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Ledl C, Frank U, Dziewas R, Arnold B, Bähre N, Betz CS, Braune S, Deitmer T, Diesener P, Fischer AS, Hamzic S, Iberl G, Konradi J, Löhler J, Platz T, Rohlfes C, Westhoff M, Winkler S, Wirth R, Graf S. [Curriculum "Tracheostomy management in dysphagia therapy"]. HNO 2024:10.1007/s00106-024-01454-7. [PMID: 38578463 DOI: 10.1007/s00106-024-01454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.
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Affiliation(s)
- C Ledl
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland.
- Schön Klinik Bad Aibling, Bad Aibling, Deutschland.
| | - U Frank
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Swallowing Research Lab, Universität Potsdam, Potsdam, Deutschland
| | - R Dziewas
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Neurologie, Berlin, Deutschland
- Deutsche Gesellschaft für NeuroIntensiv- und Notfallmedizin, Jena, Deutschland
- Klinik für Neurologie und neurologische Frührehabilitation, Klinikum Osnabrück, Osnabrück, Deutschland
| | - B Arnold
- Deutscher Berufsverband für Phoniatrie und Pädaudiologie, Berlin, Deutschland
| | - N Bähre
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
| | - C S Betz
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Braune
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
| | - P Diesener
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
- Dysphagie-Netzwerk-Südwest e. V., Überlingen, Deutschland
- Dysphagie- und Kanülensprechstunde Hegau-Jugendwerk Gailingen, Gailingen, Deutschland
- Rehaklinik Zihlschlacht, Zihlschlacht-Sitterdorf, Schweiz
| | - A S Fischer
- Juristische Fakultät, Forschungsstelle Medizinrecht, Ludwig-Maximilians-Universität, München, Deutschland
| | - S Hamzic
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Universitätsklinikum Gießen und Marburg, Campus Gießen, Neurologische Klinik, Justus-Liebig-Universität, Gießen, Deutschland
| | - G Iberl
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
| | - J Konradi
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Institut für Physikalische Therapie, Prävention und Rehabilitation, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - J Löhler
- Deutscher Berufsverband der HNO-Ärzte, Neumünster, Deutschland
| | - T Platz
- Deutsche Gesellschaft für Neurorehabilitation, Berlin, Deutschland
- Institut für Neurorehabilitation und Evidenzbasierung, An-Institut der Universität Greifswald, BDH-Klinik Greifswald, Greifswald, Deutschland
- AG Neurorehabilitation, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - C Rohlfes
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- BDH-Klinik Hessisch Oldendorf, Hessisch Oldendorf, Deutschland
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer, Deutschland
| | - S Winkler
- Deutscher Bundesverband für Logopädie, Frechen, Deutschland
| | - R Wirth
- Deutsche Gesellschaft für Geriatrie, Berlin, Deutschland
- Klinik für Altersmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
| | - S Graf
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Phoniatrie und Pädaudiologie, Göttingen, Deutschland
- Universitätsklinik für Hör‑, Stimm- und Sprachstörungen, Medizinische Universität Innsbruck, Innsbruck, Österreich
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2
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Lloyd AM, Behzadpour HK, Rana MS, Espinel AG. Time considerations and outcomes in pediatric tracheostomy decannulation. Int J Pediatr Otorhinolaryngol 2024; 179:111934. [PMID: 38537449 DOI: 10.1016/j.ijporl.2024.111934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE The study objective is to identify factors that impact the time to decannulation in pediatric patients ages 0 through 18 years who are tracheostomy-dependent. METHODS This retrospective chart review from January 1, 2005 through December 31, 2020 identified pediatric tracheostomy patients at a single pediatric institution. Data extracted included demographic, socioeconomic factors, and clinical characteristics. Multivariate regression and survival analysis were used to identify factors associated with successful decannulation and decreased time with tracheostomy. RESULTS Of the 479 tracheostomy-dependent patients identified, 162 (33.8%) were decannulated. Time to decannulation ranged from 0.5 months to 189.2 months with median of 24 months (IQR 12.91-45.71). In the multivariate analysis, patients with bronchopulmonary dysplasia (p = 0.021) and those with Passy-Muir® Valve at discharge (p = 0.015) were significantly associated with decannulation. In contrast, neurologic comorbidities (p = 0.06), presence of gastrostomy tube (p < 0.001), or discharged on a home ventilator (p < 0.001) were associated with indefinite tracheostomy. When adjusting for age, sex, race, ethnicity, and insurance status, for every one month delay in establishment of outpatient otolaryngology care, time to decannulation was delayed by 0.5 months (p = 0.010). For each additional outpatient otolaryngology follow-up visit, time to decannulation increased by 3.36 months (p < 0.001). CONCLUSIONS Decannulation in pediatric tracheostomy patients is multifactorial. While timely establishment of outpatient care did correlate with quicker decannulation, factors related to medical complexity may have a greater impact on time to decannulation. Our results can help guide institutional decannulation protocols, as well as provide guidance when counseling families regarding tracheostomy expectations.
