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Añón JM, Arellano MS, Pérez-Márquez M, Díaz-Alvariño C, Márquez-Alonso JA, Rodríguez-Peláez J, Nanwani-Nanwani K, Martín-Pellicer A, Civantos B, López-Fernández A, Seises I, García-Nerín J, Figueira JC, Casero H, Vejo J, Agrifoglio A, Cachafeiro L, Díaz-Almirón M, Villar J. The role of routine FIBERoptic bronchoscopy monitoring during percutaneous dilatational TRACHeostomy (FIBERTRACH): a study protocol for a randomized, controlled clinical trial. Trials 2021; 22:423. [PMID: 34187554 PMCID: PMC8240418 DOI: 10.1186/s13063-021-05370-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background Tracheostomy is one of the most frequent techniques in intensive care units (ICU). Fiberoptic bronchoscopy (FB) is a safety measure when performing a percutaneous dilatational tracheostomy (PDT), but the controversy surrounding the routine use of FB as part of the procedure remains open. National surveys in some European countries showed that the use of FB is non-standardized. Retrospective studies have not shown a significant difference in complications between procedures performed with or without a bronchoscope. International guidelines have not been able to establish recommendations regarding the use of FB in PDT due to lack of evidence. Design This is a multicenter (three centers at the time of publishing this paper) randomized controlled clinical trial to examine the safety of percutaneous tracheostomy using FB. We will include all consecutive adult patients admitted to the ICU in whom percutaneous tracheostomy for prolonged mechanical ventilation is indicated and with no exclusion criteria for using FB. Eligible patients will be randomly assigned to receive blind PDT or PDT under endoscopic guidance. All procedures will be performed by experienced intensivists in PDT and FB. A Data Safety and Monitoring Board (DSMB) will monitor the trial. The primary outcome is the incidence of perioperative complications. Discussion FB is a safe technique when performing PDT although its use is not universally accepted in all ICUs as a routine practice. Should PDT be monitored routinely with endoscopic guidance? This study will assess the role of FB monitoring during PDT. Trial registration ClinicalTrials.gov NCT04265625. Registered on February 11, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05370-x.
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Affiliation(s)
- José M Añón
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. .,Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain. .,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - María Soledad Arellano
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Claudia Díaz-Alvariño
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Jorge Rodríguez-Peláez
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Kapil Nanwani-Nanwani
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | - Belén Civantos
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Alba López-Fernández
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Irene Seises
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Jorge García-Nerín
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Juan C Figueira
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Henar Casero
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Javier Vejo
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Alexander Agrifoglio
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Lucía Cachafeiro
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | - Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.,Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.,Keenan Research Center for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
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2
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Abbott F, Ortega M, Bravo S, Basoalto R, Kattan E. Can we improve teaching and learning of percutaneous dilatational tracheostomy's bronchoscopic guidance? SAGE Open Med 2021; 9:20503121211002321. [PMID: 33796301 PMCID: PMC7983236 DOI: 10.1177/20503121211002321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
Percutaneous dilatational tracheostomy has become the technique of choice in multiple intensive care units. Among innovations to improve procedural safety and success, bronchoscopic guidance of percutaneous dilatational tracheostomy has been advocated and successfully implemented by multiple groups. Most published literature focuses on the percutaneous dilatational tracheostomy operator, with scarce descriptions of the bronchoscopic particularities of the procedure. In this article, we provide 10 suggestions to enhance specific procedural aspects of bronchoscopic guidance of percutaneous dilatational tracheostomy, and strategies to optimize its teaching and learning, in order to promote learners' competence acquisition and increase patient safety.
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Affiliation(s)
- Francisco Abbott
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Departamento de Enfermedades
Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Marcos Ortega
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Departamento de Enfermedades
Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Sebastian Bravo
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Roque Basoalto
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
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3
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Simulation-Based Mastery Learning of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy. Simul Healthc 2020; 16:157-162. [DOI: 10.1097/sih.0000000000000491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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4
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Dawson C, Riopelle SJ, Skoretz SA. Translating Dysphagia Evidence into Practice While Avoiding Pitfalls: Assessing Bias Risk in Tracheostomy Literature. Dysphagia 2020; 36:409-418. [PMID: 32623527 DOI: 10.1007/s00455-020-10151-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/20/2020] [Indexed: 11/29/2022]
Abstract
Critically ill patients who require a tracheostomy often have dysphagia. Widespread practice guidelines have yet to be developed regarding the acute assessment and management of dysphagia in patients with tracheostomy. In order for clinicians to base their practice on the best available evidence, they must first assess the applicable literature and determine its quality. To inform guideline development, our objective was to assess literature quality concerning swallowing following tracheostomy in acute stages of critical illness in adults. Our systematic literature search (published previously) included eight databases, nine gray literature repositories and citation chasing. Using inclusion criteria determined a priori, two reviewers, blinded to each other, conducted an eligibility review of identified citations. Patients with chronic tracheostomy and etiologies including head and/or neck cancer diagnoses were excluded. Four teams of two reviewers each, blinded to each other, assessed quality of included studies using a modified Cochrane Risk of Bias tool (RoB). Disagreements were resolved by consensus. Data were summarized descriptively according to study design and RoB domain. Of 6,396 identified citations, 74 studies met our inclusion criteria. Of those, 71 were observational and three were randomized controlled trials. Across all studies, the majority (> 75%) had low bias risk with: participant blinding, outcome reporting, and operationally defined outcomes. Areas requiring improvement included assessor and study personnel blinding. Prior to translating the literature into practice guidelines, we recommend attention to study quality limitations and its potential impact on study outcomes. For future work, we suggest an iterative approach to knowledge translation.
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Affiliation(s)
- Camilla Dawson
- School of Audiology and Speech Sciences, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, Great Britain, UK
| | - Stephanie J Riopelle
- School of Audiology and Speech Sciences, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Stacey A Skoretz
- School of Audiology and Speech Sciences, University of British Columbia, 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Department of Critical Care Medicine, University of Alberta, 2-124 Clinical Sciences Building 8440-112 ST NW, Edmonton, AB, T6G 2B7, Canada. .,Centre for Heart Lung Innovation, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,University of Alberta Hospitals, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada.
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5
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Skoretz SA, Riopelle SJ, Wellman L, Dawson C. Investigating Swallowing and Tracheostomy Following Critical Illness: A Scoping Review. Crit Care Med 2020; 48:e141-e151. [PMID: 31939813 DOI: 10.1097/ccm.0000000000004098] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Tracheostomy and dysphagia often coexist during critical illness; however, given the patient's medical complexity, understanding the evidence to optimize swallowing assessment and intervention is challenging. The objective of this scoping review is to describe and explore the literature surrounding swallowing and tracheostomy in the acute care setting. DATA SOURCES Eight electronic databases were searched from inception to May 2017 inclusive, using a search strategy designed by an information scientist. We conducted manual searching of 10 journals, nine gray literature repositories, and forward and backward citation chasing. STUDY SELECTION Two blinded reviewers determined eligibility according to inclusion criteria: English-language studies reporting on swallowing or dysphagia in adults (≥ 17 yr old) who had undergone tracheostomy placement while in acute care. Patients with head and/or neck cancer diagnoses were excluded. DATA EXTRACTION We extracted data using a form designed a priori and conducted descriptive analyses. DATA SYNTHESIS We identified 6,396 citations, of which 725 articles were reviewed and 85 (N) met inclusion criteria. We stratified studies according to content domains with some featuring in multiple categories: dysphagia frequency (n = 38), swallowing physiology (n = 27), risk factors (n = 31), interventions (n = 21), and assessment comparisons (n = 12) and by patient etiology. Sample sizes (with tracheostomy) ranged from 10 to 3,320, and dysphagia frequency ranged from 11% to 93% in studies with consecutive sampling. Study design, sampling method, assessment methods, and interpretation approach varied significantly across studies. CONCLUSIONS The evidence base surrounding this subject is diverse, complicated by heterogeneous patient selection methods, design, and reporting. We suggest ways the evidence base may be developed.
