiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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15
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Schiff E, Ma A, Cheung T, Tawfik M, Ference RS, Weinstock MS, Martin Levy I, Yang CJ. Teaching Tracheostomy Tube Changes: Comparison of Operant Learning Versus Traditional Demonstration. OTO Open 2023; 7:e93. [PMID: 38034062 PMCID: PMC10687377 DOI: 10.1002/oto2.93] [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: 02/18/2023] [Revised: 10/07/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Tracheostomy tube change is a multistep skill that must be performed rapidly and precisely. Despite the critical importance of this skill, there is wide variation in teaching protocols. Methods An innovative operant conditioning teaching methodology was employed and compared to traditional educational techniques. Medical student volunteers at a tertiary care academic institution (Albert Einstein College of Medicine) were recruited and randomly distributed into 2 groups: operant vs traditional (control). Following the educational session, each group was provided with practice time and then asked to perform 10 tracheostomy tube changes. Performance was recorded and scored by blinded raters using deidentified video recordings. Results The operant learning group (OLG) demonstrated greater accuracy in performing a tracheostomy tube change than the traditional demonstration group. Twelve of 13 operant learners performed the skill accurately each time compared to 3 of 13 in the traditional group (P = 0.002). The median lesson time was longer for the OLG (535 seconds) than for the traditional group, (200 seconds P < 0.001). The average time per tracheostomy change was not significantly different between the 2 groups (operant learners mean 7.1 seconds, traditional learners mean 7.5 seconds, P = 0.427). Discussion Although the operant conditioning methodology necessarily requires a greater time to teach, the results support this methodology over traditional learning modalities as it enhances accuracy in the acquired skill. Operant learning methodology is under consideration for other skills and education sessions in our program. Future steps include the application and adaptation of this education model to students and residents in other settings and fields. Implications for Practice Operant learning is effective for teaching multistep skills such as tracheostomy tube changes with decreased error rates.
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Affiliation(s)
| | - Anthony Ma
- Department of Emergency MedicineMount Sinai Morningside and Mount Sinai WestNew York CityNew YorkUSA
| | - Tracy Cheung
- Albert Einstein College of MedicineBronxNew YorkUSA
| | | | - Ryan S. Ference
- Department of AnesthesiologyWeill Cornell MedicineNew York CityNew YorkUSA
| | - Michael S. Weinstock
- Department of Surgery, Division of OtolaryngologyYale New Haven Children's HospitalNew HavenConnecticutUSA
| | - I. Martin Levy
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Orthopaedic SurgeryMontefiore Medical CenterNew York CityNew YorkUSA
| | - Christina J. Yang
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Otorhinolaryngology–Head and Neck SurgeryMontefiore Medical CenterNew York CityNew YorkUSA
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16
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Tamargo IA, Creel-Bulos C, Callahan MC, Miller C, Dave SB, Parrilla GA, Chan JL, Daneshmand MA, Javidfar J. Early Tracheostomy May Be Performed Safely in Obese COVID-19 Patients Supported on VV-ECMO. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:472-478. [PMID: 37864489 DOI: 10.1177/15569845231200226] [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] [Indexed: 10/23/2023]
Abstract
OBJECTIVE Obese patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory failure (ARDS) often require prolonged intubation. However, data are sparse regarding optimal tracheostomy timing in obese adults with COVID-19 requiring venovenous extracorporeal membrane oxygenation (VV-ECMO). This study retrospectively describes the course of obese patients with COVID-19 who underwent tracheostomy on VV-ECMO between March 2020 and December 2022. METHODS There were 62 participants with a median age of 43 (interquartile range [IQR] 33 to 53) years and a median body mass index of 42 (IQR 34 to 50) kg/m2 who received VV-ECMO for COVID-19-associated ARDS. Of those, 42 underwent tracheostomy on VV-ECMO, and 50% (n = 21) of the 42 patients underwent early (within 14 days of initiated ventilatory support) tracheostomy. RESULTS Among patients who received tracheostomies, the combined respiratory tract and lung parenchymal bleeding rate was 29% (n = 12), but only 7% required surgical intervention for bleeding from the tracheostomy site (n = 3). The hospital length of stay (LOS) was 42 (IQR 36 to 57) days, and mortality rate was 38% (n = 16). Tracheostomy timing was not associated with differences in respiratory tract bleeding, mechanical ventilatory support duration, VV-ECMO support duration, intensive care unit LOS, hospital LOS, mortality, or survival probability. CONCLUSIONS Although an individualized and holistic approach to clinical decision making continues to be necessary, the findings of this study suggest that early tracheostomy may be performed safely in obese patients with COVID-19 on VV-ECMO.
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Affiliation(s)
- Ian A Tamargo
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Casey Miller
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Sagar B Dave
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Gustavo A Parrilla
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Joshua L Chan
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mani A Daneshmand
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey Javidfar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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17
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Yousef A, Boys JA, Makani S, Kolb F, Weissbrod PA. Tracheal Transection After Prolonged Intubation and Tracheostomy: A Case Report. EAR, NOSE & THROAT JOURNAL 2023; 102:12S-15S. [PMID: 37246415 DOI: 10.1177/01455613231178111] [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] [Indexed: 05/30/2023] Open
Abstract
Tracheal transection is a rare, life-threatening complication after tracheal injury. Most commonly, tracheal transection presents after blunt trauma, but iatrogenic tracheal transection after tracheotomy has not been well described. Here, we present a case without a history of trauma that presented with signs of symptoms of tracheal stenosis. She was taken to the operating room for tracheal resection and anastomosis and was incidentally found to have a complete tracheal transection intraoperatively.
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Affiliation(s)
- Andrew Yousef
- Department of Otolaryngology, University of California San Diego, La Jolla, CA, USA
| | - Joshua A Boys
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, USA
| | - Samir Makani
- Department of Medicine, Scripps Encinitas, Encinitas, CA, USA
| | - Frederic Kolb
- Division of Plastic Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, USA
| | - Philip A Weissbrod
- Department of Otolaryngology, University of California San Diego, La Jolla, CA, USA
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18
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Bahk J, Dolan B, Sharma V, Sehmbhi M, Fung JY, Lee YI. Characteristics and Outcomes of Tracheostomized Patients With and Without COVID-19. Crit Care Explor 2023; 5:e0950. [PMID: 37546230 PMCID: PMC10403025 DOI: 10.1097/cce.0000000000000950] [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] [Indexed: 08/08/2023] Open
Abstract
Outcomes of tracheostomized patients with COVID-19 are seldomly investigated with conflicting evidence from the existing literature. OBJECTIVES To create a study evaluating the impact of COVID-19 on tracheostomized patients by comparing clinical outcomes and weaning parameters in COVID-19 positive and negative cohorts. DESIGN SETTING AND PARTICIPANTS A retrospective observational cohort study of 604 tracheostomized patients hospitalized in 16 ICUs in New York City between March 9, 2020, and September 8, 2021. MAIN OUTCOMES AND MEASURES Patients were stratified into two cohorts: 398 COVID-19 negative (COVID-ve) and 206 COVID-19 positive (COVID+ve) patients. Clinical characteristics, outcomes, and weaning parameters (first pressure support [PS], tracheostomy collar [TC], speech valve placement, and decannulation) were analyzed. RESULTS COVID+ve had fewer comorbidities including coronary artery disease, congestive heart failure, malignancy, chronic kidney disease, liver disease, and HIV (p < 0.05). Higher Fio2 (53% vs 44%), positive end-expiratory pressure (PEEP) (7.15 vs 5.69), Pco2 (45.8 vs 38.2), and lower pH (7.41 vs 7.43) were observed at the time of tracheostomy in COVID+ve (p < 0.005). There was no statistical difference in post-tracheostomy complication rates. Longer time from intubation to tracheostomy (15.90 vs 13.60 d; p = 0.002), tracheostomy to first PS (2.87 vs 1.80 d; p = 0.005), and TC placement (11.07 vs 4.46 d; p < 0.001) were seen in COVID+ve. However, similar time to speech valve placement, decannulation, and significantly lower 1-year mortality (23.3% vs 36.7%; p = 0.001) with higher number of discharges to long-term acute care hospital (LTACH) (23.8% vs 13.6%; p = 0.015) were seen in COVID+ve. CONCLUSIONS AND RELEVANCE Patients with COVID-19 required higher Fio2 and PEEP ventilatory support at the time of tracheostomy, with no observed change in complication rates. Despite longer initial weaning period with PS or TC, similar time to speech valve placement or decannulation with significantly lower mortality and higher LTACH discharges suggest favorable outcome in COVID-19 positive patients. Higher ventilatory support requirements and prolonged weaning should not be a deterrent to pursuing a tracheostomy.