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Affiliation(s)
- Ashley M Lloyd
- Division of Otolaryngology, George Washington University Hospital, Washington, DC, USA.
| | - Hengameh K Behzadpour
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Md Sohel Rana
- Department of Surgery, Children's National Hospital, Washington DC, USA
| | - Alexandra G Espinel
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
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Ledl C, Frank U, Dziewas R, Arnold B, Bähre N, Betz CS, Braune S, Deitmer T, Diesener P, Fischer AS, Hamzic S, Iberl G, Konradi J, Löhler J, Platz T, Rohlfes C, Westhoff M, Winkler S, Wirth R, Graf S. [Curriculum "Tracheostomy management in dysphagia therapy"]. Nervenarzt 2024; 95:342-352. [PMID: 38277047 PMCID: PMC11014872 DOI: 10.1007/s00115-023-01598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.
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Affiliation(s)
- C Ledl
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland.
- Schön Klinik Bad Aibling, Bad Aibling, Deutschland.
| | - U Frank
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Swallowing Research Lab, Universität Potsdam, Potsdam, Deutschland
| | - R Dziewas
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Neurologie, Berlin, Deutschland
- Deutsche Gesellschaft für NeuroIntensiv- und Notfallmedizin, Jena, Deutschland
- Klinik für Neurologie und neurologische Frührehabilitation, Klinikum Osnabrück, Osnabrück, Deutschland
| | - B Arnold
- Deutscher Berufsverband für Phoniatrie und Pädaudiologie, Berlin, Deutschland
| | - N Bähre
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
| | - C S Betz
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Braune
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
| | - P Diesener
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
- Dysphagie-Netzwerk-Südwest e. V., Überlingen, Deutschland
- Dysphagie- und Kanülensprechstunde Hegau-Jugendwerk Gailingen, Gailingen, Deutschland
- Rehaklinik Zihlschlacht, Zihlschlacht-Sitterdorf, Schweiz
| | - A S Fischer
- Juristische Fakultät, Forschungsstelle Medizinrecht, Ludwig-Maximilians-Universität, München, Deutschland
| | - S Hamzic
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Universitätsklinikum Gießen und Marburg, Campus Gießen, Neurologische Klinik, Justus-Liebig-Universität, Gießen, Deutschland
| | - G Iberl
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
| | - J Konradi
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Institut für Physikalische Therapie, Prävention und Rehabilitation, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - J Löhler
- Deutscher Berufsverband der HNO-Ärzte, Neumünster, Deutschland
| | - T Platz
- Deutsche Gesellschaft für Neurorehabilitation, Berlin, Deutschland
- Institut für Neurorehabilitation und Evidenzbasierung, An-Institut der Universität Greifswald, BDH-Klinik Greifswald, Greifswald, Deutschland
- AG Neurorehabilitation, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - C Rohlfes
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- BDH-Klinik Hessisch Oldendorf, Hessisch Oldendorf, Deutschland
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer, Deutschland
| | - S Winkler
- Deutscher Bundesverband für Logopädie, Frechen, Deutschland
| | - R Wirth
- Deutsche Gesellschaft für Geriatrie, Berlin, Deutschland
- Klinik für Altersmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
| | - S Graf
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Phoniatrie und Pädaudiologie, Göttingen, Deutschland
- Universitätsklinik für Hör‑, Stimm- und Sprachstörungen, Medizinische Universität Innsbruck, Innsbruck, Österreich