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Affiliation(s)
- Stacey A Skoretz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
- University of Alberta Hospitals, Alberta Health Services, Edmonton, AB, Canada
| | - Stephanie J Riopelle
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Leslie Wellman
- University of Alberta Hospitals, Alberta Health Services, Edmonton, AB, Canada
- Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Camilla Dawson
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, BC, Canada
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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6
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Sasane SP, Telang MM, Alrais ZF, Alrahma AH, Khatib KI. Percutaneous Tracheostomy in Patients at High Risk of Bleeding Complications: A Retrospective Single-center Experience. Indian J Crit Care Med 2020; 24:90-94. [PMID: 32205938 PMCID: PMC7075057 DOI: 10.5005/jp-journals-10071-23341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims To study the bleeding complications in patients undergoing percutaneous tracheostomy and who are at high risk of these complications (due to thrombocytopenia, use of anticoagulant or antiplatelet agents, and difficult anatomy). Materials and methods A retrospective study was undertaken, which included all patients undergoing percutaneous tracheostomy in the medical intensive care unit (MICU) of Rashid Hospital, Dubai, over a period of 15 months. Percutaneous tracheostomy was performed by senior medical intensivists using the single-tapered dilator technique under fiber optic bronchoscopic guidance. All patients underwent ultrasonographic evaluation of the neck to look for difficult anatomy and to determine the size of tracheostomy tube, etc. Patients were divided into two groups, those who were deemed to be at high risk of bleeding complications were compared with patients without any risk factors for bleeding complications. Other complications such as pneumothorax and tracheal leak were also looked for and were documented, if present. The data were summarized using descriptive statistics and the Fischer's exact test of significance was used for frequency distribution cross tables, at 5% level of significance (p value cutoff <0.05). Results One hundred and fifty-nine patients underwent percutaneous tracheostomy during the period of study. The age-group of patients ranged from 21 years to 104 years and males were predominant (65.41%). Of the 87 (54.71%) patients with one or more risk factors for bleeding, 53 (60.92%) patients had at least one risk factor for bleeding complications, while 34 (39.08%) had more than one risk factors. Bleeding was seen in total of two patients out of which one patient was in the group at risk of bleeding complications. Conclusion Percutaneous tracheostomy is a relatively safe procedure with very low rate of complications when performed with due precautions. Even in patients deemed to be at high risk of complications, the rate of complications is very low. How to cite this article Sasane SP, Telang MM, Alrais ZF, Alrahma AHNS, Khatib KI. Percutaneous Tracheostomy in Patients at High Risk of Bleeding Complications: A Retrospective Single-center Experience. Indian J Crit Care Med 2020;24(2):90–94.
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Affiliation(s)
- Sachin P Sasane
- Department of Medical Intensive Care Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Madhavi M Telang
- Department of Medical Intensive Care Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Zeyad F Alrais
- Department of Medical Intensive Care Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Ali Hns Alrahma
- Department of Medical Intensive Care Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Khalid I Khatib
- Department of Medicine, Smt. Kashibai Navale Medical College, Pune, Maharashtra, India
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7
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Huang YH, Tseng CH, Chan MC, Lee BJ, Lin CH, Chang GC. Antiplatelet agents and anticoagulants increased the bleeding risk of bedside percutaneous dilational tracheostomy in critically ill patients. J Formos Med Assoc 2019; 119:1193-1200. [PMID: 31685407 DOI: 10.1016/j.jfma.2019.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/02/2019] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The main objective of this study was to investigate the safety of bedside percutaneous dilational tracheostomy (PDT) by pulmonologists in critically ill patients, and the factors associated with complications resulting from PDT. METHODS We retrospectively enrolled critically ill patients who had undergone bedside PDT in the intensive care units (ICUs) and respiratory care center from February 2016 to December 2018. RESULTS A total of 312 patients were included for analysis, with a mean age of 69.6 ± 17.7 years. Two hundred and eight of the patients were male (66.7%). The mean acute physiology and chronic health evaluation II score was 25.3 ± 6.3, and the mean body mass index was 22.4 ± 4.2. Most of the patients were intubated due to respiratory disorders (51.3%). Fifty-six patients (17.9%) received antiplatelet agents or an anticoagulant regularly prior to PDT. All enrolled patients were undergone bedside PDT successfully. The total complication rate of PDT was 14.4%. Patients who took antiplatelet agents or anticoagulants regularly before PDT had a higher risk of bleeding than patients who went without (26.8% versus 7.0%, adjusted odds ratio 4.93 [95% f 2.16-11.25], p < 0.001). Finally, a longer length of intubation resulted in a higher probability in the length of ICU stay being ≧28 days (adjusted odds ratio 1.11 [95% CI 1.08-1.14], p < 0.001). CONCLUSION Our study demonstrated that it was feasible for pulmonologists to perform bedside PDT in critically ill patients. However, antiplatelet agents and anticoagulants use increased the risk of bleeding in PDT patients.
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Affiliation(s)
- Yen-Hsiang Huang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan.
| | - Chien-Hua Tseng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
| | - Ming-Cheng Chan
- Division of Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; The Science College of Tunghai University, Taichung, Taiwan.
| | - Bor-Jen Lee
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Chih-Hung Lin
- Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Gee-Chen Chang
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Comprehensive Cancer Center, Taichung Veterans General Hospital, Taichung, Taiwan.
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8
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Boran OF, Bilal B, Çakır D, Oksuz H, Yazar FM, Boran M, Orak Y. The Effect of Flexible Lightwand and Ultrasonography Combination on Complications of the Percutaneous Dilatational Tracheostomy Procedure. Cureus 2019; 11:e5232. [PMID: 31565633 PMCID: PMC6758999 DOI: 10.7759/cureus.5232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to evaluate the effect of the flexible lightwand and ultrasonography (USG) combination on reducing the complications in percutaneous dilatational tracheostomy (PDT) opened with the forceps dilatation method. A retrospective examination was made of 138 patients between January 2014 and December 2018. Before starting to process, the anatomic structures of the patients were visualized with USG and the tracheostomy area was marked. Sedation and local anesthesia were applied to patients before the procedure, then the percutaneous tracheostomy was performed using the Griggs technique after confirmation of the tracheostomy localization defined with USG using the transillumination method with a flexible lightwand within an endotracheal tube. Complications that developed associated with the procedure were recorded. The mean age of the patients was 59.1±22.0 years and the mean length of stay in the intensive care unit was 42.3±35.5 days (range, 11-207 days). Overall, complications developed in 22 (15.6%) patients, of which 10.7% were early complications (1.4% related to the tube, 5.8% minor and 3.5% major complications). Tube- related complications were seen to develop in two patients. In the evaluation of the early minor complications, the most frequently seen complication was minor bleeding in 5.8% of the patients. No major vessel bleeding was determined in any patient in the early or late period. Of the late complications, the infection was seen to develop in four (2.8%) patients and stenosis in three (2.1%). The combination of flexible lightwand and USG in the PDT procedure minimized tube-related complications and contributed to the prevention of bleeding complications.