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Affiliation(s)
- Jeeyune Bahk
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bridget Dolan
- Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Venus Sharma
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mantej Sehmbhi
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer Y Fung
- Division of Pulmonary and Critical Care, Department of Medicine, Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Young Im Lee
- Division of Pulmonary and Critical Care, Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY
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19
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Moguillansky N, Mathelier M, Tuna IS. Brain Dead and Pregnant. Cureus 2023; 15:e44172. [PMID: 37753021 PMCID: PMC10519615 DOI: 10.7759/cureus.44172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
The presence of pregnancy in a brain-dead woman is a rare circumstance. We present a case of a 31-year-old woman who was 22 weeks pregnant at the time of diagnosis of brain death after intracranial and subarachnoid hemorrhage. After a multidisciplinary approach, the decision was made to continue somatic support to maintain the pregnancy until optimal fetus viability. Cesarean section was performed after 11 weeks (33 weeks gestational age) of brain-death diagnosis with a successful delivery of a live infant. Management of brain-death complications during pregnancy is described.
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Affiliation(s)
- Natalia Moguillansky
- Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, University of Florida Health, Gainesville, USA
| | - Michael Mathelier
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Ibrahim S Tuna
- Department of Radiology, University of Florida College of Medicine, Gainesville, USA
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20
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Batth SK, Singh G. Air Will Find a Way: A Case Report and Literature Review on Tracheostomy-Induced Ectopic Air. Cureus 2023; 15:e42446. [PMID: 37637541 PMCID: PMC10449268 DOI: 10.7759/cureus.42446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Tracheostomy can lead to various complications, one of which is ectopic air in different compartments of the body. Here, we present a rare case of tracheostomy-induced ectopic air: a combination of subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum. This case also presents a literature review on some of the common mechanisms responsible for pneumomediastinum following tracheostomy and the mechanism of pneumoperitoneum following pneumomediastinum. Tracheal injury, tube-related complications, and alveolar rupture are common mechanisms that can lead to pneumomediastinum and subcutaneous emphysema after tracheostomy. Air can then dissect into the abdomen leading to pneumoperitoneum. Knowledge of the anatomic or embryologic development of the thoracoabdominal continuum can help understand the spread of air from one compartment to another. Investigation as simple as a chest X-ray, along with clinical features, can help identify these complications and be used to monitor the course.
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Affiliation(s)
- Simrat K Batth
- Medicine, Elmhurst Hospital Centre (Icahn School of Medicine at Mount Sinai), New York, USA
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21
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Chakma A, Siddiqui OA, Ali S, Nadeem A. Track your trach: Removal of a fractured tracheostomy tube using a flexible fibreoptic bronchoscope in a patient with severe head injury. Med J Armed Forces India 2023; 79:481-484. [PMID: 37441303 PMCID: PMC10334239 DOI: 10.1016/j.mjafi.2021.08.014] [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: 04/08/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022] Open
Abstract
Tracheostomy is a common airway procedure for life support in critically ill patients with head injuries. This procedure is safe but also associated with early and late complications. Tube fracture and dislodgement into the tracheobronchial tree leading to airway obstruction is a rare but life-threatening complication after prolonged tracheostomy tube placement. There are very few published reports of tracheostomy tube fracture and dislodgement into tracheobronchial tree in a neurologically injured patient. We report a case of a fractured tracheostomy tube which got impacted in the left main bronchus, in a 41-year-old male patient who had been on prolonged tracheostomy tube after craniotomy and evacuation of subdural hematoma. The distal part of the tracheostomy tube fractured and impacted in the left main bronchus. Fibreoptic bronchoscopy was performed through the oral cavity to extract it, and the anaesthetic management during the period is discussed.
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Affiliation(s)
- Avishek Chakma
- Resident, Jawaharlal Nehru Medical College, Aligarh, India
| | | | - Shahna Ali
- Assistant Professor, Jawaharlal Nehru Medical College, Aligarh, India
| | - Abu Nadeem
- Associate Professor, Jawaharlal Nehru Medical College, Aligarh, India
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22
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Kolethekkat AA, Al Salmi HZ, Al Abri HK, Al Abri R. Insights on Competency and Knowledge Related to the Tracheostomy Care of Nurses at a Tertiary Referral Hospital in Oman. Indian J Otolaryngol Head Neck Surg 2023; 75:737-743. [PMID: 37275066 PMCID: PMC10235375 DOI: 10.1007/s12070-022-03433-2] [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: 11/08/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives: To assess the efficacy of current knowledge and competency of tracheostomy care providers in inpatient setting. Methods: A real-time questionnaire-based cross-sectional study was carried out on 34 tracheostomy nursing care providers from different in patient settings. There were 50 questions in 8 sections, covering most of the aspects and steps of tracheostomy. The assessment of efficacy of the current knowledge and competency of tracheostomy care were assessed based on the response of the survey. Results: The overall competency of nursing for tracheostomy care was only 63.5%. In 5.9% of them, it was less than 50%. 30 (88.2%) tracheostomy care givers answered between 50% and 80% of the questionnaire correctly, and only 2 (5.9%) of them managed to get higher than 80%. Conclusion: The competency and knowledge regarding the tracheostomy care is low and the study highlight the importance of staff education for post-operative tracheostomy care to increase the level of care and to reduce adverse events. A re audit is needed to ensure that the care is improved qualitatively after training.
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Affiliation(s)
- Arif Ali Kolethekkat
- ENT Division, Department of Surgery, Sultan Qaboos University Hospital, P O 38, PC 123, Sib, AL Khoud Oman
| | | | | | - Rashid Al Abri
- ENT Division, Department of Surgery, Sultan Qaboos University Hospital, P O 38, PC 123, Sib, AL Khoud Oman
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23
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Cavalli E, Belfiori G, Molinari G, Peghetti A, Zanoni A, Chinelli E. Does a decannulation protocol exist in COVID-19 patients? The importance of working in a multiprofessional team. DISCOVER HEALTH SYSTEMS 2023; 2:14. [PMID: 37520514 PMCID: PMC10099004 DOI: 10.1007/s44250-023-00031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/27/2023] [Indexed: 08/01/2023]
Abstract
As a Covid Hub in Emilia Romagna, we have experienced an increasing number of tracheostomized patients, prompting us to develop a standardized decannulation protocol for COVID-19 ARDS patients. Currently, there are no guidelines or protocols for decannulation in this population, and few studies have investigated the early outcomes of tracheostomy in COVID-19 patients, with no detailed analysis of the decannulation process. We recognized the importance of mutual reliance among our team members and the significant achievements we made compared to previous decannulation methods. Through the optimization of the decannulation process, we identified a clear, safe, and repeatable method based on clinical best practice and literature evidence. We decided to implement an existing standardized decannulation protocol, which was originally designed for severe brain-damaged patients, due to the growing number of COVID-19 patients with tracheostomy. This protocol was designed for daily practice and aimed to provide a uniform approach to using devices like fenestrated cannulas, speaking valves, and capping. The results of our implementation include:expanding the applicability of the protocol beyond severe brain-damaged patients to different populations and settings (in this case, patients subjected to a long period of sedation and invasive ventilation)early activation of speech therapy to facilitate weaning from the cannula and recovery of physiological swallowing and phonationearly activation of otolaryngologist evaluation to identify organic problems related to prolonged intubation, tracheostomy, and ventilation and address proper speech therapy treatmentactivation of more fluid and effective management paths for decannulation with a multiprofessional team.