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Bertolin A, Varago C, Salemi M, Piccoli G, Nicolai P, Lionello M. Isoprognostic functional CT map for open partial horizontal laryngectomy. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08596-y. [PMID: 38554153 DOI: 10.1007/s00405-024-08596-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 03/04/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE To identify a radiological map of laryngeal subsites whose involvement by the tumor could predict patients' functional outcomes after open partial horizontal laryngectomy (OPHL). METHODS The present retrospective analysis concerned 96 patients with glottic squamous cell carcinoma, who were radiologically staged with contrast-enhanced neck CT scans before undergoing supracricoid or supratracheal laryngectomy. A radiological map of patients' functional risk was developed by considering the distribution of functional outcomes in relation to the laryngeal subsites involved. The functional outcomes considered were: (i) decannulation at discharge; (ii) time to removal of the nasogastric feeding tube (NFT); (iii) postoperative complication rate; and (iv) length of hospital stay. RESULTS Involvement of the anterior supraglottis was related to a longer need for NFT, and a longer hospital stay (p = 0.003, and p = 0.003, respectively). Involvement of the posterior glottis negatively affected the time to decannulation, and the likelihood of postoperative complications (p = 0.000, and p = 0.002, respectively). CONCLUSIONS Anterior glottic small tumors (without significant subglottic and/or supraglottic extension) are related to the best functional outcomes after OPHL, since the suprahyoid epiglottis and both the arytenoids are likely to be spared.
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Affiliation(s)
- Andy Bertolin
- Otolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | - Chiara Varago
- Otolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy
| | | | | | - Piero Nicolai
- Neuroscience Department, Otolaryngology Section, University of Padova, Padua, Italy
| | - Marco Lionello
- Otolaryngology Unit, Vittorio Veneto Hospital, Vittorio Veneto, Treviso, Italy.
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5
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Komori M. Update on pediatric tracheostomy. Auris Nasus Larynx 2024; 51:429-432. [PMID: 38520972 DOI: 10.1016/j.anl.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/30/2023] [Accepted: 01/12/2024] [Indexed: 03/25/2024]
Abstract
Pediatric tracheostomy has been widely performed since the 1800s, and in recent years, with advances in neonatal medicine, it has been performed at younger ages, starting at 0. In addition, advances in surgical techniques and postoperative tube management have reduced complications. This review will discuss the entire process of pediatric tracheostomy, starting with the history of tracheostomy and ending with indications, contraindications, techniques (slit, Björk, EXIT), complications, tube management, and decannulation. Pediatric tracheostomy patients require long-term care and management as they grow after the surgery itself, so otolaryngologists and pediatric tracheostomists are particularly involved in tube management and decannulation. We believe that sharing this information with all healthcare professionals will lead to better care for children with tracheostomies.
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Affiliation(s)
- Manabu Komori
- Department of Otolaryngology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki-city, Kanagawa, Japan.
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6
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Raynor EM, Wohl D. Tracheostomy-Related Swallowing Issues in Children. Otolaryngol Clin North Am 2024:S0030-6665(24)00030-6. [PMID: 38508881 DOI: 10.1016/j.otc.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Children with tracheostomies have multiple challenges with respect to achieving normal deglutition. These children may have underlying neurologic or genetic conditions that can predispose to dysphagia, but even in children without underlying comorbidities, the presence of a tracheostomy tube impacts the mechanics of swallowing, leading to difficulty with different consistencies as well as management of normal oral secretions. Intubation prior to tracheostomy also impacts sensation in the upper aerodigestive tract increasing the risk of aspiration. Occlusion of the tracheostomy with a speaking valve or cap improves outcomes in swallow and prognosis for oral feeding.
