1
|
Samornpitakul P, Watcharaporn W, Setabutr D. Increased Intervals Between Paediatric Tracheostomy Tube Changes: Is it a Safe Technique? Indian J Otolaryngol Head Neck Surg 2023; 75:503-507. [PMID: 37275110 PMCID: PMC10234948 DOI: 10.1007/s12070-022-03302-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022] Open
Abstract
To evaluate the safety of changing tracheostomy tubes every three months in paediatric patients and determine the occurrence of tube-related complications. Retrospective observational chart review was completed from 2018 to 2021 at a tertiary medical centre in Thailand. Tube associated complications were assessed with regards to interval length between tracheostomy tube changes. The rate of complication was compared with previous studies. Out of a total of 108 visits, the average interval between each tube change was 87 days. Of all encounters, 6.48% resulted in a tube-related complication. Of these seven visits, two had an admission for a respiratory infection within 30 days, three experienced accidental decannulation and two resulted in excess granulation tissue formation. A p-value of 0.8 was obtained from a chi-squared test. An interval of 90-days between paediatric tracheostomy tube changes does not increase the rate of tracheostomy tube related complications. This interval may be practical for those in resource limited settings.
Collapse
Affiliation(s)
- Pheemaphol Samornpitakul
- Chulabhorn International College of Medicine, Thammasat University, Khlong Nueng, Pathum Thani 12120 Thailand
| | - Warisra Watcharaporn
- Chulabhorn International College of Medicine, Thammasat University, Khlong Nueng, Pathum Thani 12120 Thailand
| | - Dhave Setabutr
- Chulabhorn International College of Medicine, Thammasat University, Khlong Nueng, Pathum Thani 12120 Thailand
- Department of Otolaryngology Head and Neck Surgery, Thammasat University Hospital, Khlong Nueng, Pathum Thani 12120 Thailand
| |
Collapse
|
2
|
Cathelain G, Perrier A, Folliot L, Le Gloanec C, Rarrbo M, Jouen F, Saudeau E, Costa G, Carlier R, Bergounioux J. Bench testing of tracheostomy tube-related insults using an instrumented manikin. Eur Arch Otorhinolaryngol 2021; 279:1593-1599. [PMID: 34499203 DOI: 10.1007/s00405-021-07054-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Choosing the right tracheal tube for the right patient is a daily preoccupation for intensivists and emergency physicians. Tracheal tubes can generate severe complications, which are chiefly due to the pressures applied by the tube to the trachea. We designed a bench study to assess the frequency of pressure levels likely to cause tracheal injury. METHODS We tested the pressure applied on the trachea by 17 tube models of a given size range. To this end, we added a pressure sensor to the posterior tracheal wall of a standardized manikin. RESULTS Only 2 of the 17 tubes generated pressures under the threshold likely to induce tracheal injury (30 mmHg/3.99 kPa). The force exerted on the posterior wall of the trachea varied widely across tube models. CONCLUSION Most models of tracheal tubes resulted in forces applied to the trachea that are usually considered capable of causing tracheal tissue injury. LEVEL OF EVIDENCE Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence: How common is the problem?: step 1; Is this diagnostic or monitoring test accurate? (Diagnosis) step 5; What will happen if we do not add a therapy? (Prognosis) n/a; Does this intervention help? (Treatment Benefits) step 5; What are the COMMON harms?(Treatment Harms) step 5; What are the RARE harms? (Treatment Harms) step 5; Is this (early detection) test worthwhile? (Screening) step 5.