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Affiliation(s)
- Omer Faruk Boran
- Anesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University, Kahramanmaras, TUR
| | - Bora Bilal
- Anesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University, Kahramanmaras, TUR
| | - Deniz Çakır
- Anesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University, Kahramanmaras, TUR
| | - Hafize Oksuz
- Anesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University, Kahramanmaras, TUR
| | - Fatih Mehmet Yazar
- General Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaras, TUR
| | - Maruf Boran
- Internal Medicine Intensive Care Unit, Amasya Şerefeddin Sabuncuoğlu Hospital, Amasya, TUR
| | - Yavuz Orak
- Anesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University, Kahramanmaras, TUR
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Pastene B, Cinotti R, Gayat E, Duranteau J, Lu Q, Montravers P, Pili-Floury S, Rennuit I, Mebazaa A, Leone M. Long-term mortality and quality of life after trauma: an ancillary study from the prospective multicenter trial FROG-ICU. Eur J Trauma Emerg Surg 2019; 47:461-466. [PMID: 31214722 DOI: 10.1007/s00068-019-01176-4] [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: 11/03/2018] [Accepted: 06/13/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The long-term outcomes of intensive care unit (ICU) patients are known to be worse than those of the general population, but they are poorly known in severe trauma patients. We conducted an ancillary examination of the FROG-ICU study to identify risk factors and biomarkers associated with the poorer long-term outcomes and mortality in trauma ICU patients. METHODS Mortality, quality of life (QoL) and stress level scores were obtained 1 year after discharge from ICU. Blood samples were collected at ICU admission and discharge for measurement of inflammatory and cardiovascular biomarkers. RESULTS ICU trauma patients had a significantly lower 1-year mortality than non-trauma patients (7% vs. 23%, p < 0.001), but had worse stress levels scores (19 vs. 13, p = 0.041). No difference was found regarding physical and mental QoL scores (33 vs. 31, p = 0.19 and 30 vs. 28, p = 0.42). Patients with better QoL scores had lower tracheotomy rates (11% vs. 30%, p = 0.01). Worse stress level scores are associated with poor QoL scores and vice versa. Some study biomarkers were significantly higher in those ICU trauma patients who had worse QoL scores at 1 year after discharge. DISCUSSION Our study suggests that quality of life 1 year after an ICU stay is poor and is similar in both trauma and non-trauma patients, but ICU trauma patients are at greater risk of developing post-traumatic stress disorder-related symptoms. Tracheotomy and high levels of inflammatory biomarkers could be associated with impaired quality of life.
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Affiliation(s)
- Bruno Pastene
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France.
| | - Raphaël Cinotti
- Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Saint-Louis, Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France.,Biomarkers in CArdio-Neuro-VAScular Diseases (bioCANVAS), UMR-S 942, Inserm, Paris, France
| | - Etienne Gayat
- Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Saint-Louis, Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France.,Biomarkers in CArdio-Neuro-VAScular Diseases (bioCANVAS), UMR-S 942, Inserm, Paris, France
| | - Jacques Duranteau
- Service de Réanimation Chirurgicale, Hôpital Bicêtre, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Qin Lu
- Service de Réanimation Chirurgicale, Hôpital Universitaire Pitié-Salpêtrière, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Philippe Montravers
- Service de Réanimation Chirurgicale, Hôpital Bichat-Claude Bernard, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Sébastien Pili-Floury
- Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Isabelle Rennuit
- Service de Réanimation Polyvalente, Hôpital Beaujon, Assistance Publiques Hôpitaux de Paris, Paris, France
| | - Alexandre Mebazaa
- Département d'Anesthésie-Réanimation, Hôpitaux Universitaires Saint-Louis, Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France.,Biomarkers in CArdio-Neuro-VAScular Diseases (bioCANVAS), UMR-S 942, Inserm, Paris, France
| | - Marc Leone
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Aix Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
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10
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Johnson RF, Saadeh C. Nationwide estimations of tracheal stenosis due to tracheostomies. Laryngoscope 2018; 129:1623-1626. [PMID: 30569511 DOI: 10.1002/lary.27650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/10/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Tracheal stenosis is a recognized complication of tracheostomy. Yet, the incidence and demographics of tracheal stenosis due to tracheostomies have infrequently been studied. METHODS We performed a cross-sectional analysis of U.S. emergency department (ED) visits, hospital discharges, and readmissions using the 2013 National Emergency Department Sample, 2013 National Inpatient Sample, and 2013 Nationwide Readmission Database for patients with tracheal stenosis due to tracheostomies. Also, we queried the readmission database for new tracheostomy patients who were readmitted within the same calendar year with tracheal stenosis due to the tracheostomy tube. RESULTS There were an estimated 6,156 ED visits; 4,920 hospital discharges; and 2,316 readmissions for tracheal stenosis due to tracheostomies in 2013. These cases represented 28% of all tracheostomy-related complications. Of the 103,484 patients who underwent tracheostomy in 2013, 739 (1.05%) patients were readmitted within the calendar year with tracheal stenosis due to the tracheostomy tube. These stenosis patients' average age was 55 years old. Forty-five percent of the patients were female and 60% were white. The mortality rate was 7.9%. The demographic risk of stenosis mirrored the risk of tracheostomy: increasing age, male gender, and black ethnicity. CONCLUSION Tracheal stenosis due to tracheostomy was uncommon, accounting for 1% of readmissions after tracheostomies, although it represented 28% of tracheostomy-related complications and had a high mortality rate. The risk of stenosis reflected the overall tracheostomy population without apparent age, gender, or racial predilections. LEVEL OF EVIDENCE NA Laryngoscope, 129:1623-1626, 2019.
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Affiliation(s)
- Romaine F Johnson
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Charles Saadeh
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas, U.S.A.,the Department of Pediatric Otolaryngology, Children's Health-Children's Medical Center Dallas, Dallas, Texas, U.S.A
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11
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Cohen O, Shnipper R, Yosef L, Stavi D, Shapira-Galitz Y, Hain M, Lahav Y, Shoffel-Havakuk H, Halperin D, Adi N. Bedside percutaneous dilatational tracheostomy in patients outside the ICU: a single-center experience. J Crit Care 2018; 47:127-132. [PMID: 29957510 DOI: 10.1016/j.jcrc.2018.06.020] [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] [Received: 02/11/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the safety of medical-ward bedside percutaneous dilatational tracheostomy (GWB-PDT). MATERIALS AND METHODS A retrospective study of all patients who underwent elective GWB-PDT between 2009 and 2015. A joint otolaryngology-ICU team performed all GWB-PDTs. The patients were followed until decannulation, discharge or death. Complications were divided into early (within 24 h) and late, and into minor and major. RESULTS Two hundred and fifty six patients were included in the study. The mean age was 77.7 ± 11.8 Medical history included cardiac comorbidities (42.6%) and cerebrovascular accidents (34.4%). Overall, 48 patients (18.9%) had 60 complications, of which 70% (42/60) were minor (13 early; 29 late complications). Fifteen patients (5.9%) had major complications. Eight patients had early major complications (loss of airway - two patients [0.8%], pneumothorax - two patients [0.8%], resuscitation - one patient [0.4%], and a single patient (0.4%) died within 24 h following PDT). Two additional patients (0.8%) underwent conversion to an open tracheostomy. Seven patients had late complications (airway complications in six patients [2.3%] and major bleeding in a single patient [0.4%]). Of the seven patients with late major complications, three had two major complications. Half of the complications occurred by POD 3. CONCLUSION GWB-PDT is a feasible and safe solution for tracheostomies in general-ward ventilated patients.
