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Zhao OS, Peterson A, Patel K, Wilcox L. Utility of chest x-ray for tracheostomy tube placement in pediatric patients. Laryngoscope Investig Otolaryngol 2024; 9:e1302. [PMID: 38984073 PMCID: PMC11231926 DOI: 10.1002/lio2.1302] [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: 02/15/2024] [Revised: 06/03/2024] [Accepted: 06/23/2024] [Indexed: 07/11/2024] Open
Abstract
Objective To evaluate the utility of ordering chest x-rays after pediatric tracheostomy tube placement in identifying acute, post-operative complications and how it impacts clinical decision-making. Methods In this retrospective cohort study, we identified tracheostomies performed in 139 pediatric patients through CPT codes over a 5-year period from 2013 to 2018. Manual chart review was performed for demographic and clinical characteristics, pre-procedure and post-procedure chest x-ray interpretations, and the presence of complications. Each complication was reviewed to see if action was taken due to post-procedure chest x-ray findings. Multivariable logistic regression was performed to determine associations with changes in pre-procedure versus post-procedure chest x-rays. Results In a cohort of 139 pediatric patients with pre-procedure and post-procedure chest x-rays, 40 (28.8%) of patients had new significant post-procedure chest x-ray findings compared to pre-procedure chest x-ray findings. Of these 40 instances of changes in pre-procedure versus post-procedure chest x-ray findings, only eight resulted in action being taken due to the observed findings. Among these eight instances of action being taken, only one instance involved in invasive action being taken with a bronchoscopy. With multivariable regression analysis, patient age, race, gender, and the presences of genetic syndromes, were not found to be significant risk factors in predicting changes in pre-procedure versus post-procedure chest x-ray. Conclusion In our study, post-procedure chest x-ray after tracheostomy tube placement did not significantly impact clinical decision making. It may be worth reconsidering the value in routine chest x-rays after tracheostomy tube placement in pediatric patients.
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Affiliation(s)
- Oliver S. Zhao
- Department of Otolaryngology: Head and Neck SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - April Peterson
- Department of Otolaryngology: Head and Neck SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Kalpnaben Patel
- Department of Otolaryngology: Head and Neck SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Lyndy Wilcox
- Department of Otolaryngology: Head and Neck SurgeryVanderbilt University Medical CenterNashvilleTennesseeUSA
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2
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Ghattas C, Alsunaid S, Pickering EM, Holden VK. State of the art: percutaneous tracheostomy in the intensive care unit. J Thorac Dis 2021; 13:5261-5276. [PMID: 34527365 PMCID: PMC8411160 DOI: 10.21037/jtd-19-4121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/27/2020] [Indexed: 12/24/2022]
Abstract
Percutaneous tracheostomy is a commonly performed procedure for patients in the intensive care unit (ICU) and offers many benefits, including decreasing ICU length of stay and need for sedation while improving patient comfort, effective communication, and airway clearance. However, there is no consensus on the optimal timing of tracheostomy in ICU patients. Ultrasound (US) and bronchoscopy are useful adjunct tools to optimize procedural performance. US can be used pre-procedurally to identify vascular structures and to select the optimal puncture site, intra-procedurally to assist with accurate placement of the introducer needle, and post-procedurally to evaluate for a pneumothorax. Bronchoscopy provides real-time visual guidance from within the tracheal lumen and can reduce complications, such as paratracheal puncture and injury to the posterior tracheal wall. A step-by-step detailed procedural guide, including preparation and procedural technique, is provided with a team-based approach. Technical aspects, such as recommended equipment and selection of appropriate tracheostomy tube type and size, are discussed. Certain procedural considerations to minimize the risk of complications should be given in circumstances of patient obesity, coagulopathy, or neurologic illness. Herein, we provide a practical state of the art review of percutaneous tracheostomy in ICU patients. Specifically, we will address pre-procedural preparation, procedural technique, and post-tracheostomy management.