Collapse
Affiliation(s)
- Guillaume Cathelain
- CHArt Laboratory, Ecole Pratique Des Hautes Etudes, PSL University, Paris, France
| | - Antoine Perrier
- Université Grenoble Alpes and CNRS, TIMC-IMAG, 38000, Grenoble, France.,Pitié-Salpêtrière Teaching Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Ludivine Folliot
- DMU Smart Imaging, Radiology Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - Cyrielle Le Gloanec
- Clinical Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - Mohamed Rarrbo
- Clinical Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - François Jouen
- CHArt Laboratory, Ecole Pratique Des Hautes Etudes, PSL University, Paris, France
| | - Etienne Saudeau
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Guillaume Costa
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Robert Carlier
- DMU Smart Imaging, Radiology Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Jean Bergounioux
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France. .,Simone Veil Health Science Centre, Université Versailles SQY, Paris-Saclay, Versailles, France. .,Réanimation et Soins Intensifs Pédiatriques, Batiment Letulle, 3ème étage, Hôpital Universitaire Raymond Poincaré, APHP, 104 Boulevard Raymond Poincaré, Garches, 92380, Paris, France.
| |
Collapse
|
3
|
Rosero EB, Corbett J, Mau T, Joshi GP. Intraoperative Airway Management Considerations for Adult Patients Presenting With Tracheostomy: A Narrative Review. Anesth Analg 2021; 132:1003-1011. [PMID: 33369928 DOI: 10.1213/ane.0000000000005330] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tracheotomy is a surgical procedure through which a tracheostomy, an opening into the trachea, is created. Indications for tracheostomy include facilitation of airway management during prolonged mechanical ventilation, treatment of acute upper airway obstruction when tracheal intubation is unfeasible, management of chronic upper airway obstructive conditions, and planned airway management for major head and neck surgery. Patients who have a recent or long-term tracheostomy may present for a variety of surgical or diagnostic procedures performed under general anesthesia or sedation/analgesia. Airway management of these patients can be challenging and should be planned ahead of time. Anesthesia personnel should be familiar with the different components of cuffed and uncuffed tracheostomy devices and their connectivity to the anesthesia circuits. An appropriate airway management plan should take into account the indication of the tracheostomy, the maturity status of the stoma, the type and size of tracheostomy tube, the expected patient positioning, and presence of patient's concurrent health conditions. Management of the patient with a T-tube is highlighted. Importantly, there is a need for multidisciplinary care involving anesthesiologists, surgical specialists, and perioperative nurses. The aim of this narrative review is to discuss the anesthesia care of patients with a tracheostomy. Key aspects on relevant tracheal anatomy, tracheostomy tubes/devices, alternatives of airway management, and possible complications related to tracheostomy are summarized with a recommendation for an algorithm to manage intraoperative tracheostomy tube dislodgement.
Collapse
Affiliation(s)
- Eric B Rosero
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - John Corbett
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Girish P Joshi
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| |
Collapse
|
4
|
Richards N, Herath J. Death Due to Obstruction of Airways by a Hyperplastic Polyp: An Unusual Complication of Treated Desmoid Fibromatosis. Acad Forensic Pathol 2020; 10:97-103. [PMID: 33282044 DOI: 10.1177/1925362120964084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/09/2020] [Indexed: 11/17/2022]
Abstract
Desmoid fibromatosis (DF) is a rare, locally aggressive but benign clonal fibroblastic lesion of deep soft tissue. It can occur at any age. Extra-abdominal lesions are more common in the pediatric population, with equal sex predilection. Desmoid fibromatosis of the head and neck, particularly the anterior neck, is more difficult to manage because of the proximity to vital structures and may eventually require definitive airway management with insertion of a tracheostomy tube. Indwelling tracheostomy tubes carry their own set of complications. This is the case of a 21-month-old boy who died suddenly due to tracheal obstruction by a hyperplastic polyp. He was diagnosed with DF of the neck before he was 1 month old and required an indwelling tracheostomy tube as a result. Chronic tracheostomy intubation can be complicated by granulation tissue polyp or, less commonly, fibroepithelial polyp formation that can become large enough to cause airway obstruction. To the authors' knowledge, this is the first case of hyperplastic polyp causing fatal airway obstruction.