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Affiliation(s)
- Eileen M Raynor
- Department of Head and Neck Surgery & Communication Sciences, Duke Health System, DUMC Box 3805, Durham, NC 27710, USA.
| | - Daniel Wohl
- Pediatric Otolaryngology Associates, 4114 Sunbeam Road, Jacksonville, FL 32257, USA
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Ge J, Niu G, Li Q, Li Y, Yang B, Guo H, Wang J, Zhang B, Zhang C, Zhou T, Zhao Z, Jiang H. Cough flows as a criterion for decannulation of autonomously breathing patients with tracheostomy tubes. Respir Res 2024; 25:128. [PMID: 38500141 PMCID: PMC10949589 DOI: 10.1186/s12931-024-02762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Adequate cough or exsufflation flow can indicate an option for safe tracheostomy decannulation to noninvasive management. Cough peak flow via the upper airways with the tube capped is an outcome predictor for decannulation readiness in patients with neuromuscular impairment. However, this threshold value is typically measured with tracheotomy tube removed, which is not acceptable culturally in China. The aim of this study was to assess the feasibility and safety of using cough flow measured with tracheostomy tube and speaking valve (CFSV) > 100 L/min as a cutoff value for decannulation. STUDY DESIGN Prospective observational study conducted between January 2019 and September 2022 in a tertiary rehabilitation hospital. METHODS Patients with prolonged tracheostomy tube placement were referred for screening. Each patient was assessed using a standardized tracheostomy decannulation protocol, in which CFSV greater than 100 L/min indicated that the patients' cough ability was sufficient for decannulation. Patients whose CFSV matched the threshold value and other protocol criteria were decannulated, and the reintubation and mortality rates were followed-up for 6 months. RESULTS A total of 218 patients were screened and 193 patients were included. A total of 105 patients underwent decannulation, 103 patients were decannulated successfully, and 2 patients decannulated failure, required reinsertion of the tracheostomy tube within 48 h (failure rate 1.9%). Three patients required reinsertion or translaryngeal intubation within 6 months. CONCLUSIONS CFSV greater than 100 L/min could be a reliable threshold value for successful decannulation in patients with various primary diseases with a tracheostomy tube. TRIAL REGISTRATION This observational study was not registered online.
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Affiliation(s)
- Jingyi Ge
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Guangyu Niu
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Qing Li
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Yi Li
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Bo Yang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Haiming Guo
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Jianjun Wang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Bin Zhang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Chenxi Zhang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Ting Zhou
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Zhanqi Zhao
- School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Hongying Jiang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China.
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8
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Li BL, An Z, Zhou W, Pan JJ, Wang J, Xu ZY, Han L. Comparation of the outcomes between ProGlide based post-closure technique and arteriotomy repair for veno-arterial extracorporeal membrane oxygenation decannulation. J Crit Care 2024; 79:154434. [PMID: 37742517 DOI: 10.1016/j.jcrc.2023.154434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/11/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To compare outcomes between post-closure technique based on ProGlide and arteriotomy repair for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decannulation in this study. MATERIALS AND METHODS Patients who received VA-ECMO treatment and successfully removed from its support in Changhai Hospital from January 2018 to December 2021 were included in this study. Patients was divided into post-closure group and surgical repair group according to the artery access closure method used. Clinical data of these patients were retrospectively collected and analyzed. RESULTS A total of 58 patients were eventually enrolled in this study, including 26 (44.83%) patients in post-closure group and 32 (55.17%) patients in surgical repair group. Post-closure group had shorter procedure time, less minor bleeding events, estimated blood loss and packed cells transfused compared with the surgical repair group. The intensive care unit (ICU) length of stay after decannulation and the hospital length of stay after ICU in post-closure group were both shorter than surgical repair group. Nine patients (15.52%) died of multiple system organ failure after decannulation in this cohort and there were no significant differences between two groups. CONCLUSIONS Our study showed the post-closure technique based on ProGlide for VA-ECMO decannulation is feasible, safe and effective.