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Affiliation(s)
- E. Cavalli
- Physical Medicine and Rehabilitation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni N°15, 40138 Bologna, Italy
| | - G. Belfiori
- Physical Medicine and Rehabilitation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni N°15, 40138 Bologna, Italy
| | - G. Molinari
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni N°15, 40138 Bologna, Italy
| | - A. Peghetti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni N°15, 40138 Bologna, Italy
| | - A. Zanoni
- Anesthesia and Intensive Care in Local, Regional and National Emergencies and in Major Abdominal Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni N°15, 40138 Bologna, Italy
| | - E. Chinelli
- Anesthesia and Intensive Care in Local, Regional and National Emergencies and in Major Abdominal Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni N°15, 40138 Bologna, Italy
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Carboni Bisso I, Ruiz V, Huespe IA, Rosciani F, Cantos J, Lockhart C, Fernández Ceballos I, Las Heras M. Bronchoscopy-guided percutaneous tracheostomy during the COVID-19 pandemic. Surgery 2023; 173:944-949. [PMID: 36621447 PMCID: PMC9771743 DOI: 10.1016/j.surg.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/17/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Assessment of the efficacy and complications associated with performing bronchoscopy-guided percutaneous tracheostomy in COVID-19 and non-COVID-19 patients. METHODS Prospective observational study conducted between March of 2020 and February of 2022. All adult patients who underwent elective bronchoscopy-guided percutaneous tracheostomy were included. The efficacy of the procedure was evaluated based either on the success rate in the execution or on the need for conversion to open technique. Percutaneous tracheostomy-related complications were registered during the procedure. We performed 6-month follow-up for identifying late complications. RESULTS During the study period, 312 bronchoscopy-guided percutaneous tracheostomies were analyzed. One hundred and eighty-three were performed in COVID-19 patients and 129 among non-COVID-19 patients. Overall, 64.1% (200) of patients were male, with a median age of 66 (interquartile range 54-74), and 65% (205) presented at least 1 comorbidity. Overall, oxygen desaturation was the main complication observed (20.8% [65]), being more frequent in the COVID-19 group occurring in 27.3% (50) with a statistically significant difference versus the non-COVID-19 patients' group (11.6% [15]); P < .01). Major complications such as hypotension, arrhythmias, and pneumothorax were more frequently observed among COVID-19 patients as well but with no significant differences. Percutaneous tracheostomy could be executed quickly and satisfactorily in all the patients with no need for conversion to the open technique. Likewise, no suspension of the procedure was required in any case. During 6-month follow-up, we found an incidence of 0.96% (n = 3) late complications, 2 tracheal granulomas, and 1 ostomal infection. CONCLUSION Bronchoscopy-guided percutaneous tracheostomy can be considered an effective and safe procedure in COVID-19 patients. Nevertheless, it is highly remarkable that in the series under study, a great number of COVID-19 patients presented oxygen desaturation during the procedure.
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Affiliation(s)
| | - Victoria Ruiz
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
| | | | - Foda Rosciani
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
| | - Joaquín Cantos
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
| | | | | | - Marcos Las Heras
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
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Sussman S, Philips R, Renslo B, Givens A, Swendseid B, Tassone P, Goldman RA, Curry JM, Cognetti DM, Luginbuhl AJ. Effects of Prior Tracheostomy on Total Laryngectomy Outcomes. Otolaryngol Head Neck Surg 2023; 168:782-789. [PMID: 35943815 DOI: 10.1177/01945998221116761] [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: 02/10/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess whether preoperative tracheostomy (PreOT) increases risk of complications after total laryngectomy (TL) and to determine if timing of tracheostomy creation is associated with an increased risk. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care hospital between 2007 and 2020. METHODS Inclusion criteria were patients who underwent primary or salvage TL for oncologic treatment. Dependent variables of interest included surgical complications, such as wound dehiscence, infection, hematoma, complete flap failure, fistula formation, and stoma stenosis, as well as medical complications. Categorical variables were compared with chi-square test or Fisher exact test, and continuous variables were compared with an independent t test. Multivariable regression was conducted to assess predictors of complications after laryngectomy. RESULTS A total of 306 patients were included. Primary TL was performed in 161 (53%) patients and salvage in 145 (47%) patients. Of the patients undergoing primary laryngectomy, 105 (65%) received a PreOT. Of the patients undergoing salvage laryngectomy, 86 (59%) received a PreOT. In both primary and salvage cases, there was no association between PreOT and surgical or medical complications. Additionally, there was no significant association between timing of tracheostomy and surgical complications. On multivariable analysis, the presence of a PreOT was not associated with surgical complications. In salvage cases, those with a PreOT had a significantly longer average length of stay than those without a PreOT (12 vs 9 days, P = .008). CONCLUSION PreOT in patients undergoing primary and salvage laryngectomies was not associated with surgical or medical complications postlaryngectomy. Timing of tracheostomy in relation to laryngectomy was not found to adversely affect clinical outcomes.
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Affiliation(s)
- Sarah Sussman
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ramez Philips
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bryan Renslo
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alyssa Givens
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian Swendseid
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Patrick Tassone
- Department of Otolaryngology, University of Missouri, Columbia, Missouri, USA
| | - Richard A Goldman
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam J Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Bódis F, Orosz G, Tóth JT, Szabó M, Élő LG, Gál J, Élő G. Percutaneous tracheostomy: Comparison of three different methods with respect to tracheal cartilage injury in cadavers—Randomized controlled study. Pathol Oncol Res 2023; 29:1610934. [PMID: 37123534 PMCID: PMC10135429 DOI: 10.3389/pore.2023.1610934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023]
Abstract
Background: Performing tracheostomy improves patient comfort and success rate of weaning from prolonged invasive mechanical ventilation. Data suggest that patients have more benefit of percutaneous technique than the surgical procedure, however, there is no consensus on the percutaneous method of choice regarding severe complications such as late tracheal stenosis. Aim of this study was comparing incidences of cartilage injury caused by different percutaneous dilatation techniques (PDT), including Single Dilator, Griggs’ and modified (bidirectional) Griggs’ method.Materials and methods: Randomized observational study was conducted on 150 cadavers underwent post-mortem percutaneous tracheostomy. Data of cadavers including age, gender and time elapsed from death until the intervention (more or less than 72 h) were collected and recorded. Primary and secondary outcomes were: rate of cartilage injury and cannula malposition respectively.Results: Statistical analysis revealed that method of intervention was significantly associated with occurrence of cartilage injury, as comparing either standard Griggs’ with Single Dilator (p = 0.002; OR: 4.903; 95% CI: 1.834–13.105) or modified Griggs’ with Single Dilator (p < 0.001; OR: 6.559; 95% CI: 2.472–17.404), however, no statistical difference was observed between standard and modified Griggs’ techniques (p = 0.583; OR: 0.748; 95% CI: 0.347–1.610). We found no statistical difference in the occurrence of cartilage injury between the early- and late post-mortem group (p = 0.630). Neither gender (p = 0.913), nor age (p = 0.529) influenced the rate of cartilage fracture. There was no statistical difference between the applied PDT techniques regarding the cannula misplacement/malposition.Conclusion: In this cadaver study both standard and modified Griggs’ forceps dilatational methods were safer than Single dilator in respect of cartilage injury.
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Affiliation(s)
- Fruzsina Bódis
- Department of Otorhinolaryngology and Head and Neck Surgery, Semmelweis University, Budapest, Hungary
- *Correspondence: Fruzsina Bódis,
| | - Gábor Orosz
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - József T. Tóth
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Marcell Szabó
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - László Gergely Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - János Gál
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Gábor Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
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Pandev R, Khan M, Ratheesh V. Riedel's Thyroiditis: Pitfalls in Diagnosis and Subsequent Complications. Case Rep Endocrinol 2023; 2023:9989953. [PMID: 37096012 PMCID: PMC10122592 DOI: 10.1155/2023/9989953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023] Open
Abstract
Riedel's thyroiditis is a rare disease of chronic inflammation with fibrotic infiltration of the thyroid gland and its surrounding vital structures. Due to its low incidence, there are often delays in diagnosis as it is commonly mistaken for other thyroid diseases. We report the case of a 34-year-old female patient who presented with a firm, enlarged mass in the neck, compression symptoms, and hypothyroidism. Lab tests showed elevated A-TG (thyroglobulin antibodies) and A-TPO (thyroid peroxidase antibodies) levels. Based on the disease presentation and supporting lab findings, the patient was misdiagnosed with Hashimoto's thyroiditis and treated accordingly. Yet the patient's symptoms grew progressively worse. She was discovered to have severe tracheal compression and bilateral RLN (recurrent laryngeal nerve) palsy. Tracheotomy became a necessary surgical intervention after the development of respiratory failure, but this procedure was complicated by the development of an intraoperative pneumothorax. After an open biopsy, histology revealed Riedel's thyroiditis. A new treatment was introduced, with which the patient's condition improved. However, she continued to suffer from the open tracheocutaneous fistula left by the tracheostomy, which adversely affected her everyday life. A follow-up operation was performed to close the fistula. In this case report, we discuss the consequences of misdiagnosing the patient and delaying the appropriate treatment for her disease.