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Affiliation(s)
- Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel.
| | - Ruth Shnipper
- Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Liron Yosef
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Dekel Stavi
- Intensive Care Unit, Kaplan Medical Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Shapira-Galitz
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Moshe Hain
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Hagit Shoffel-Havakuk
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Doron Halperin
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel; Hebrew University- Hadassah Medical School, Jerusalem, Israel
| | - Nimrod Adi
- Intensive Care Unit, Kaplan Medical Center, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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12
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Lee DH, Jeong JH. Safety and Feasibility of Percutaneous Dilatational Tracheostomy in the Neurocritical Care Unit. JOURNAL OF NEUROCRITICAL CARE 2018. [DOI: 10.18700/jnc.170031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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13
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Bösel J. Use and Timing of Tracheostomy After Severe Stroke. Stroke 2017; 48:2638-2643. [DOI: 10.1161/strokeaha.117.017794] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Julian Bösel
- From the Department of Neurology, University Hospital Heidelberg, Germany
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14
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Romero CM, Cornejo R, Tobar E, Gálvez R, Luengo C, Estuardo N, Neira R, Navarro JL, Abarca O, Ruiz M, Berasaín MA, Neira W, Arellano D, Llanos O. Fiber optic bronchoscopy-assisted percutaneous tracheostomy: a decade of experience at a university hospital. Rev Bras Ter Intensiva 2016; 27:119-24. [PMID: 26340151 PMCID: PMC4489779 DOI: 10.5935/0103-507x.20150022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/12/2015] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the efficacy and safety of percutaneous tracheostomy by means of
single-step dilation with fiber optic bronchoscopy assistance in critical care
patients under mechanical ventilation. Methods Between the years 2004 and 2014, 512 patients with indication of tracheostomy
according to clinical criteria, were prospectively and consecutively included in
our study. One-third of them were high-risk patients. Demographic variables,
APACHE II score, and days on mechanical ventilation prior to percutaneous
tracheostomy were recorded. The efficacy of the procedure was evaluated according
to an execution success rate and based on the necessity of switching to an open
surgical technique. Safety was evaluated according to post-operative and operative
complication rates. Results The mean age of the group was 64 ± 18 years (203 women and 309 males). The
mean APACHE II score was 21 ± 3. Patients remained an average of 11
± 3 days on mechanical ventilation before percutaneous tracheostomy was
performed. All procedures were successfully completed without the need to switch
to an open surgical technique. Eighteen patients (3.5%) presented procedure
complications. Five patients experienced transient desaturation, 4 presented low
blood pressure related to sedation, and 9 presented minor bleeding, but none
required a transfusion. No serious complications or deaths associated with the
procedure were recorded. Eleven patients (2.1%) presented post-operative
complications. Seven presented minor and transitory bleeding of the percutaneous
tracheostomy stoma, 2 suffered displacement of the tracheostomy cannula, and 2
developed a superficial infection of the stoma. Conclusion Percutaneous tracheostomy using the single-step dilation technique with fiber
optic bronchoscopy assistance seems to be effective and safe in critically ill
patients under mechanical ventilation when performed by experienced intensive care
specialists using a standardized procedure.
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Affiliation(s)
- Carlos M Romero
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Rodrigo Cornejo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Eduardo Tobar
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Ricardo Gálvez
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Cecilia Luengo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Nivia Estuardo
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Rodolfo Neira
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - José Luis Navarro
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Osvaldo Abarca
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Mauricio Ruiz
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - María Angélica Berasaín
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Wilson Neira
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Daniel Arellano
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
| | - Osvaldo Llanos
- Unidad de Pacientes Críticos, Departamento de Medicina, Hospital Clínico, Universidad de Chile, Chile
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15
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Abstract
OBJECTIVES The prevalence and impact of longer-term outcomes following percutaneous tracheostomy, particularly tracheal stenosis, are unclear. Previous meta-analyses addressing this problem have been confounded by the low prevalence of tracheal stenosis and a limited number of studies. DESIGN Embase, PubMed-Medline, and the Cochrane Central Register of Clinical Trials were searched to identify all prospective studies of tracheostomy insertion in the critically ill. To reflect contemporary practice, the search was limited to studies published from 2000 onward. We scrutinized the bibliographies of returned studies for additional articles. Meta-analyses were undertaken to estimate the pooled risk difference of tracheal stenosis, bleeding, and wound infection comparing different techniques. MEASUREMENTS AND MAIN RESULTS We identified a total of 463 studies, 29 (5,473 patients) of which met the inclusion criteria. Nine were randomized controlled trials, six were nonrandomized comparative studies, and 14 were single-arm cohort studies. Risk of wound infection was greater for the surgical tracheostomy than for the Ciaglia multiple dilator technique, pooled risk difference 0.12 (95% CI, 0.02-0.23). We did not identify significant risk differences in other meta-analyses. Pooling across all studies according to the random-effects proportion meta-analysis suggests a higher prevalence of tracheal stenosis, wound infection, and major bleeding for surgical tracheostomies. CONCLUSIONS Considering comparative data, there was no significant difference in the prevalence of tracheal stenosis or major bleeding between percutaneous and surgical tracheostomy. In relation to wound infection, we have found a reduction associated with the original Ciaglia technique when compared with that with the surgical tracheostomy. Considering all published data reporting long-term outcomes pooled proportion meta-analysis indicates a trend toward a higher rate of tracheal stenosis and an increased risk of major bleeding and wound infection for surgical tracheostomies. This finding may be biased as a result of targeted patient selection, and further, high-quality long-term comparative data are needed to confirm these findings.
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16
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Pasin L, Frati E, Cabrini L, Landoni G, Nardelli P, Bove T, Calabro MG, Scandroglio AM, Pappalardo F, Zangrillo A. Percutaneous tracheostomy in patients on anticoagulants. Ann Card Anaesth 2016; 18:329-34. [PMID: 26139737 PMCID: PMC4881694 DOI: 10.4103/0971-9784.159802] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: To determine if percutaneous tracheostomy is safe in critically ill patients treated with anticoagulant therapies. Settings and Design: Single-center retrospective study including all the patients who underwent percutaneous dilatational tracheostomy (PDT) placement over a 1-year period in a 14-bed, cardiothoracic and vascular Intensive Care Unit (ICU). Materials and Methods: Patients demographics and characteristics, anticoagulant and antiplatelet therapies, coagulation profile, performed technique and use of bronchoscopic guidance were retrieved. Results: Thirty-six patients (2.7% of the overall ICU population) underwent PDT over the study period. Twenty-six (72%) patients were on anticoagulation therapy, 1 patient was on antiplatelet therapy and 2 further patients received prophylactic doses of low molecular weight heparin. Only 4 patients had normal coagulation profile and were not receiving anticoagulant or antiplatelet therapies. Overall, bleeding of any severity complicated 19% of PDT. No procedure-related deaths occurred. Conclusions: PDT was proved to be safe even in critically ill-patients treated with anticoagulant therapies. Larger prospective studies are needed to confirm our findings.