Collapse
|
5
|
Angula LN, Teng Y, Sun L, Wang X, Shang J, Fang N. Otoendoscope combined with ablation electrodes for treatment of benign tracheal stenosis caused by granulation tissue hyperplasia after tracheotomy. Pan Afr Med J 2020; 36:382. [PMID: 33235659 PMCID: PMC7666696 DOI: 10.11604/pamj.2020.36.382.25125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 11/11/2022] Open
Abstract
Benign tracheal stenosis mainly appears due to tracheotomy, tuberculosis, trauma, benign tumor, or ventilation. With the increase in the number of tracheotomies and the prolongation of the life span of patients after incision, the long-term complications after tracheotomy gradually increase, among which intratracheal granulation hyperplasia is a more serious complication. The present case describes a 59-year-old male with granulation tissue hyperplasia induced by tracheotomy. He underwent tracheal resection to remove the granulation tissue and he remained well after the follow-up. Even though the endoscopic intervention and tracheal resection are readily accessible, they usually quite challenging. Here we summarize the present details on this condition.
Collapse
Affiliation(s)
- Laina Ndapewa Angula
- Department of Otolaryngology, First Hospital of Jilin University, Changchun, China
| | - Yongliang Teng
- Department of Otolaryngology, First Hospital of Jilin University, Changchun, China
| | - Le Sun
- Department of Otolaryngology, First Hospital of Jilin University, Changchun, China
| | - Xin Wang
- Department of Otolaryngology, First Hospital of Jilin University, Changchun, China
| | - Jing Shang
- Department of Otolaryngology, First Hospital of Jilin University, Changchun, China
| | - Ning Fang
- Department of Otolaryngology, First Hospital of Jilin University, Changchun, China
| |
Collapse
|
6
|
Dilation of tracheal stenosis below tracheostomy tube with Dolphin percutaneous tracheostomy kit : Tracheal stenosis treated with Dolphin PDT. Gen Thorac Cardiovasc Surg 2020; 68:655-658. [PMID: 32048145 DOI: 10.1007/s11748-020-01311-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
We reported a new minimally invasive procedure to treat tracheal stenosis below tracheostomy tube using standard Ciaglia Blue Dolphin kit for percutaneous tracheostomy. Under endoscopic view, the Dolphin kit was inserted through the stoma into the stenosis; the balloon was inflated until a sufficient tracheal diameter was obtained; then, a longer tracheostomy tube was inserted through the stenosis and the distal tip placed near the carina. This procedure was succesfully applied in seven patients.
Collapse
|
7
|
Ilan O, Gross M, Zaltzman Y, Sasson A, Marcus EL. Diagnosis and conservative management of late tracheotomy complications in chronic ventilator-dependent patients. Head Neck 2015; 37:716-21. [PMID: 24596164 DOI: 10.1002/hed.23665] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 12/08/2013] [Accepted: 03/02/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Complications associated with long-term tracheotomy are obstruction of the distal end of the tube by granulation tissue and tracheomalacia. These complications have traditionally been surgically treated. METHODS Prospective study in a chronic ventilator-dependent division, including 234 consecutive patients with tracheotomy and mechanical ventilation. Endoscopic evaluation was performed in patients in whom there was respiratory distress with difficulty in passing a suction catheter through the tube, and/or increased inspiratory resistance and increased peak inspiratory pressure. RESULTS Nineteen patients were diagnosed with granulation or tracheomalacia. Two patients were treated by surgical removal of the obstructing tissue. Nonsurgical patients were conservatively managed with symptoms' resolution by bypassing the pathology with a longer tube than the previous one or by an adjustable flange tube under endoscopic visualization, with a median symptom-free period of 433 days (range, 55-1230 days). CONCLUSION In nonsurgical candidates, insertion of a longer tube is a conservative and feasible long-term treatment.