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Affiliation(s)
- Christian Ghattas
- Division of Pulmonary, Critical Care, & Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sammar Alsunaid
- Division of Pulmonary & Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Edward M Pickering
- Division of Pulmonary & Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Van K Holden
- Division of Pulmonary & Critical Care Medicine, Section of Interventional Pulmonology, University of Maryland School of Medicine, Baltimore, MD, USA
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3
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Yener N, Üdürgücü M, Alaçam F, Şükrü Paksu M, Sarı İ, Ceyhan Bilgici M. Should pulmonary radiographs be taken routinely following paediatric tracheostomy? Asian Cardiovasc Thorac Ann 2021; 30:245-248. [PMID: 33779303 DOI: 10.1177/02184923211006312] [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: 11/16/2022]
Abstract
AIM As the rates of complications related to tracheostomy procedures have fallen in recent years, the routine taking of pulmonary radiographs following tracheostomy has become a matter of debate. The aim of this study was to compare the incidence of complications developing in 120 children who had pulmonary radiographs taken following surgical tracheostomy and to thereby evaluate the necessity of routine pulmonary radiographs after tracheostomy. METHODS The data were retrospectively reviewed of 120 children who had pulmonary radiographs taken following surgical tracheostomy between January 2012 and January 2018. The pulmonary radiographs taken before and immediately after tracheostomy were evaluated independently by two paediatric radiology specialists and the results were recorded. RESULTS The incidence of complications after tracheostomy was determined as 23.3%, and no pneumothorax was determined in any patient. An increase was not seen in the complication incidence in those who had undergone emergency tracheostomy and patients aged < 2 years, which are accepted as high-risk groups. In the evaluation of the pre- and post-tracheostomy radiographs, new findings were determined on the post-tracheostomy radiograph that had not been there previously in eight patients (6.6%). These findings were newly formed infiltration in seven patients (5.8%), and malposition of the tracheostomy tube in one patient (0.8%). No pathology requiring intervention was determined on the radiographs of any patient. CONCLUSION The results of this study support the view that it is not necessary to take pulmonary radiographs routinely following tracheostomy in the paediatric age group, including those at higher risk.
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Affiliation(s)
- Nazik Yener
- Division of Pediatric Critical Care, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Muhammed Üdürgücü
- Division of Pediatric Critical Care, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Fatma Alaçam
- Department of Pediatrics, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Muhammed Şükrü Paksu
- Division of Pediatric Critical Care, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - İrem Sarı
- Division of Pediatric Radiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Meltem Ceyhan Bilgici
- Division of Pediatric Radiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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Nam IC, Shin YS, Jeong WJ, Park MW, Park SY, Song CM, Lee YC, Jeon JH, Lee J, Kang CH, Park IS, Kim K, Sun DI. Guidelines for Tracheostomy From the Korean Bronchoesophagological Society. Clin Exp Otorhinolaryngol 2020; 13:361-375. [PMID: 32717774 PMCID: PMC7669309 DOI: 10.21053/ceo.2020.00353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/19/2020] [Indexed: 12/17/2022] Open
Abstract
The Korean Bronchoesophagological Society appointed a task force to develop a clinical practice guideline for tracheostomy. The task force conducted a systematic search of the Embase, Medline, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to key questions. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. An external expert review and a Delphi questionnaire were conducted to reach a consensus regarding the recommendations. Accordingly, the committee developed 18 evidence-based recommendations, which are grouped into seven categories. These recommendations are intended to assist clinicians in performing tracheostomy and in the management of tracheostomized patients.
