Variations of venous drainage of the thyroid gland and their surgical implications: a narrative review

Minimally-invasive tracheostomy (MIT): A care bundle for safety improvement in high-risk critically ill patients

BACKGROUND

Detailed reports are scarce on minimally-invasive tracheostomy (MIT) techniques for critically ill patients with challenging anatomy or complex coagulopathies. In such high-risk patients, conventional percutaneous dilatational tracheostomy (PDT) may lead to severe complications.

METHODS

Aiming to broaden the scope of MIT for patients previously excluded due to high risks, we developed a new care bundle (MIT technique), specifically designed for intensive care specialists. Our study examined the outcomes of MIT in 32 high-risk patients treated in an ICU of a University Hospital with specific focus on gastrointestinal and liver diseases.

RESULTS

We have modified the conventional PDT technique by incorporating an initial skin incision, blunt dissection, diaphanoscopy-guided probe puncture, and continuous bronchoscopic monitoring. Our care bundle also introduces an anterolateral approach for tracheal entry, a significant advancement for patients with complex neck anatomy or dense vasculature, where an anterolateral trajectory avoids midline blood vessels. This enhanced method has proven to be safer than traditional PDT, with a notable absence of post-procedural hemorrhages, cannula misplacements, or infections.

CONCLUSION

The use of our refined care bundle enabled swift minimally-invasive tracheostomy in high-risk patients without the occurrence of serious complications.

Association Between Thyrotoxicosis and Cerebral Venous Thrombosis

Thyrotoxicosis appears to be a predisposing factor for cerebral venous thrombosis (CVT), which is a rare but important cause of stroke in young adults. The presentation of CVT is highly variable, ranging from a history of headaches (in the majority of cases) to deep coma, with the latter requiring invasive neurosurgical decompression. Although the long-term outcomes of CVT are favorable, multicenter cohort studies have shown that death may occur in up to 4% of cases in the acute phase and 8-10% of cases in the long term. It has been argued that the substantial decrease in mortality in patients with CVT that has been observed during the past few decades may be the result of an increased awareness of CVT among clinicians. Given that thyrotoxicosis is a risk factor for CVT, clinicians (and endocrinologists) should be alert to the possibility of CVT in patients with thyroid disease in order to prevent it whenever possible or treat it promptly. In this review, we provide an updated overview of the characteristics of patients with thyrotoxicosis who presented with CVT, the underlying mechanisms, and a few tips for clinicians.