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Affiliation(s)
- R. Pandev
- Medical University of Pleven, Pleven, Bulgaria
- University Hospital Saint Marina, Pleven, Bulgaria
| | - M. Khan
- Medical University of Pleven, Pleven, Bulgaria
| | - V. Ratheesh
- Medical University of Pleven, Pleven, Bulgaria
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Reddy A, Bansal R, Kaloria N, Patel S, Gowda PK. Utility of the Awake Video Laryngoscopy Assisted Fibreoptic Intubation Technique in Maxillofacial Gunshot Injury - A Case Report. Ann Maxillofac Surg 2023; 13:120-122. [PMID: 37711543 PMCID: PMC10499282 DOI: 10.4103/ams.ams_31_23] [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: 02/12/2023] [Revised: 04/21/2023] [Accepted: 05/22/2023] [Indexed: 09/16/2023] Open
Abstract
Rationale Maxillofacial gunshot injury leads to significant soft tissue and bone defects, which compromise airway patency, thus posing a challenge for the anaesthesiologist. The utility of the videolaryngoscopy-assisted fibreoptic intubation (VAFI) technique in maxillofacial gunshot injury has not yet been described in the literature. Patient Concerns We report the case of a young male presenting with extensive maxillofacial wounds with fractures of the bilateral maxilla, mandible and floor of orbit secondary to self-inflicted gunshot injury. Diagnosis Major peri-operative concerns included anticipated difficult airway, control of potential haemorrhage and airway oedema. Treatment A flexible fibreoptic bronchoscope used in combination with a video laryngoscope was used to successfully secure the airway. Outcome He was extubated on the same day and discharged after two weeks. Take-Away Lessons The current case highlights the safe and effective use of the videolaryngoscopy-assisted fibreoptic intubation technique in maxillofacial gunshot injury.
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Affiliation(s)
- Ashwini Reddy
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Bansal
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narender Kaloria
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swati Patel
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Punith K. Gowda
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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30-Day Postoperative Outcomes in Adults with Obstructive Sleep Apnea Undergoing Upper Airway Surgery. J Clin Med 2022; 11:jcm11247371. [PMID: 36555986 PMCID: PMC9783895 DOI: 10.3390/jcm11247371] [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: 10/21/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Obstructive sleep apnea (OSA) is a chronic disorder of the upper airway. OSA surgery has oftentimes been researched based on the outcomes of single-institutional facilities. We retrospectively analyzed a multi-institutional national database to investigate the outcomes of OSA surgery and identify risk factors for complications. Methods: We reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2008−2020) to identify patients who underwent OSA surgery. The postoperative outcomes of interest included 30-day surgical and medical complications, reoperation, readmission, and mortality. Additionally, we assessed risk-associated factors for complications, including comorbidities and preoperative blood values. Results: The study population included 4662 patients. Obesity (n = 2909; 63%) and hypertension (n = 1435; 31%) were the most frequent comorbidities. While two (0.04%) deaths were reported within the 30-day postoperative period, the total complication rate was 6.3% (n = 292). Increased BMI (p = 0.01), male sex (p = 0.03), history of diabetes (p = 0.002), hypertension requiring treatment (p = 0.03), inpatient setting (p < 0.0001), and American Society of Anesthesiology (ASA) physical status classification scores ≥ 4 (p < 0.0001) were identified as risk-associated factors for any postoperative complications. Increased alkaline phosphatase (ALP) was identified as a risk-associated factor for the occurrence of any complications (p = 0.02) and medical complications (p = 0.001). Conclusions: OSA surgery outcomes were analyzed at the national level, with complications shown to depend on AP levels, male gender, extreme BMI, and diabetes mellitus. While OSA surgery has demonstrated an overall positive safety profile, the implementation of these novel risk-associated variables into the perioperative workflow may further enhance patient care.
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Perez G, Young L, Kravitz R, Sheehan D, Adang L, Van Haren K, Lin JL, Jaffe NN, Kuo D, Ball L, Keller J, Sank J, DiVito D, Naime S. Pulmonological issues. Curr Probl Pediatr Adolesc Health Care 2022; 52:101313. [PMID: 36470809 PMCID: PMC11348663 DOI: 10.1016/j.cppeds.2022.101313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pediatric leukodystrophies are rare neurodegenerative diseases involving multiple systems. Each form has unique neurologic features but are characterized by encephalopathy with accompanying impairments evidenced in reflexes, muscle tone and movement control. Weakness of expiratory, inspiratory, and upper airway muscles may lead to impaired airway secretion clearance resulting in recurrent respiratory infections, dysphagia, sleep-disordered breathing, restrictive lung disease, and ultimately chronic respiratory insufficiency.
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Affiliation(s)
| | - Lisa Young
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | - Laura Adang
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jody L Lin
- Universty of Utah, Salt Lake City, UT, USA
| | | | - Dennis Kuo
- Strong Memorial Hospital, Rochester, NY, USA
| | - Laura Ball
- Children's National Medical Center, Washington DC, USA
| | | | | | - Donna DiVito
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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31
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Silva‐Nash J, Campbell JB, Gardner JR, Daigle O, King D, Moreno M, Vural E, Tulunay‐Ugur OE. Early postoperative complications following tracheotomy: Does suturing technique influence outcomes? Laryngoscope Investig Otolaryngol 2022; 8:156-161. [PMID: 36846406 PMCID: PMC9948586 DOI: 10.1002/lio2.907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Tracheotomy is one of the most commonly performed procedure by otolaryngologists, but no consensus exists on the effect of suturing techniques on postoperative complications. Stay sutures and Bjork flaps are utilized frequently for securing the tracheal incision to the neck skin in order to create a tract for recannulation. Methods Retrospective cohort study of tracheotomies performed by Otolaryngology-Head and Neck Surgery providers (May 2014 to August 2020) was conducted to determine the effect of suturing technique on postoperative complications and patient outcomes. Patient demographics, medical comorbidities, indication for tracheostomy, and postoperative complications were analyzed with a statistical alpha set of .05. Results Out of 1395 total tracheostomies performed at our institution during the study period, 518 met inclusion criteria for this study. Three hundred and seventeen tracheostomies were secured by utilizing a Bjork flap, while 201 were secured with up and down stay sutures. Neither technique was noted to be more commonly associated with tracheal bleeding, infection, mucus plugging, pneumothorax, or false passage of the tracheostomy tube. One mortality was noted following decannulation during the study period. Conclusion Though various techniques exist; adverse outcomes are not associated with the manner in which a new tracheostomy stoma is secured. Medical comorbidities and the indications for tracheostomy likely play a more significant role in postoperative outcomes and complications. Level of evidence Level 3.
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Affiliation(s)
- Jennifer Silva‐Nash
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Jessica B. Campbell
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - James Reed Gardner
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Olivia Daigle
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Deanne King
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Mauricio Moreno
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Emre Vural
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Ozlem E. Tulunay‐Ugur
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
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Waindeskar V, Kumar S, Agrawal D. Tracheostomy Tube as Foreign Body in Right Main Bronchus: A Case Report. Indian J Otolaryngol Head Neck Surg 2022; 74:4835-4836. [PMID: 36742719 PMCID: PMC9895710 DOI: 10.1007/s12070-020-01817-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/07/2020] [Indexed: 02/07/2023] Open
Abstract
Tracheostomy is a commonly performed procedure to secure airway in patients who need prolonged airway support (Marchese et al. in Respir Med 104(5):749-753, 2010). It is relatively safe procedure but associated with few early and late complications (Fernandez-Bussy et al. in J Bronchol Interv Pulmonol 22(4):357-364, 2015). Metallic tracheostomy tubes were used in patients in the past. Those tubes were associated with fracture and dislodgement due to corrosive injury. Few case reports have been published in the past (Lynrah et al. in Int J Pediatr Otorhinolaryngol 76(11):1691-1695, 2012; Agarwal and Agarwal in Indian J Chest Dis Allied Sci 53(2):111, 2011). PVC tubes are less prone for fracture, but wear and tear associated with prolonged use can lead to break in the tube and dislodgement. We successfully diagnosed and managed such a case of broken PVC Tracheostomy tube in right main bronchus and share our experiences.