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Affiliation(s)
- Bai-Ling Li
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhao An
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jia-Jun Pan
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jun Wang
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhi-Yun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
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9
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Schneider H, Meis J, Klose C, Ratzka P, Niesen WD, Seder DB, Bösel J. Surgical Versus Dilational Tracheostomy in Patients with Severe Stroke: A SETPOINT2 Post hoc Analysis. Neurocrit Care 2024:10.1007/s12028-023-01933-9. [PMID: 38291277 DOI: 10.1007/s12028-023-01933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Tracheostomy in mechanically ventilated patients with severe stroke can be performed surgically or dilationally. Prospective data comparing both methods in patients with stroke are scarce. The randomized Stroke-Related Early Tracheostomy vs Prolonged Orotracheal Intubation in Neurocritical Care Trial2 (SETPOINT2) assigned 382 mechanically ventilated patients with stroke to early tracheostomy versus extubation or standard tracheostomy. Surgical tracheostomy (ST) was performed in 41 of 307 SETPOINT2 patients, and the majority received dilational tracheostomy (DT). We aimed to compare ST and DT in these patients with patients. METHODS All SETPOINT2 patients with ST were compared with a control group of patients with stroke undergoing DT (1:2), selected by propensity score matching that included the factors stroke type, SETPOINT2 randomization group, Stroke Early Tracheostomy score, patient age, and premorbid functional status. Successful decannulation was the primary outcome, and secondary outcome parameters included functional outcome at 6 months and adverse events attributable to tracheostomy. Potential predictors of decannulation were evaluated by regression analysis. RESULTS Baseline characteristics were comparable in the two groups of patients with stroke undergoing ST (n = 41) and matched patients with stroke undergoing DT (n = 82). Tracheostomy was performed significantly later in the ST group than in the DT group (median 9 [interquartile range {IQR} 5-12] vs. 9 [IQR 4-11] days after intubation, p = 0.025). Patients with ST were mechanically ventilated longer (median 19 [IQR 17-24] vs.14 [IQR 11-19] days, p = 0.008) and stayed in the intensive care unit longer (median 23 [IQR 16-27] vs. 17 [IQR 13-24] days, p = 0.047), compared with patients with DT. The intrahospital infection rate was significantly higher in the ST group compared to the DT group (14.6% vs. 1.2%, p = 0.002). At 6 months, decannulation rates (56% vs. 61%), functional outcomes, and mortality were not different. However, decannulation was performed later in the ST group compared to the DT group (median 81 [IQR 66-149] vs. 58 [IQR 32-77] days, p = 0.004). Higher baseline Stroke Early Tracheostomy score negatively predicted decannulation. CONCLUSIONS In ventilated patients with severe stroke in need of tracheostomy, surgical and dilational methods are associated with comparable decannulation rate and functional outcome at 6 months. However, ST was associated with longer time to decannulation and higher rates of early infections, supporting the dilational approach to tracheostomy in ventilated patients with stroke.
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Affiliation(s)
- Hauke Schneider
- Department of Neurology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Medical Faculty, University of Dresden, Dresden, Germany.
| | - Jan Meis
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Peter Ratzka
- Department of Neurology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David B Seder
- Department of Critical Care Services, Maine Medical Center, Portland, ME, USA
| | - Julian Bösel
- University of Heidelberg, Heidelberg, Germany
- Johns Hopkins University Hospital, Baltimore, MD, USA
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10
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Gallice T, Cugy E, Branchard O, Dehail P, Moucheboeuf G. Predictive Factors for Successful Decannulation in Patients with Tracheostomies and Brain Injuries: A Systematic Review. Dysphagia 2024:10.1007/s00455-023-10646-2. [PMID: 38189928 DOI: 10.1007/s00455-023-10646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024]
Abstract
Neurological patients frequently have disorders of consciousness, swallowing disorders, or neurological states that are incompatible with extubation. Therefore, they frequently require tracheostomies during their stay in an intensive care unit. After the acute phase, tracheostomy weaning and decannulation are generally expected to promote rehabilitation. However, few reliable predictive factors (PFs) for decannulation have been identified in this patient population. We sought to identify PFs that may be used during tracheostomy weaning and decannulation in patients with brain injuries. We conducted a systematic review of the literature regarding potential PFs for decannulation; searches were performed on 16 March 2021 and 1 June 2022. The following databases were searched: MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, PEDro, OPENGREY, OPENSIGLE, Science Direct, CLINICAL TRIALS and CENTRAL. We searched for all article types, except systematic reviews, meta-analyses, abstracts, and position articles. Retrieved articles were published in English or French, with no date restriction. In total, 1433 articles were identified; 26 of these were eligible for inclusion in the review. PFs for successful decannulation in patients with acquired brain injuries (ABIs) included high neurological status, traumatic brain injuries rather than stroke or anoxic brain lesions, younger age, effective swallowing, an effective cough, and the absence of pulmonary infections. Secondary PFs included early tracheostomy, supratentorial lesions, the absence of critical illness polyneuropathy/myopathy, and the absence of tracheal lesions. To our knowledge, this is the first systematic review to identify PFs for decannulation in patients with ABIs. These PFs may be used by clinicians during tracheostomy weaning.