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Affiliation(s)
- Laura Pasin
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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17
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Pilarczyk K, Haake N, Dudasova M, Huschens B, Wendt D, Demircioglu E, Jakob H, Dusse F. Risk Factors for Bleeding Complications after Percutaneous Dilatational Tracheostomy: A Ten-year Institutional Analysis. Anaesth Intensive Care 2016; 44:227-36. [PMID: 27029655 DOI: 10.1177/0310057x1604400209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Summary Bleeding complications after percutaneous dilatational tracheostomy (PDT) are infrequent but may have a tremendous impact on a patient's further clinical course. Therefore, it seems necessary to perform risk stratification for patients scheduled for PDT. We retrospectively reviewed the records of 1001 patients (46% male, mean age 68.1 years) undergoing PDT (using the Ciaglia Blue Rhino® technique with direct bronchoscopic guidance) in our cardiothoracic ICU between January 2003 and February 2013. Patients were stratified into two groups: patients suffering acute moderate, severe, or major bleeding (Group A) and patients who had no or only mild bleeding (Group B). In the majority of patients, no or only mild bleeding during PDT occurred (none: 425 [42.5%], mild: 488 [48.8%]). In 84 patients (8.4%), bleeding was classified as moderate. Three patients suffered from severe bleeding; only one major bleed with need for emergency surgery occured. Patients in Group A had a significantly higher Simplified Acute Physiology Score on the day of PDT ( P=0.042), higher prevalence of renal replacement therapy on the day of PDT ( P=0.026), higher incidence of coagulopathy ( P=0.043), lower platelet counts ( P=0.037), lower fibrinogen levels ( P=0.012), higher proportion of PDTs performed by residents ( P=0.034) and higher difficulty grading of PDT ( P=0.001). Using logistic regression analyses, difficult PDT, less experienced operator, Simplified Acute Physiology Score >40 and low fibrinogen levels were independent predictors of clinically significant bleeding after PDT.
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Affiliation(s)
- K. Pilarczyk
- Intensive Care Medicine, West German Heart and Vascular Center, Department for Thoracic and Cardiovascular Surgery, University Hospital Essen, Essen, Germany
| | - N. Haake
- Medical Director, Specialist Intensive Care Medicine, Department of Intensive Care Medicine, Imland Klinik Rendsburg, Rendsburg, Germany
| | - M. Dudasova
- West German Heart and Vascular Center, Department for Thoracic and Cardiovascular Surgery, University Hospital Essen, Essen, Germany
| | - B. Huschens
- Department for Anaesthesiology and Intensive Care, University Hospital Essen, Essen, Germany
| | - D. Wendt
- West German Heart and Vascular Center, Department for Thoracic and Cardiovascular Surgery, University Hospital Essen, Essen, Germany
| | - E. Demircioglu
- West German Heart and Vascular Center, Department for Thoracic and Cardiovascular Surgery, University Hospital Essen, Essen, Germany
| | - H. Jakob
- Chief of Department for Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Department for Thoracic and Cardiovascular Surgery, University Hospital Essen, Essen, Germany
| | - F. Dusse
- West German Heart and Vascular Center, Department for Thoracic and Cardiovascular Surgery, University Hospital Essen, Essen, Germany
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18
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Dizdarevic A, Pagano P, Desai S. Anesthetic Implications for Tracheal Injury During Bronchoscopy-Guided Percutaneous Dilational Tracheostomy. ACTA ACUST UNITED AC 2016; 6:90-4. [PMID: 26859284 DOI: 10.1213/xaa.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bronchoscopic-guided percutaneous dilational tracheostomy has become one of the most common elective tracheostomy methods for patients requiring prolonged ventilatory support. The safety profile, patient selection, and risks as well as complication management, when compared with an open surgical technique, remain somewhat controversial with no clear recommendations. We present a case of a critically ill patient undergoing percutaneous dilation tracheostomy complicated by tracheal wall injury and airway loss. The airway was successfully conservatively managed as well as the tracheal injury. Anesthetic implications, safety, and management options as well as recommendations are reviewed.
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Affiliation(s)
- Anis Dizdarevic
- From the Department of Anesthesiology and Pain Management, Columbia University Medical Center, New York, New York
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19
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Young E, Pugh R, Hanlon R, O'Callaghan E, Wright C, Jeanrenaud P, Jones TM. Tracheal stenosis following percutaneous dilatational tracheostomy using the single tapered dilator: an MRI study. Anaesth Intensive Care 2014; 42:745-51. [PMID: 25342407 DOI: 10.1177/0310057x1404200610] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite widespread adoption of percutaneous dilatational tracheostomy within the critical care setting, there is still uncertainty regarding long-term complications, particularly in relation to missed or subclinical tracheal stenosis. In this study, all patients underwent tracheostomy using a single tapered dilator ≥ three months prior to enrollment and were evaluated using magnetic resonance imaging, spirometry and questionnaire. Tracheal area was recorded and deemed to be stenotic if a reduction of ≥10% was found. Fifty patients underwent magnetic resonance imaging and 49 attended for interview. Five patients were diagnosed with tracheal stenosis-none were symptomatic. Six of the 50 tracheostomies were technically difficult. Spirometry was not predictive of stenosis. A post critical care exercise tolerance of less than 100 metres was found in four tracheal stenosis patients. The prevalence of subclinical tracheal stenosis following percutaneous tracheostomy is low, with limited clinical significance. No patients required corrective surgery for tracheal stenosis. Routine airway follow-up in asymptomatic patients appears to be unwarranted.
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Affiliation(s)
- E Young
- Department of Critical Care, Aintree University Hospital, NHS Foundation Trust, Liverpool, United Kingdom
| | - R Pugh
- Department of Critical Care, Aintree University Hospital, NHS Foundation Trust, Liverpool, United Kingdom
| | - R Hanlon
- Department of Radiology, Aintree University Hospital, NHS Foundation Trust, Liverpool, United Kingdom
| | - E O'Callaghan
- Department of Critical Care, Aintree University Hospital, NHS Foundation Trust, Liverpool, United Kingdom
| | - C Wright
- Department of Critical Care, Aintree University Hospital, NHS Foundation Trust, Liverpool, United Kingdom
| | - P Jeanrenaud
- Department of Critical Care, Aintree University Hospital, NHS Foundation Trust, Liverpool, United Kingdom
| | - T M Jones
- Department of Critical Care, Aintree University Hospital, NHS Foundation Trust, Liverpool, United Kingdom
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20
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21
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Gill S, Low WY, Coggon JM, Slaney K, Stewart P, Norton A, Beed M, Gardiner D. Tracheostomy on the Intensive Care Unit – A Two-Month Network-Wide Snapshot. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500202] [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] Open
Abstract
Tracheostomy is a common and invasive procedure performed on the intensive care unit and has significant associated complications. Current evidence is insufficient to clearly guide practice. We conducted a two-month prospective service evaluation of tracheostomy within our local critical care network. We found 80 tracheostomies were performed during this time. Tracheostomy was performed at a median of six days after commencement of invasive ventilation, most commonly using the Ciaglia technique. Eighteen tracheostomies (23%) were performed surgically. The facilitation of weaning from invasive ventilation was the most common indication for tracheostomy. The median (IQR) time from tracheostomy to completion of weaning from mechanical ventilation was seven (4–11) days and from tracheostomy to decannulation was 14 (9–26) days. Eleven patients (14%) sustained complications possibly relating to tracheostomy insertion, three of whom subsequently died, although tracheostomy insertion was only possibly linked to one of these deaths. While our sample is small, it benchmarks a UK critical care network's tracheostomy practice in the UK.