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Affiliation(s)
- Vaishali Waindeskar
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, MP India
| | - Sanjay Kumar
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, MP India
| | - Deepti Agrawal
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, MP India
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Maheshwaran S, Thomas SV, Raman GK, Pookamala S. Safety of Percutaneous vs Open Tracheostomy on Intubated Patients in ICU Setting: Which One is Better? Indian J Otolaryngol Head Neck Surg 2022; 74:4978-4981. [PMID: 36742846 PMCID: PMC9895692 DOI: 10.1007/s12070-021-02544-6] [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: 02/08/2021] [Accepted: 04/12/2021] [Indexed: 02/07/2023] Open
Abstract
To study the safety of percutaneous vs open tracheostomy approaches on patients requiring long term ventilation in ICU setting. It is a prospective study done over a period of 2 years on 105 patients requiring long term ventilation in ICU set up in a tertiary care hospital. Patients were subjected to either open approach or percutaneous tracheostomy bedside in ICU itself. Then patients were followed during their hospital stay to look for any tracheostomy related complications. Data regarding age, gender, indications of long term ventilation and complications were compiled and analysis was done. It was found that most of the patients were of male gender (88.6%) in the age group of 50-59 years of age. The most common cause for tracheostomy was head injury secondary to road traffic accident, seen in 79 out of 105 cases. On comparing complications rate, there was no statistically significant difference in both the groups. However rate of peristomal infection is more with open approach group (P < 0.05). Percutaneous tracheostomy can be performed safely in ICU as a bedside procedure. There is significant reduction in peristomal infection with percutaneous tracheostomy and there is no significant difference in other complications between the two groups. Thus percutaneous tracheostomy is as safe as an open approach tracheostomy in properly selected cases.
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Affiliation(s)
- S. Maheshwaran
- Department of Otorhinolaryngology, Head and Neck Surgery, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu 625009 India
| | | | | | - S. Pookamala
- Department of Otorhinolaryngology, Head and Neck Surgery, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu 625009 India
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Papi D, Montigiani G, Bucciardini L. How the work of respiratory physiotherapists changes the tracheostomy management and decannulation in a NICU department: an Italian experience. Monaldi Arch Chest Dis 2022; 93. [PMID: 36426898 DOI: 10.4081/monaldi.2022.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/25/2022] Open
Abstract
Tracheotomy is a clinical procedure that is often necessary though not without complications, hence the need for appropriate and timely decannulation. The inclusion of trained respiratory physiotherapists (RPT) in the staff and the use of shared protocols could help the team to manage the patient with tracheotomy cannula. The objective of this study was to describe the difference in the rate of decannulation and clinical outcomes of tracheostomized patients admitted to a NeuroIntensive Care Unit (NICU) team after the inclusion of a group of physiotherapists specialized in respiratory physiotherapy and a new phoniatric protocol. It is a 6-year retrospective study, in which two periods of 3 years each were compared: in the first period (P1: September 2013-August 2016) physiotherapists were called to treat NICU patients on a consultative basis (2 hours/day for 5 days a week); in the second period (P2: September 2016-August 2019) two full-time respiratory physiotherapists were present on the ward (7 hours/day, 6/7 days/week). In P2 period, a decannulation protocol was used. Patients who had undergone a tracheotomy procedure and who were alive at the time of discharge were retrospectively evaluated. We described the number of decannulations, the length of stay in NICU and decannulation time; the diagnosis of decannulated patients and the number of deaths. 928 total patients were analysed: 468 in P1, 460 in P2. Total length of stay or number of deaths did not change significantly between the two periods, while the number of decannulated patients before the discharge was higher in P2 143 (64%), compared with P1 79 (36%) p<0.001. More patients with neurological pathologies involving possible swallowing disorders, such as cerebral haemorrhage, head trauma and stroke, have been successfully decannulated in P2 than in P1 (120 patients in P2 vs 54 in P1). A multidisciplinary approach, including respiratory physiotherapist, dedicated to tracheostomy management, decannulation and early mobilization in NICU is safe, feasible and seems to improve the number of severe patients decannulated, even if no change was observed in NICU length of stay or deaths. Further studies must confirm our results in other ICU settings.
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Affiliation(s)
- Davide Papi
- NeuroIntensive Care Unit, Careggi University Hospital, Florence.
| | | | - Luca Bucciardini
- NeuroIntensive Care Unit, Careggi University Hospital, Florence.
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Jung DTU, Grubb L, Moser CH, Nazarian JTM, Patel N, Seldon LE, Moore KA, McGrath BA, Brenner MJ, Pandian V. Implementation of an evidence-based accidental tracheostomy dislodgement bundle in a community hospital critical care unit. J Clin Nurs 2022:10.1111/jocn.16535. [PMID: 36200145 PMCID: PMC9874912 DOI: 10.1111/jocn.16535] [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: 04/06/2022] [Revised: 07/13/2022] [Accepted: 08/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Tracheostomy dislodgment can lead to catastrophic neurological injury or death. A fresh tracheostomy amplifies the risk of such events, where an immature tract predisposes to false passage. Unfortunately, few resources exist to prepare healthcare professionals to manage this airway emergency. AIM To create and implement an accidental tracheostomy dislodgement (ATD) bundle to improve knowledge and comfort when responding to ATD. MATERIALS & METHODS A multidisciplinary team with expertise in tracheostomy developed a 3-part ATD bundle including (1) Tracheostomy Dislodgement Algorithm, (2) Head of Bed Tracheostomy Communication Tool and (3) Emergency Tracheostomy Kit. The team tested the bundle during the COVID-19 pandemic in a community hospital critical care unit with the engagement of nurses and Respiratory Care Practitioners. Baseline and post-implementation knowledge and comfort levels were measured using Dorton's Tracheotomy Education Self-Assessment Questionnaire, and adherence to protocol was assessed. Reporting follows the revised Standards for Quality Improvement Reporting Excellence (SQUIRE). RESULTS Twenty-four participants completed pre-test and post-test questionnaires. The median knowledge score on the Likert scale increased from 4.0 (IQR = 1.0) pre-test to 5.0 (IQR = 1.0) post-test. The median comfort level score increased from 38.0 (IQR = 7.0) pre-test to 40.0 (IQR = 5.0) post-test). In patient rooms, adherence was 100% for the Head of Bed Tracheostomy Communication Tool and Emergency Tracheostomy Kit. The adherence rate for using the Dislodgement Algorithm was 55% in ICU and 40% in SCU. DISCUSSION This study addresses the void of tracheostomy research conducted in local community hospitals. The improvement in knowledge and comfort in managing ATD is reassuring, given the knowledge gap among practitioners demonstrated in prior literature. The ATD bundle assessed in this study represents a streamlined approach for bedside clinicians - definitive management of ATD should adhere to comprehensive multidisciplinary guidelines. CONCLUSIONS ATD bundle implementation increased knowledge and comfort levels with managing ATD. Further studies must assess whether ATD bundles and other standardised approaches to airway emergencies reduce adverse events. Relevance to Clinical Practice A streamlined intervention bundle employed at the unit level can significantly improve knowledge and comfort in managing ATD, which may reduce morbidity and mortality in critically ill patients with tracheostomy.
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Affiliation(s)
- Dawn Ta Un Jung
- Division of Cardiac SurgeryJohns Hopkins HospitalBaltimoreMarylandUSA
| | - Lisa Grubb
- Johns Hopkins Medicine Howard County General HospitalColumbiaMarylandUSA,Johns Hopkins School of NursingBaltimoreMarylandUSA
| | | | | | - Neesha Patel
- Johns Hopkins Medicine Howard County General HospitalColumbiaMarylandUSA
| | - Lisa E. Seldon
- Johns Hopkins Medicine Howard County General HospitalColumbiaMarylandUSA
| | - Kristin A. Moore
- Johns Hopkins Medicine Howard County General HospitalColumbiaMarylandUSA
| | - Brendan A. McGrath
- University of Manchester, NHS Foundation Trust, National Tracheostomy Safety ProjectManchesterUK
| | - Michael J. Brenner
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA,Global Tracheostomy CollaborativeRaleighNorth CarolinaUSA
| | - Vinciya Pandian
- Department of Nursing FacultyJohns Hopkins UniversityBaltimoreMarylandUSA
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Park YJ, Kim E, Jung HS. Successful management of a tracheomalacia patient with active endotracheal bleeding due to intraoperative innominate artery injury: A case report. Medicine (Baltimore) 2022; 101:e30797. [PMID: 36181007 PMCID: PMC9524874 DOI: 10.1097/md.0000000000030797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Intraoperative innominate artery injury is life-threatening in tracheomalacia patients with prolonged tracheostomy. Anesthetic management is challenging in cases with massive hemorrhage into the endotracheal tube. We report a case in which we successfully managed a tracheomalacia patient with acute endotracheal bleeding due to innominate artery injury. PATIENT CONCERNS A 24-year-old patient with tracheomalacia was scheduled to undergo exploratory thoracotomy for the treatment of intermittent bleeding at the tracheostomy site. During exploration, sudden active bleeding due to innominate artery injury was observed in the endotracheal lumen. DIAGNOSES The patient was diagnosed with tracheomalacia. INTERVENTIONS We immediately used the bronchoscope to place the tip of the endotracheal tube at the bleeding site and hyperinflated the cuff. OUTCOMES The ballooned cuff compressed the active bleeding site, so no additional bleeding was detected by bronchoscopy, and no additional massive bleeding was observed in the operative field. LESSONS Immediate and appropriate overinflation of the endotracheal tube cuff by an anesthesiologist may provide improved surgical field visibility and time for critical surgical procedures in cases of massive hemorrhaging.