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Affiliation(s)
| | - Inn-Chul Nam
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo Seob Shin
- Department of Otolaryngology-Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Min Woo Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jongmin Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Il Sun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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5
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Geng Y, Diao R, Lv H, Zhang Y. Pneumomediastinum and Subcutaneous Emphysema After Tracheotomy Tube Decannulation. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Singh J, Sing RF. Performance, Long-term Management, and Coding for Percutaneous Dilational Tracheostomy. Chest 2019; 155:639-644. [DOI: 10.1016/j.chest.2018.10.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 10/07/2018] [Accepted: 10/31/2018] [Indexed: 01/10/2023] Open
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McGrath BA, Lynch K, Templeton R, Webster K, Simpson W, Alexander P, Columb MO. Assessment of scoring systems to describe the position of tracheostomy tubes within the airway - the lunar study. Br J Anaesth 2018; 118:132-138. [PMID: 28039250 DOI: 10.1093/bja/aew336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Malposition of tracheostomy tubes is difficult to detect at the bedside and may contribute to eventual device misplacement. Endoscopic examination can be undertaken via tracheoscopic (T-view) or trans-laryngeal (L-view) approach, offering more precise detail regarding positioning within the airway. The aims of this study were to evaluate inter-rater agreement between bespoke T and L view scoring systems and subsequently whether T-views could predict L-views. METHODS Adult intensive care unit patients with percutaneous or surgical tracheostomies were included and paired T and L-views of their tracheostomy tube within the airway were taken on up to four occasions. Images were later scored by five independent raters using bespoke scoring systems. The primary outcome was to determine the T and L view scoring system with the best inter-rater agreement, defined by weighted kappa and intra-class correlation coefficients. The secondary outcome was to assess agreement between T and L-view scoring systems. RESULTS Seventy-one T-views and 43 L-views were obtained from a total of 20 patients. Images were scored by five raters, resulting in 355 T-view scores, 215 L-view scores and 215 paired T and L-view scores for comparison. There was good inter-rater agreement (highest T-view k = 0.84, L-view k = 0.72). There was poor agreement between T and L-view scores for each of the paired images (highest k = 0.25) although extreme-to-extreme misclassification rates remained acceptable. CONCLUSIONS Whilst our data demonstrated good inter-rater agreement between scoring systems, it is not possible to reliably predict the T-view orientation and position of a tracheostomy tube within the airway from the paired L-view. CLINICAL TRIAL REGISTRATION NCT01356719.
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Affiliation(s)
- B A McGrath
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of South Manchester, Manchester, UK .,Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, Manchester, UK
| | - K Lynch
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of South Manchester, Manchester, UK
| | - R Templeton
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of South Manchester, Manchester, UK
| | - K Webster
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of South Manchester, Manchester, UK
| | - W Simpson
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of South Manchester, Manchester, UK
| | - P Alexander
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of South Manchester, Manchester, UK
| | - M O Columb
- Department of Anaesthesia and Intensive Care Medicine, University Hospital of South Manchester, Manchester, UK
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8
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Doherty C, Neal R, English C, Cooke J, Atkinson D, Bates L, Moore J, Monks S, Bowler M, Bruce IA, Bateman N, Wyatt M, Russell J, Perkins R, McGrath BA. Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies. Anaesthesia 2018; 73:1400-1417. [PMID: 30062783 DOI: 10.1111/anae.14307] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 01/09/2023]
Abstract
Temporary and permanent tracheostomies are required in children to manage actual or anticipated long-term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.
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Affiliation(s)
- C Doherty
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Neal
- Paediatric Intensive Care Medicine, Paediatrics, Birmingham Children's Hospital, Birmingham, UK
| | - C English
- Department of Paediatric ENT, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Cooke
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - D Atkinson
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - L Bates
- Department of Anaesthesia and Intensive Care Medicine, Royal Bolton Hospital, Bolton, UK
| | - J Moore
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Monks
- Department of Anaesthesia, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - M Bowler
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - I A Bruce
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - N Bateman
- Department of Paediatric Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
| | - M Wyatt
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - J Russell
- Department of Paediatric ENT, Our Lady's Children's Hospital, Dublin, Ireland
| | - R Perkins
- Department of Paediatric Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - B A McGrath
- Department of Anaesthesia and Intensive Care Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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9
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Lamperti M, Caldiroli D. Tracheal visualization during tracheostomy: the dark side of the moon or just the moon and mars. Br J Anaesth 2017; 118:8-10. [PMID: 28039237 DOI: 10.1093/bja/aew406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Lamperti
- General Anesthesia Department, Cleveland Clinic Lerner College of Medicine, Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, Po Box 112412, UAE
| | - D Caldiroli
- Neuroanaesthesia and Neuroicu Department, Neurological Institute Besta, Via Celoria 11, Milano, 20136, Italy
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10
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de la Matta-Martín M, Galán MJ, Gallego J. Pneumomediastinum and pneumothorax during emergency tracheotomy under spontaneous ventilation: Macklin meets Müeller? REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:231-234. [PMID: 26626433 DOI: 10.1016/j.redar.2015.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 06/05/2023]
Abstract
Potentially serious complications associated to emergency tracheotomy continue being a matter of concern. We review the pathogenesis of gas leakage in this setting and discuss about the possible mechanisms involved in its cause. We present two cases of pneumomediastinum, subcutaneous emphysema and pneumothorax in the context of emergency tracheotomy under spontaneous ventilation, finally resolved by chest drainage. The combination of overly negative pleural pressures due to extreme inspiratory efforts in the context of an almost completely obstructed airway together with over-pressurized alveoli because of gaseous entrapment secondary to serious expiratory obstruction appears to be the most plausible primary cause of air leaks in our patients. Understanding the underlying mechanisms evolved in its production will help clinicians to suspect and diagnose this phenomenon.