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Affiliation(s)
- Steven Gill
- Consultant in Adult intensive Care Medicine and Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham
| | - Wei Yang Low
- Speciality Registrar in Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham
| | - J Mandy Coggon
- Clinical Nurse Educator for Critical Care, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire
| | - Kerry Slaney
- Senior Sister, Intensive Care Unit, United Lincolnshire Hospitals NHS Trust, Lincoln
| | - Paul Stewart
- Consultant in Intensive Care Medicine, Burton Hospitals NHS Foundation Trust, Burton-upon-Trent
| | - Andrew Norton
- Consultant in Intensive Care Medicine, United Lincolnshire Hospitals NHS Trust, Boston
| | - Martin Beed
- Consultant in Adult Intensive Care Medicine and Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham
| | - Dale Gardiner
- Consultant in Adult Intensive Care Medicine, Nottingham University Hospitals NHS Trust, Nottingham
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22
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Lee D, Chung CR, Park SB, Ryu JA, Cho J, Yang JH, Park CM, Suh GY, Jeon K. Safety and Feasibility of Percutaneous Dilatational Tracheostomy Performed by Intensive Care Trainee. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.2.64] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daesang Lee
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Bum Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Am Ryu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joongbum Cho
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi-Min Park
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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23
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Abstract
OPINION STATEMENT Patients with severe ischemic and hemorrhagic stroke may require tracheostomy in the course of their disease. This may apply to stroke unit patients whose deficits include a severe dysphagia posing such risk of aspiration as it cannot be sufficiently counteracted by tube feeding and swallowing therapy alone. More often, however, tracheostomy is performed in stroke patients so severely afflicted that they require intensive care unit treatment and mechanical ventilation. In these, long-term ventilation and prolonged insufficient airway protection are the main indications for tracheostomy. Accepted advantages are less pharyngeal and laryngeal lesions than with prolonged orotracheal intubation, better oral hygiene and nursing care, and higher patient comfort. Optimal timing of tracheostomy is unclear, in general, as in stroke intensive care unit patients. Potential benefits of early tracheostomy concerning ventilation duration and length of stay, respirator weaning, airway safety, rate of pneumonia, and other complications, outcome and mortality have been suggested in studies on non-neurologic subgroups of critical care patients. Stroke patients have hardly been investigated with regard to these aspects, and mainly retrospectively. A single randomized pilot trial on early tracheostomy in 60 ventilated patients with severe hemorrhagic and ischemic stroke demonstrated feasibility, safety, and less need of sedation. Regarding the technique, bedside percutaneous dilational tracheostomy should be preferred over surgical tracheostomy because of several reported advantages. As the procedural risk is low and early tracheostomy does not seem to worsen the clinical course of the ventilated stroke patient, it is reasonable to assess the need of further ventilation at the end of the first week of intensive care and proceed to tracheostomy if extubation is not feasible. Reliable prediction of prolonged ventilation need and outcome benefits of early tracheostomy, however, await further clarification. Decannulation of stroke patients after discontinued ventilation has to follow reliable confirmation of swallowing ability, as by endoscopy.
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Affiliation(s)
- Julian Bösel
- Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany,
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24
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Parchani A, Peralta R, El-Menyar A, Tuma M, Zarour A, Kumar S, Abdulrahman H, AbdulRahman Y, Al-Thani H, Latifi R. Percutaneous dilatational tracheostomies in a newly established trauma center: a report from Qatar. Eur J Trauma Emerg Surg 2013; 39:507-10. [PMID: 26815448 DOI: 10.1007/s00068-013-0299-x] [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: 03/07/2013] [Accepted: 05/19/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Percutaneous dilatational tracheostomy (PDT) is a routine surgical procedure for critically ill patients who require prolonged ventilatory support. METHODS We conducted a retrospective cohort study of all PDTs performed at the adult Trauma Intensive Care Unit (TICU) of Hamad Medical Corporation in Doha, Qatar, from January 2009 through September 2012. For all adult patients, we analyzed the demographic characteristics, mean ventilator time before the procedure, injury severity score (ISS), complications, and outcomes. RESULTS Of the 1,442 trauma patients admitted to the adult TICU during our study period, 124 (8.5 %) underwent PDT using the Ciaglia Blue Rhino technique. The vast majority were male (94.3 %). The mean age was 35 ± 15.6 years; mean ventilator time before the procedure, 12 ± 3 days; and mean ISS, 24.2 ± 9.3. More than half of patients had head injury (56 %), followed by chest and abdomen (26 %) and cervical spine injuries (18 %). Early complications included difficult tube placement (0.8 %), hypoxemia (0.8 %), minor bleeding (1.6 %), and hypotension (0.8 %), but the vast majority (93 %) of patients had no complications. The procedure-related mortality rate was 0 %. CONCLUSION PDT is safe and can be performed with minimal complications even in a newly established trauma center.
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Affiliation(s)
- A Parchani
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - R Peralta
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - A El-Menyar
- Weill Cornell Medical College, Doha, Qatar.,Clinical Research, Section of Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - M Tuma
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - A Zarour
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - S Kumar
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - H Abdulrahman
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Y AbdulRahman
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - H Al-Thani
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - R Latifi
- Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar. .,Weill Cornell Medical College, Doha, Qatar. .,Department of Surgery, University of Arizona, Tucson, AZ, USA.
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25
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Dennis BM, Eckert MJ, Gunter OL, Morris JA, May AK. Safety of bedside percutaneous tracheostomy in the critically ill: evaluation of more than 3,000 procedures. J Am Coll Surg 2013; 216:858-65; discussion 865-7. [PMID: 23403139 DOI: 10.1016/j.jamcollsurg.2012.12.017] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Bedside percutaneous dilational tracheostomy has been demonstrated to be equivalent to open tracheostomy. At our institution, percutaneous dilational tracheostomy without routine bronchoscopy is our preferred method. My colleagues and I hypothesized that our 10-year percutaneous dilational tracheostomy experience would demonstrate that the technique is safe with low complication rates, even in obese patient populations. STUDY DESIGN We conducted a retrospective review of all bedside percutaneous dilational tracheostomy performed by the Division of Trauma and Surgical Critical Care faculty from 2001 to 2011, excluding patients younger than 18 years of age. All major airway complications and procedure-related deaths were evaluated during the early (≤48 hours postprocedure), intermediate (in hospital), and late (after discharge) periods. Incidence of post-tracheostomy stenosis was also evaluated. RESULTS There were 3,162 percutaneous dilational tracheostomies performed during the study period. Mean body mass index was 28 (16% with body mass index ≥35), mean Injury Severity Score was 32, and mean APACHE II score was 19. Major airway complications occurred in 12 (0.38%) patients, accounting for 5 (0.16%) deaths. Early major complications included 3 airway losses and 1 bleeding event requiring formal exploration with procedure-related deaths occurring in 3 patients. Intermediate major complications included 2 tube occlusion/dislodgement events with 2 related deaths. Late complications included 5 (0.16%) cases of tracheal stenosis requiring intervention without associated deaths. CONCLUSIONS Bedside percutaneous dilational tracheostomy is safe across a broad critically ill patient population. The safety of this technique, even in the obese population, is demonstrated by its low complication rate. Routine bronchoscopic guidance is not necessary. Specially trained procedure nurse and process improvement programs contribute to the safety and efficacy of this procedure.