Collapse
Affiliation(s)
- Ophir Ilan
- Department of Otolaryngology/Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | | | | | | |
Collapse
|
8
|
Abstract
The etiologies of pediatric lung injury requiring surgical intervention can be infectious, traumatic, congenital, or iatrogenic. Childhood pneumonia is a significant global health problem affecting 150 million children worldwide. Sequelae of pulmonary infections potentially requiring surgery include bronchiectasis, lung abscess, pneumatocele, and empyema. Trauma, congenital conditions such as cystic fibrosis and iatrogenic injuries can result in pneumothoraces, chylothoraces, or bronchopleural fistulae. Recurrence rates for spontaneous pneumothorax treated non-operatively in pediatric patients approach 50-60%. Chylothoraces in newborns may occur spontaneously or due to birth trauma, whereas in older children the etiology is almost always iatrogenic. This article examines the surgical management for the complications of lung injury in pediatric patients. In addition, we review the available pediatric evidence for early tracheostomy as well as treatment strategies for the negative ramifications of tracheostomy.
Collapse
Affiliation(s)
| | - Chad Hamner
- Cook Children׳s Medical Center, Fort Worth, Texas.
| |
Collapse
|
9
|
Ahn YC, Kim SW, Hwang SS, Chae YG, Lee AS, Jung MH, Chun BK, Lee SJ, Park EK, Oak C. Optical imaging of subacute airway remodeling and adipose stem cell engraftment after airway injury. BIOMEDICAL OPTICS EXPRESS 2013; 5:312-321. [PMID: 24466496 PMCID: PMC3891342 DOI: 10.1364/boe.5.000312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/07/2013] [Accepted: 12/12/2013] [Indexed: 06/03/2023]
Abstract
Acquired airway injury is frequently caused by endotracheal intubations, long-term tracheostomies, trauma, airway burns, and some systemic diseases. An effective and less invasive technique for both the early assessment and the early interventional treatment of acquired airway stenosis is therefore needed. Optical coherence tomography (OCT) has been proposed to have unique potential for early monitoring from the proliferative epithelium to the cartilage in acute airway injury. Additionally, stem cell therapy using adipose stem cells is being investigated as an option for early interventional treatment in airway and lung injury. Over the past decade, it has become possible to monitor the level of injury using OCT and to track the engraftment of stem cells using stem cell imaging in regenerative tissue. The purpose of this study was to assess the engraftment of exogenous adipose stem cells in injured tracheal epithelium with fluorescent microscopy and to detect and monitor the degree of airway injury in the same tracheal epithelium with OCT. OCT detected thickening of both the epithelium and basement membrane after tracheal scraping. The engraftment of adipose stem cells was successfully detected by fluorescent staining in the regenerative epithelium of injured tracheas. OCT has the potential to be a high-resolution imaging modality capable of detecting airway injury in combination with stem cell imaging in the same tracheal mucosa.
Collapse
Affiliation(s)
- Yeh-Chan Ahn
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology, Pukyong National University, 45 Yongso-ro, Nam-gu, Busan, 608-737, South Korea
- Yeh-Chan Ahn and Sung Won Kim contributed equally to this work
| | - Sung Won Kim
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
- Yeh-Chan Ahn and Sung Won Kim contributed equally to this work
| | - Sang Seok Hwang
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology, Pukyong National University, 45 Yongso-ro, Nam-gu, Busan, 608-737, South Korea
| | - Yu-Gyeong Chae
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology, Pukyong National University, 45 Yongso-ro, Nam-gu, Busan, 608-737, South Korea
| | - Andrew Sungwan Lee
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
- Department of Internal Medicine, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Maan Hong Jung
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
- Department of Internal Medicine, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Bong Kwon Chun
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
- Department of Pathology, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030 South Korea
| | - Sang Joon Lee
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
- Department of Ophthalmology, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Eun-Kee Park
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
- Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| | - Chulho Oak
- Innovative Biomedical Technology Research Center, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
- Department of Internal Medicine, College of Medicine, Kosin University, 34 Amnam-dong, Seo-Gu, Busan, 602-030, South Korea
| |
Collapse
|