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Affiliation(s)
- Yoo Jung Park
- Department of Anesthesiology and Pain Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eunji Kim
- Department of Anesthesiology and Pain Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hong Soo Jung
- Department of Anesthesiology and Pain Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- *Correspondence: Hong Soo Jung, Department of Anesthesiology and Pain Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, 16247, Republic of Korea (e-mail: )
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Park BC, Mallemat H. Special Procedures for Pulmonary Disease in the Emergency Department. Emerg Med Clin North Am 2022; 40:583-602. [PMID: 35953218 DOI: 10.1016/j.emc.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In the emergency department, there are infrequent but essential procedures related to pulmonary diseases that emergency physicians must be able to perform. These include thoracentesis, chest tube thoracostomy, tracheostomy manipulation, and fiberoptic intubation.
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Affiliation(s)
- Brian C Park
- Critical Care Medicine Program, Cooper Medical School of Rowan University, Cooper University Hospital, 1 Cooper Plaza, Dorrance 4th Floor, Suite D427, Camden, NJ 08103, USA.
| | - Haney Mallemat
- Emergency Medicine/Critical Care Medicine Program, Cooper Medical School of Rowan University, Cooper University Hospital, 1 Cooper Plaza, Dorrance 4th Floor, Suite D427, Camden, NJ 08103, USA. https://twitter.com/CritCareNow
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Mortality Risk Factors in Patients Admitted with the Primary Diagnosis of Tracheostomy Complications: An Analysis of 8026 Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159031. [PMID: 35897404 PMCID: PMC9332357 DOI: 10.3390/ijerph19159031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
Background: Tracheostomy is a procedure commonly conducted in patients undergoing emergency admission and requires prolonged mechanical ventilation. In the present study, the aim was to determine the prevalence and risk factors of mortality among emergently admitted patients with tracheostomy complications, during the years 2005−2014. Methods: This was a retrospective cohort study. Demographics and clinical data were obtained from the National Inpatient Sample, 2005−2014, to evaluate elderly (65+ years) and non-elderly adult patients (18−64 years) with tracheostomy complications (ICD-9 code, 519) who underwent emergency admission. A multivariable logistic regression model with backward elimination was used to identify the association between predictors and in-hospital mortality. Results: A total of 4711 non-elderly and 3315 elderly patients were included. Females included 44.5% of the non-elderly patients and 47.6% of the elderly patients. In total, 181 (3.8%) non-elderly patients died, of which 48.1% were female, and 163 (4.9%) elderly patients died, of which 48.5% were female. The mean (SD) age of the non-elderly patients was 50 years and for elderly patients was 74 years. The mean age at the time of death of non-elderly patients was 53 years and for elderly patients was 75 years. The odds ratio (95% confidence interval, p-value) of some of the pertinent risk factors for mortality showed by the final regression model were older age (OR = 1.007, 95% CI: 1.001−1.013, p < 0.02), longer hospital length of stay (OR = 1.008, 95% CI: 1.001−1.016, p < 0.18), cardiac disease (OR = 3.21, 95% CI: 2.48−4.15, p < 0.001), and liver disease (OR = 2.61, 95% CI: 1.73−3.93, p < 0.001). Conclusion: Age, hospital length of stay, and several comorbidities have been shown to be significant risk factors in in-hospital mortality in patients admitted emergently with the primary diagnosis of tracheostomy complications. Each year of age increased the risk of mortality by 0.7% and each additional day in the hospital increased it by 0.8%.
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Magge A, Oberg CL. Interventional Pulmonology and the Esophagus: Tracheostomy and Percutaneous Endoscopic Gastrostomy Placement. Semin Respir Crit Care Med 2022; 43:492-502. [PMID: 35714628 DOI: 10.1055/s-0042-1748763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Tracheostomy is a procedure commonly performed in intensive care units (ICU) for patients who are unable to be weaned from mechanical ventilation. Both percutaneous and surgical techniques have been validated and are chosen based on the local expertise available. A primary advantage to the percutaneous technique is the ability to perform this procedure in the ICU without transporting the patient to a procedure suite or operating room; this has become particularly important with the novel coronavirus disease 2019 (COVID-19) pandemic. An additional advantage is the ability to perform both the tracheostomy and the gastrostomy tube placement, if needed, during the same anesthetic episode. This decreases the need for additional sedation, interruption of anticoagulation, repeat transfusion, and coordination of care between multiple services. In the context of COVID-19, combined tracheostomy and gastrostomy placement exposes less health care providers overall and minimizes transportation needs.
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Affiliation(s)
- Anil Magge
- Section of Interventional Pulmonology, Department of Pulmonary and Critical Care Medicine, Massachusetts General Hospital/Beth Israel Deaconess Medical Center, Massachusetts
| | - Catherine L Oberg
- Section of Interventional Pulmonology, Department of Pulmonary and Critical Care Medicine, Clinical Immunology and Allergy, David Geffen School of Medicine at University of California, Los Angeles, California
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40
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Sánchez-Guerrero JA, Cebrià I Iranzo MÀ, Ferrer-Sargues FJ, Périé S. Feasibility of face mask spirometry during decannulation in head and neck surgery: prospective cohort study. Clin Otolaryngol 2022; 47:521-528. [PMID: 35510380 PMCID: PMC9324810 DOI: 10.1111/coa.13938] [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: 07/06/2021] [Revised: 04/03/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze the relationship between spirometric parameters measured with a face mask versus a mouthpiece, as well as the feasibility of face mask spirometric evaluation in a head and neck surgery (HNS) decannulation context. Furthermore, we examine peak inspiratory flow (PIF) cut-off values before and after decannulation. DESIGN Prospective cohort study. SETTING Otolaryngology HNS Department of a University teaching hospital. PARTICIPANTS Twenty-four patients were selected. A maximal flow-volume loop was conducted before (with mouthpiece) and after (with mouthpiece and face mask) decannulation. MAIN OUTCOME MEASURES Recorded outcomes were forced vital capacity (FVC), forced expiratory volume in the first second, peak expiratory flow, PIF, forced expiratory flow at 50% of FVC and forced inspiratory flow at 50% of FVC. Spearman correlation coefficients between spirometric parameters measured with a face mask versus a mouthpiece were calculated. Wilcoxon test was used to check differences between mouthpiece and face mask values. RESULTS Correlation between mouthpiece and face mask spirometric values was moderate to high (r = 0.46 to 0.95). All parameters measured by spirometry were significantly lower with a face mask than those obtained with a mouthpiece (p < 0.05). Before decannulation, the lowest PIF value (tested with mouthpiece) that allowed successful decannulation was 1 L/s. After decannulation, the lowest PIF value tested with mouthpiece and face mask for successful completion of the decannulation process were 0.77 and 0.56 L/s, respectively. CONCLUSION Face mask is a feasible option to perform a spirometry when face diseases hinder spirometric evaluation through a mouthpiece in an HNC surgery context.