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Affiliation(s)
- Bradley M Dennis
- Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
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Abstract
Tracheotomy in mechanically ventilated critically ill patients is a procedure commonly performed in the intensive care unit. The aim is to facilitate respiratory weaning and improve clinical outcome by reducing side effects of prolonged invasive mechanical ventilation and sedation. At the same time, the risk of tracheotomy associated complications must be minimized. Indications, method and timing must be individualized for each patient. Main determinants for decision-making, success and safety are the expected individual clinical benefits, the patient risk factors for complications and aspects of local experience and logistics. This review summarizes current concepts and evidence.
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Percutaneous tracheostomy. J Trauma Acute Care Surg 2012. [DOI: 10.1097/ta.0b013e3182601d9f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Safety, efficiency, and cost-effectiveness of a multidisciplinary percutaneous tracheostomy program. Crit Care Med 2012; 40:1827-34. [PMID: 22610187 DOI: 10.1097/ccm.0b013e31824e16af] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The frequency of bedside percutaneous tracheostomies is increasing in intensive care medicine, and both safety and efficiency of care are critical elements in continuing success of this procedure. Prioritizing patient safety, a tracheostomy team was created at our institution to provide bedside expertise in surgery, anesthesiology, respiratory, and technical support. This study was performed to evaluate the metrics of patient outcome, efficiency of care, and cost-benefit analysis of the multidisciplinary Johns Hopkins Percutaneous Tracheostomy Program. DESIGN A review was performed for patients who received tracheostomies in 2004, the year before the Johns Hopkins Percutaneous Tracheostomy Program was established, and those who received tracheostomies in 2008, the year following the program's establishment. Comparative outcomes were evaluated, including the efficiency of procedure and intensive care unit length of stay, complication rate including bleeding, hypoxia, loss of airway, and a financial cost-benefit analysis. SETTING Single-center, major university hospital. PATIENTS The sample consisted of 363 patients who received a tracheostomy in the years 2004 and 2008. MEASUREMENTS AND MAIN RESULTS The number of percutaneous procedures increased from 59 of 126 tracheostomy patients in 2004, to 183 of 237 in 2008. There were significant decreases in the prevalence of procedural complications, particularly in the realm of airway injuries and physiologic disturbances. Regarding efficiency, the structured program reduced the time to tracheostomy and overall procedural time. The intensive care unit length of stay in nonpulmonary patients and improvement in intensive care unit and operating room back-fill efficiency contributed to an overall institutional financial benefit. CONCLUSIONS An institutionally subsidized, multi-disciplinary percutaneous tracheostomy program can improve the quality of care in a cost-effective manner by decreasing the incidence of tracheostomy complications and improving both the time to tracheostomy, duration of procedure, and postprocedural intensive care unit stay.
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McGrath BA, Bates L, Atkinson D, Moore JA. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia 2012; 67:1025-41. [DOI: 10.1111/j.1365-2044.2012.07217.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Anticoagulation management around percutaneous bedside procedures. J Trauma Acute Care Surg 2012; 72:815-20; quiz 1124-5. [DOI: 10.1097/ta.0b013e31824fbadf] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
BACKGROUND Percutaneous tracheostomy is a routine procedure in the intensive care unit (ICU). Some surgeons perform percutaneous tracheostomies using bronchoscopy believing that it increases safety. The purpose of this study was to evaluate percutaneous tracheostomy in the trauma population and to determine whether the use of a bronchoscope decreases the complication rate and improves safety. METHODS A retrospective review was completed from January 2007 to November 2010. Inclusion criteria were trauma patients undergoing percutaneous tracheostomy. Data collected included age, Abbreviated Injury Score by region, Injury Severity Score, ventilator days, and outcomes. Complications were classified as early (occurring within <24 hours) or late (>24 hours after the procedure). RESULTS During the study period, 9,663 trauma patients were admitted, with 1,587 undergoing intubation and admission to the ICU. Tracheostomies were performed in 266 patients and 243 of these were percutaneous; 78 (32%) were performed with the bronchoscope (Bronch) and 168 (68%) without bronchoscope (No Bronch). There were no differences between the groups in Abbreviated Injury Score by region, Injury Severity Score, probability of survival, ventilator days, and length of ICU or overall hospital stay. There were 16 complications, 5 (Bronch) and 11 (No Bronch). Early complications were primarily bleeding (Bronch 3% vs. No Bronch 4%, not statistically significant). Late complications included tracheomalacia, tracheal granulation tissue, bleeding, and stenosis; Bronch 4% versus No Bronch 3%, (not statistically significant). One major complication occurred, with loss of airway and cardiac arrest, in the bronchoscopy group. CONCLUSION Percutaneous tracheostomy was safely and effectively performed by an experienced surgical team both with and without bronchoscopic guidance with no difference in the complication rates. This study suggests that the use of bronchoscopic guidance during tracheostomy is not routinely required but may be used as an important adjunct in selected patients, such as those with HALO cervical fixation, obesity, or difficult anatomy.
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Abstract
Airway management in the intensive care unit is more problematic than during anaesthesia. In general, critically ill patients have less physiological reserve and complications are more common, both during the initial airway intervention (which includes risks associated with induction of anaesthesia), and later once the airway has been secured. Despite these known risks, those managing the airway of a critically ill patient, particularly out of hours, may be relatively inexperienced. Solutions to these challenging airway problems include: recognition of those patients with a potential airway problem; implementation of a plan to deal with their airway; immediate availability of a difficult airway trolley; use of capnography for every airway intervention and continuously in all ventilator-dependent patients; and appropriate training of all intensive care unit staff including use of simulation.
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Affiliation(s)
- J P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
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Rosseland LA, Laake JH, Stubhaug A. Percutaneous dilatational tracheotomy in intensive care unit patients with increased bleeding risk or obesity. A prospective analysis of 1000 procedures. Acta Anaesthesiol Scand 2011; 55:835-41. [PMID: 21615346 DOI: 10.1111/j.1399-6576.2011.02458.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Percutaneous dilatational tracheotomy (PT) is safe and cost effective, and has become a routine method in intensive care units (ICU), but safety concerns persist for obese patients and for patients with a high risk of bleeding. In this prospective study of 1000 PTs, we have investigated whether such patient characteristics were associated with an increased procedural risk. METHODS We prospectively recorded all PTs performed in our ICU from 2001 to 2009. Data on blood transfusion were entered from a central database. The association of risk factors with bleeding and other complications was analysed with logistic regression. RESULTS The total number of PTs and surgical tracheotomies was 1.454. The median number of days on a ventilator until PT was 6 in 2001, decreasing to 3 in 2009. A procedure-related complication was reported in 17.5%. There was no PT-related mortality. The rate of potentially life-threatening complications was 1.2%. Three patients developed pneumothorax and one of these had circulatory arrest and was successfully resuscitated. Three hundred and twelve patients had one or more units of blood transfused, but only 19 (1.9%) were PT related. Increased INR was the most important risk factor for bleeding [odds ratio (OR) 2.99], followed by low platelets (OR 1.99). The rate of complications in patients with high body mass index was not increased. CONCLUSION PT is a safe procedure that can be performed with a low complication rate in patients with increased risk of bleeding as well as in obese patients.