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Affiliation(s)
- M de la Matta-Martín
- Unidad de gestión clínica Bloque quirúrgico, Hospital General, Hospital Universitario Virgen del Rocío de Sevilla, Spain.
| | - M J Galán
- Unidad de gestión clínica Bloque quirúrgico, Hospital General, Hospital Universitario Virgen del Rocío de Sevilla, Spain
| | - J Gallego
- Unidad de gestión clínica Bloque quirúrgico, Hospital General, Hospital Universitario Virgen del Rocío de Sevilla, Spain
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Tracheostomy in neurologically compromised paediatric patients: role of starplasty. The Journal of Laryngology & Otology 2015; 129:1009-12. [PMID: 26279145 DOI: 10.1017/s002221511500208x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Starplasty tracheostomy is an alternative to traditional tracheostomy. This paper reviews neurologically compromised paediatric patients with tracheostomies and discusses the role of starplasty tracheostomy. METHOD A retrospective review was conducted of paediatric patients with a neurological disorder who underwent tracheostomy between 1997 and 2011. RESULTS Forty-eight patients, with an average age of 7.3 years, were identified. The most common indications for tracheostomy were: ventilator dependence (39.6 per cent), an inability to tolerate secretions or recurrent aspiration pneumonia (33.3 per cent), and upper respiratory obstruction or hypotonia (12.5 per cent). The most common underlying neurological diagnosis was cerebral palsy. There were no early complications. Eighteen (43 per cent) of 42 patients with follow up experienced at least 1 delayed complication. Only 12 patients (28.6 per cent) were decannulated. CONCLUSION Patients with primary neurological diagnoses have low rates of decannulation; starplasty tracheostomy should be considered for these patients. Patients with seizure disorder or acute neurological injury tended to have a higher short-term decannulation rate; traditional tracheostomy is recommended in these patients.
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12
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Bjerregaard LS, Jensen K, Petersen RH, Hansen HJ. Routinely obtained chest X-rays after elective video-assisted thoracoscopic surgery can be omitted in most patients; a retrospective, observational study. Gen Thorac Cardiovasc Surg 2015; 63:465-71. [PMID: 26007694 DOI: 10.1007/s11748-015-0560-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate whether the use of routinely obtained chest X-rays is necessary after elective VATS. METHODS We retrospectively reviewed 1097 chest X-rays obtained routinely after elective VATS, performed in patients aged over 15 years during an 18-month period. VATS procedures were divided into three groups according to the degree of pulmonary resection. The chest X-rays (obtained anterior-posterior in one plane with the patient in the supine position) were categorized as abnormal if showing pneumothorax >5 cm, possible intra-thoracic bleeding and/or a displaced chest tube. Medical charts were reviewed for all patients with abnormal chest X-rays to see if an intervention was made based on the X-ray. In case of an intervention, detailed clinical data were collected. RESULTS 44 of 1097 chest X-rays (4.0 %) were abnormal and 10 of these X-rays (0.9 %) led to a clinical intervention. Proportions of abnormal chest X-rays were unequally distributed between groups (p < 0.001), whereas the number of interventions was not (p = 0.43). Of the ten chests X-rays that led to an intervention, three showed possible intra-thoracic bleeding, six showed pneumothorax >5 cm and one showed a kinked chest tube. All the patients with possible intra-thoracic bleeding were re-explored in the operating theatre the same day. CONCLUSIONS Only 10 of 1097 chest X-rays (0.9 %) obtained routinely after elective VATS procedures led to a clinical intervention, supporting the abandon of routine chest X rays in favour of a more individualised approach, based on clinical observations.
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Affiliation(s)
- Lars S Bjerregaard
- Department of Cardiothoracic Anaesthesia and Section for Surgical Pathophysiology, Rigshospitalet Dept. 7621, Copenhagen University Hospital, Copenhagen, Denmark,
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