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Affiliation(s)
- José Antonio Sánchez-Guerrero
- Department of Otolaryngology Head Neck Surgery, Faculty Medicine, Assistance Publique Hôpitaux Paris (APHP), Sorbonne University, Paris, France
| | - Maria Àngels Cebrià I Iranzo
- Department of Otolaryngology Head Neck Surgery, Faculty Medicine, Assistance Publique Hôpitaux Paris (APHP), Sorbonne University, Paris, France
| | - Francisco José Ferrer-Sargues
- Department of Otolaryngology Head Neck Surgery, Faculty Medicine, Assistance Publique Hôpitaux Paris (APHP), Sorbonne University, Paris, France
| | - Sophie Périé
- Department of Otolaryngology Head Neck Surgery, Faculty Medicine, Assistance Publique Hôpitaux Paris (APHP), Sorbonne University, Paris, France
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Pulmonary infection in traumatic brain injury patients undergoing tracheostomy: predicators and nursing care. BMC Pulm Med 2022; 22:130. [PMID: 35392885 PMCID: PMC8988413 DOI: 10.1186/s12890-022-01928-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Pulmonary infection is common yet serious complication in patients with severe traumatic brain injury (STBI). We aimed to evaluate the predicators of pulmonary infection in STBI patients undergoing tracheostomy, to provide evidence for the clinical nursing care of STBI patients. Methods This study was a retrospective cohort design. STBI patients undergoing tracheostomy treatment from January 1, 2019 to August 31, 2021 in our hospital were included. The characteristics of pulmonary infection and no pulmonary infection patients were analyzed. Results A total 216 STBI patients undergoing tracheostomy were included, the incidence of pulmonary infection was 26.85%. Diabetes (r = 0.782), hypoproteinemia (r = 0.804), duration of coma(r = 0.672), duration of mechanical ventilation(r = 0.724) and length of hospital stay (r = 0.655), length of hospital stay post tracheostomy (r = 0.554), mortality (r = 0.598) were all correlated with pulmonary infection (all p < 0.05). Klebsiella pneumoniae (33.87%) and Staphylococcus aureus (29.03%) were the most commonly seen pathogens in the pulmonary infection of TBI patients. Logistic regression analyses indicated that diabetes (OR 2.232, 95% CI 1.215–3.904), hypoproteinemia with plasma total protein < 60 g/L (OR 1.922, 95% CI 1.083–3.031), duration of coma ≥ 22 h (OR 2.864, 95% CI 1.344–5.012), duration of mechanical ventilation ≥ 5 days (OR 3.602, 95% CI 1.297–5.626), length of hospital stay ≥ 21 days (OR 2.048, 95% CI 1.022–3.859) were the risk factors of pulmonary infection in TBI patients undergoing tracheostomy (all p < 0.05). Conclusions Further investigations on the early preventions and treatments targeted on those risk factors are needed to reduce the pulmonary infection in clinical practice.
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Menegozzo CAM, Sorbello CCJ, Santos-Jr JP, Rasslan R, Damous SHB, Utiyama EM. Safe ultrasound-guided percutaneous tracheostomy in eight steps and necessary precautions in COVID-19 patients. Rev Col Bras Cir 2022; 49:e20223202. [PMID: 35319567 PMCID: PMC10578852 DOI: 10.1590/0100-6991e-20223202] [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: 10/05/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022] Open
Abstract
Percutaneous tracheostomy has been considered the standard method today, the bronchoscopy-guided technique being the most frequently performed. A safe alternative is ultrasound-guided percutaneous tracheostomy, which can be carried out by the surgeon, avoiding the logistical difficulties of having a specialist in bronchoscopy. Studies prove that the efficacy and safety of the ultrasound-guided technique are similar when compared to the bronchoscopy-guided one. Thus, it is of paramount importance that surgeons have ultrasound-guided percutaneous tracheostomy as a viable and beneficial alternative to the open procedure. In this article, we describe eight main steps in performing ultrasound-guided percutaneous tracheostomy, highlighting essential technical points that can reduce the risk of complications from the procedure. Furthermore, we detail some precautions that one must observe to reduce the risk of aerosolization and contamination of the team when percutaneous tracheostomy is indicated in patients with COVID-19.
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Affiliation(s)
- Carlos Augusto Metidieri Menegozzo
- - Hospital das Clínicas da Faculdade de Medicina da USP, Divisão de Clínica Cirúrgica III - Cirurgia Geral e Trauma - São Paulo - SP - Brasil
| | - Carolina Carvalho Jansen Sorbello
- - Hospital das Clínicas da Faculdade de Medicina da USP, Divisão de Clínica Cirúrgica III - Cirurgia Geral e Trauma - São Paulo - SP - Brasil
| | - Jones Pessoa Santos-Jr
- - Hospital das Clínicas da Faculdade de Medicina da USP, Divisão de Clínica Cirúrgica III - Cirurgia Geral e Trauma - São Paulo - SP - Brasil
| | - Roberto Rasslan
- - Hospital das Clínicas da Faculdade de Medicina da USP, Divisão de Clínica Cirúrgica III - Cirurgia Geral e Trauma - São Paulo - SP - Brasil
| | - Sergio Henrique Bastos Damous
- - Hospital das Clínicas da Faculdade de Medicina da USP, Divisão de Clínica Cirúrgica III - Cirurgia Geral e Trauma - São Paulo - SP - Brasil
| | - Edivaldo Massazo Utiyama
- - Hospital das Clínicas da Faculdade de Medicina da USP, Divisão de Clínica Cirúrgica III - Cirurgia Geral e Trauma - São Paulo - SP - Brasil
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Phuaksaman C, Niyomkarn W, Somboon P, Boonjindasup W, Hantragool S, Sritippayawan S. Long-term Outcomes of Pediatric Tracheostomy Home Care in a Limited Resource Setting of Professional Home Nurse. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221082661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Long-term outcomes of pediatric patients with a tracheostomy in developing countries where professional home nurse is not accessible has rarely been reported. We, therefore, investigated the prevalence and associating factors of long-term outcomes in these children. Retrospective chart review was conducted in 85 tracheostomized children who were discharged to home during January 2012 to December 2020. Tracheostomy home care was provided by caregivers who completed the tracheostomy home care program. Prevalence of unplanned readmission with acute respiratory problems within 30 days after the first hospital discharge was 17.6%. Lower respiratory tract infection (LRTI) after hospital discharge was found in 72.9% (median frequency of 1.0 episode/case/year). Among 80 children who had surveillance airway endoscopy, 46.3% demonstrated late tracheostomy-related airway complications. Independent factor associated with late tracheostomy-related airway complications was a follow-up period longer than 1 year. Decannulation success was found in 21.2%. Most of them had tracheostomy for their upper airway anomalies. The mortality rate was 7%. Most of them died from their underlying diseases. In conclusion, pediatric tracheostomy home care undertaken by caregivers is feasible in developing countries where home nurse is not available. The prevalence of unplanned readmission with acute respiratory problems within 30 days after hospital discharge and late tracheostomy-related airway complications were comparable with those reported in developed countries. However, we still had a high prevalence of post-tracheostomy LRTI which was a challenging problem that needed to be investigated and resolved.
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Miyata J, Dateoka K, Yoshioka T. Acute airway obstruction by a mucus plug in a patient with a 12-year history of inserting a double cannula tracheostomy tube: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221100874. [PMID: 35619750 PMCID: PMC9127856 DOI: 10.1177/2050313x221100874] [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] [Received: 09/08/2021] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
Acute airway obstruction long after tracheostomy has rarely been reported. An 81-year-old Japanese woman with a tracheostomy tube for 12 years developed a 2-day history of coughing-up sputum with difficulty, foreign body sensation, and mild dyspnea. Dyspnea worsened immediately after computed tomography, showing soft tissue opacity between the tip of the tracheostomy tube and the bronchi. A movable mass in the trachea, identified as mucus by pathological examination, was removed using bronchoscopy. Acute airway obstruction by a mucus plug potentially occurred with a long history of insertion of a tracheostomy tube. Emergency imaging studies and bronchoscopy were useful for management.
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Affiliation(s)
- Jun Miyata
- Department of Family Medicine, Medical Center for the Entire Family, Keiju Medical Center, Nanao, Japan
- Keiju Laurel Clinic, Nanao, Japan
| | - Kaname Dateoka
- Department of Family Medicine, Medical Center for the Entire Family, Keiju Medical Center, Nanao, Japan
- Keiju Laurel Clinic, Nanao, Japan
| | - Tetsuya Yoshioka
- Department of Family Medicine, Medical Center for the Entire Family, Keiju Medical Center, Nanao, Japan
- Keiju Laurel Clinic, Nanao, Japan
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Zaki HA, Zahran A, Elsafti Elsaeidy AM, Shaban AE, Shaban EE. A Case of Complicated Traumatic Generalized Surgical Emphysema, Pneumomediastinum, Pneumopericardium, Pneumothorax, and Pneumoperitoneum Due to Accidental Dislodgement of Tracheostomy Tube. Cureus 2021; 13:e20762. [PMID: 35111448 PMCID: PMC8794462 DOI: 10.7759/cureus.20762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/28/2022] Open
Abstract
A tracheostomy tube (TT) is usually taken out in a well-planned and coordinated manner after the underlying condition that necessitated the procedure is resolved. The inadvertent removal or dislodgement of the TT from the stroma is known as accidental extubation or decannulation. This event may prove fatal in a stable patient. Like other respiratory procedures, tracheostomy with the long-term placement of tracheal tube comes with several risks, including scarring of the trachea, pneumothorax, tracheal rupture, and tracheoesophageal fistula. Other complications may include pneumomediastinum (PM) or the escape of air into the surrounding tissue. This may be attributed to several reasons, including mispositioning of the tracheal tube, barotrauma, or tracheal rupture. In some cases, PM presents with free air into cavities such as the thorax, peritoneum, or subcutaneous tissue. Although not fatal, it may require complex treatments such as ventilator management, high-flow oxygen, or, in some cases, surgical intervention. In this article, we describe a rare case of PM and generalized surgical emphysema due to mispositioning of the tracheal tube.