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Affiliation(s)
- Leiv Arne Rosseland
- Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Norway.
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Luyet C, Boudah R, McCartney CJ, Zeldin R, Rizoli S. Low-frequency jet ventilation through a bronchial blocker for tracheal repair after a rare complication of percutaneous dilatational tracheostomy. J Cardiothorac Vasc Anesth 2011; 27:108-10. [PMID: 21723145 DOI: 10.1053/j.jvca.2011.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Cedric Luyet
- Department of Anaesthesia, Sunnybrook Health Science Centres, Toronto, Ontario, Canada.
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Montcriol A, Bordes J, Asencio Y, Prunet B, Lacroix G, Meaudre E. Bedside Percutaneous Tracheostomy: A Prospective Randomised Comparison of PercuTwist® versus Griggs’ Forceps Dilational Tracheostomy. Anaesth Intensive Care 2011; 39:209-16. [PMID: 21485668 DOI: 10.1177/0310057x1103900209] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tracheostomy is considered the airway management of choice for patients who require prolonged mechanical ventilation. The development of percutaneous techniques offers many advantages including the ability to perform the procedure in the intensive care unit. The aim of this study was to compare the controlled rotating dilation method (PercuTwist®) and the Griggs’ forceps dilational tracheostomy. Patients over 18 years of age undergoing tracheostomy in the intensive care unit were included in the study. They were divided in two random samples – either PercuTwist or forceps dilational tracheostomy. Data collected prospectively included demographic characteristics, procedure duration, blood gas analysis, intracranial pressure, arterial blood pressure and heart rate before and after the procedure. Any complications during or after the procedure due to the tracheostomy were also recorded. Contrary to the main hypothesis, PercuTwist technique took significantly longer to perform than forceps dilational tracheostomy technique (five minutes [2 to 25] vs three minutes [1 to 17][P=0.006]). A significant increase in PaCO2 and decrease in arterial pH were observed in both groups between the pre-tracheostomy and post-tracheostomy blood gas analysis. Haemodynamic tolerance was good. Our results show that intracranial pressure is affected by the procedure whatever the technique used. However we did not observe a decrease in cerebral perfusion pressure. The incidence of complications was 23% (20/87). These complications were minor in 18/20 and were not significantly different between the two groups. In conclusion, we consider that the PercuTwist technique is safe despite the longer duration of the procedure. Nevertheless the forceps dilational technique remains our routine procedure.
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Affiliation(s)
- A. Montcriol
- Department of Anaesthesia and Intensive Care, Sainte Anne Military Teaching Hospital, Toulon, France
| | - J. Bordes
- Department of Anaesthesia and Intensive Care, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Y. Asencio
- Department of Anaesthesia and Intensive Care, Sainte Anne Military Teaching Hospital, Toulon, France
| | - B. Prunet
- Department of Anaesthesia and Intensive Care, Sainte Anne Military Teaching Hospital, Toulon, France
| | - G. Lacroix
- Department of Anaesthesia and Intensive Care, Sainte Anne Military Teaching Hospital, Toulon, France
| | - E. Meaudre
- Department of Anaesthesia and Intensive Care, Sainte Anne Military Teaching Hospital, Toulon, France
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Dempsey GA, Grant CA, Jones TM. Percutaneous tracheostomy: a 6 yr prospective evaluation of the single tapered dilator technique. Br J Anaesth 2010; 105:782-8. [PMID: 20813838 DOI: 10.1093/bja/aeq238] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The single tapered dilator (STD) percutaneous dilatational tracheostomy (PDT) technique now appears to be the single most common method of performing a tracheostomy in the critical care unit (CCU). METHODS A single-centre, prospective evaluation of all PDTs performed in an adult mixed surgical and medical CCU between November 2003 and October 2009 was done. All procedures were undertaken by critical care physicians. A proforma recorded intraoperative complications and technical difficulties encountered during the procedure; all patients were followed up for a minimum of 3 months for delayed complications. RESULTS A tracheostomy was performed on 589 patients during the study period. PDT was attempted in 576 patients and successfully completed in 572. PDT was abandoned in four patients due to bleeding, with three of these subsequently undergoing surgical tracheostomy (ST). ST was performed in 17 patients. Intraoperative technical difficulties were encountered in 149 (26%) cases. Sixteen (3%) procedures were deemed as having early complications. A further four (0.7%) cases had significant late complications including two tracheo-innominate fistulae (TIF). Both TIF patients died as a result of their complications giving a mortality directly attributable to PDT of 0.35%. There were no differences with respect to the occurrence of complications according to grade of operator. CONCLUSIONS PDT performed by the STD technique is a relatively safe procedure with more than 96% of procedures performed without any early or late complications. Using this technique, more than 97% of tracheostomies undertaken during the study period were performed percutaneously. Further audit at a national level is warranted to fully evaluate long-term complications after PDT.
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Affiliation(s)
- G A Dempsey
- Critical Care Unit, Aintree University Hospitals, Lower Lane, Liverpool L9 7AL, UK.
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Gandía-Martínez F, Martínez-Gil I, Andaluz-Ojeda D, Bobillo de Lamo F, Parra-Morais L, Díez-Gutiérrez F. Análisis de la traqueotomía precoz y su impacto sobre la incidencia de neumonía, consumo de recursos y mortalidad en pacientes neurocríticos. Neurocirugia (Astur) 2010. [DOI: 10.1016/s1130-1473(10)70078-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Li YW, Chandan GS. Bilateral Tension Pneumothoraces following Percutaneous Tracheostomy. J Intensive Care Soc 2009. [DOI: 10.1177/175114370901000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Percutaneous tracheostomy is a relatively safe bedside alternative to surgical tracheostomy. However, there are significant risks and complications, such as pneumothorax. This case report describes what is believed to be the first example of bilateral tension pneumothorax secondary to percutaneous tracheostomy insertion which occurred despite bronchoscopic guidance.
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Affiliation(s)
- Yat Wah Li
- ST3 Anaesthetics Department of Anaesthesia, Stafford General Hospital
| | - Garud S Chandan
- Consultant in Intensive Care and Anaesthesia Department of Anaesthesia, Stafford General Hospital
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Bleeding around a tracheostomy wound: what to consider and what to do? The Journal of Laryngology & Otology 2009; 123:952-6. [PMID: 19374781 DOI: 10.1017/s002221510900526x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
All patients with bleeding in and around a tracheostomy must be investigated to exclude a serious cause. The overall incidence is approximately 5 per cent of tracheostomies performed in Adult Intensive Care Units (AICU). When bleeding commences more than 72 hours post-operatively, the possibility of a trachea innominate artery fistula needs to be excluded by endoscopic examination of the trachea in an operating theatre environment, with the facility to proceed to exploration of the neck and possibly to sternotomy to enable ligation of the innominate artery. With appropriate recognition, diagnosis, resuscitation and surgical intervention, the associated high death rate of trachea innominate artery fistula can be reduced.
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