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Tube tip in pharynx-a conduit for awake oral intubation in patients with extremely restricted mouth opening. Can J Anaesth 2021; 69:504-508. [PMID: 34907504 DOI: 10.1007/s12630-021-02174-0] [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: 06/07/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Awake flexible bronchoscope-guided intubation is challenging in patients with extremely limited mouth opening (when there is inadequate space for an oropharyngeal airway), especially when nasal access is unavailable. Alternatives include awake front of neck access, which is an invasive procedure and not suitable for elective surgery. We present a novel technique to facilitate flexible bronchoscope-guided oral intubation in these patients. CLINICAL FEATURES Tube tip in pharynx (TTIP) is a technique for establishing a patent airway if ventilation is difficult or has failed using a face mask, supraglottic airway, or endotracheal tube. The technique involves placing the tip of the endotracheal tube in the pharynx, 10-14 cm past the teeth, filling the cuff with air, closing the mouth and nose of the patient, and then initiating ventilation. The TTIP method thus combines the function of an oropharyngeal airway and a face mask akin to a supraglottic airway device, but is more flexible with regard to insertion depth and cuff inflation and demands only minimal mouth opening. We have adapted the TTIP technique for awake flexible bronchoscope-guided oral intubation and report the technique illustrated with three cases where mouth opening was so restricted that it precluded insertion of an oropharyngeal airway. CONCLUSION By placing an endotracheal tube with the tip in the pharynx, TTIP can establish a conduit for awake oral flexible bronchoscope-guided intubation in patients with extremely limited mouth opening and unavailable nasal access. This technique requires equipment that is readily available and may help avoid unnecessary awake tracheostomy.
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Zouk AN, Batra H. Managing complications of percutaneous tracheostomy and gastrostomy. J Thorac Dis 2021; 13:5314-5330. [PMID: 34527368 PMCID: PMC8411191 DOI: 10.21037/jtd-19-3716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/05/2020] [Indexed: 01/02/2023]
Abstract
Percutaneous tracheostomy and gastrostomy are some of the most commonly performed procedures at bedside in the intensive care unit. While they are generally considered safe, they can be associated with numerous short and long-term complications, many of which can occur long after their placement and cause significant morbidity. Performers of these procedures should possess a comprehensive understanding of procedural indications and contraindications, and know how to recognize and manage complications that may arise. In this review, we highlight complications of percutaneous tracheostomy and describe strategies for their prevention and management, with a special focus on post-tracheostomy tracheal stenosis. Other complications reviewed include bleeding, pneumothorax and subcutaneous emphysema, posterior wall injury, tube displacement, tracheomalacia, tracheoinominate artery fistula, tracheo-esophageal fistula, and stomal cellulitis. Gastrostomy complications and their management are also discussed including bleeding, internal organ injury, necrotizing fasciitis, aspiration pneumonia, buried bumper syndrome, tumor seeding, wound infection, tube displacement, peristomal leakage, and gastric outlet obstruction. In light of the potentially serious outcomes associated with complications of percutaneous tracheostomy and gastrostomy, the emphasis should be placed on risk-reduction strategies to minimize morbidity and mortality. We therefore present detailed pragmatic and comprehensive checklists to serve as a reference for clinicians involved in performing these procedures.
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Affiliation(s)
- Aline N Zouk
- Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hitesh Batra
- Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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48
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Newton M, Johnson RF, Wynings E, Jaffal H, Chorney SR. Pediatric Tracheostomy-Related Complications: A Cross-sectional Analysis. Otolaryngol Head Neck Surg 2021; 167:359-365. [PMID: 34520273 DOI: 10.1177/01945998211046527] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the rate of tracheostomy-related complications in pediatric patients from nationally representative databases. STUDY DESIGN Cross-sectional analysis. SETTING 2016 Kids' Inpatient Database and 2016 Nationwide Readmission Database. METHODS All pediatric tracheostomy procedures were included. Complication type, admission outcomes, and readmission rates were recorded with a logistic regression analysis to determine patient characteristics associated with complications. RESULTS An estimated 5309 tracheostomies were performed among pediatric patients in 2016, 8% (n = 432) of whom developed tracheostomy-related complications. This group was younger (4.7 vs 8.7 years, P < .001) and required longer hospital admissions (68.7 vs 33.2 days, P < .001) than children without tracheostomy-related complications. Mean costs ($459,324 vs $397,937, P < .001) and mean total charges ($1,573,964 vs $1,099,347, P < .001) were increased if a tracheostomy-related complication occurred. These events occurred more often in those with bronchopulmonary dysplasia (24% vs 12%, P < .001), heart disease (24% vs 12%, P = .001), gastroesophageal reflux disease (31% vs 19%, P < .001), short gestational age (24% vs 14%, P < .001), and subglottic stenosis (9.9% vs 5.4%, P = .001). The estimated 30-day readmission rate was 24% (SE, 1.7%) but did not increase after tracheostomy complications (27% vs 15%, P = .04). Tracheostomy-related complications were predicted by gastroesophageal reflux disease (odds ratio [OR], 1.50; 95% CI, 1.14-1.97; P = .004), younger age (OR, 1.12; 95% CI, 1.04-1.22; P = .002), and lengthier hospitalization (OR, 1.00; 95% CI, 1.00-1.01; P < .001) on multiple logistic regression analysis. CONCLUSION Tracheostomy-related complications occur in approximately 8% of pediatric patients and are higher in younger children or those with longer admission lengths. These data have implications for benchmarking standards of posttracheostomy complications across institutions.
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Affiliation(s)
- Micah Newton
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Romaine F Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Children's Health Airway Management Program, Children's Medical Center Dallas, Dallas, Texas, USA
| | - Erin Wynings
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hussein Jaffal
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen R Chorney
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Children's Health Airway Management Program, Children's Medical Center Dallas, Dallas, Texas, USA
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Filice G, Patel P, Kata P, Kanukuntla A, Patel V, Gallagher N, Cheriyath P. An Overview of Outcomes Associated With Early Versus Late Tracheostomy From a National Standpoint. Cureus 2021; 13:e16325. [PMID: 34395112 PMCID: PMC8357015 DOI: 10.7759/cureus.16325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
Tracheostomy is a procedure that is commonly used in critically ill patients who require prolonged mechanical ventilation due to acute respiratory failure or airway problems. The best tracheostomy timing (early vs. late) and techniques (percutaneous dilatational, other new percutaneous procedures, open surgery) have been hotly debated. This research aimed to evaluate the outcome of early versus late tracheostomy in terms of in-hospital mortality, patient length of stay in the hospital, and cost after a detailed analysis and review using National Inpatient Survey (NIS) data. This study indicates that early tracheostomy greatly reduces in-hospital mortality, the need to transfer to skilled nursing facilities as well as direct variables, length of stay, and potentially overall hospital cost in the ICU.
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Affiliation(s)
- Guiseppe Filice
- Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA
| | - Palak Patel
- Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA
| | - Priyaranjan Kata
- Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA
| | - Anish Kanukuntla
- Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA
| | - Vraj Patel
- Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA
| | - Neil Gallagher
- Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA
| | - Pramil Cheriyath
- Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA
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50
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Matsumoto H, Hanada S, Yamamoto K, Takaya H. Endotracheal granulation after tracheostomy in acute respiratory distress syndrome from COVID-19. Respirol Case Rep 2021; 9:e00787. [PMID: 34094572 PMCID: PMC8150530 DOI: 10.1002/rcr2.787] [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: 04/12/2021] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
Granulation tissue formation is one of the late complications of tracheostomy. It can cause stomal stenosis secondary to chondritis because of disproportionate excision of the anterior cartilage. Clinicians should carefully determine the incision point, which is typically located half way between the cricoid cartilage and the sternal notch.
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Affiliation(s)
- Haruko Matsumoto
- Department of Respiratory MedicineToranomon Hospital KajigayaKawasakiJapan
| | - Shigeo Hanada
- Department of Respiratory MedicineToranomon Hospital KajigayaKawasakiJapan
- Okinaka Memorial Institute for Medical ResearchTokyoJapan
| | - Kazumasa Yamamoto
- Department of Respiratory MedicineToranomon Hospital KajigayaKawasakiJapan
| | - Hisashi Takaya
- Department of Respiratory MedicineToranomon Hospital KajigayaKawasakiJapan
- Okinaka Memorial Institute for Medical ResearchTokyoJapan
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