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Affiliation(s)
- Thomas Gallice
- Neurosurgery Unit B, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France.
- Neurological ICU, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France.
- Physical and Rehabilitation Medicine Unit, Swallowing Evaluation Unit, Bordeaux University Hospital, Tastet-Girard Hospital, 33000, Bordeaux, France.
- Bordeaux Research Center for Population Health (BPH), Team: ACTIVE, University Bordeaux Segalen, UMR_S 1219, 33000, Bordeaux, France.
| | - Emmanuelle Cugy
- Physical and Rehabilitation Medicine Unit, Swallowing Evaluation Unit, Bordeaux University Hospital, Tastet-Girard Hospital, 33000, Bordeaux, France
- Physical and Rehabilitation Medicine Unit, Bordeaux University Hospital, Tastet-Girard Hospital, 33000, Bordeaux, France
- Physical and Rehabilitation Medicine Unit, Arcachon Hospital, 33260, La Teste de Buch, France
| | - Olivier Branchard
- Neurosurgery Unit B, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France
| | - Patrick Dehail
- Bordeaux Research Center for Population Health (BPH), Team: ACTIVE, University Bordeaux Segalen, UMR_S 1219, 33000, Bordeaux, France
- Physical and Rehabilitation Medicine Unit, Bordeaux University Hospital, Tastet-Girard Hospital, 33000, Bordeaux, France
| | - Geoffroy Moucheboeuf
- Neurological ICU, Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France
- Physical and Rehabilitation Medicine Unit, Bordeaux University Hospital, Tastet-Girard Hospital, 33000, Bordeaux, France
- Traumatic and Surgical ICU, , Bordeaux University Hospital, Pellegrin Hospital, 33000, Bordeaux, France
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11
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Miu K, Magill J, Wyatt M, Hewitt R, Butler C, Cooke J. Revisiting the Great Ormond Street Hospital protocol for ward decannulation of children with tracheostomy. Int J Pediatr Otorhinolaryngol 2024; 176:111787. [PMID: 37988917 DOI: 10.1016/j.ijporl.2023.111787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Tracheostomy decannulation is an important and final step in managing patients once the underlying issue requiring a tracheostomy resolves. However, no consensus exists on the optimal method to decannulate a paediatric patient. We revisit the Great Ormond Street Hospital (GOSH) tracheostomy decannulation protocol, a 5-day process involving downsizing the tracheostomy tube, capping, and observation, to evaluate its effectiveness and assess if changes to the protocol are required. METHOD This is a retrospective study, reviewing patient records between April 2018 and April 2023 from a single quaternary care centre. Data extracted include comorbidities, age at the time of decannulation, duration of tracheostomy, reason for tracheostomy insertion, whether a decannulation attempt was successful or not, and the timings of decannulation failure. RESULTS 66 patients that met the selection criteria underwent a decannulation trial between April 2018 and April 2023. 32 patients were male, and 34 patients were female. Age at attempted decannulations ranged from 1 year to 18 years, with an average age of 6.1 years. There were a total of 93 attempts at decannulation, with 51 (54.8%) successful attempts, 35 (56.5%) first decannulation attempt successes, and 42 (45.2%) unsuccessful attempts. 17 patients had 2 attempts at decannulation, and 4 patients had 3 or more attempts at decannulation. Of the unsuccessful attempts, patients mostly failed on capping of the tracheostomy tube with 33 failures (35.5%). CONCLUSION The GOSH protocol achieved similar success rates to comparable protocols. The protocol's multi-step approach provides thorough evaluation and support for patients during the decannulation process, and its success on a complex patient cohort supports its continued use.
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Affiliation(s)
- Kelvin Miu
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Jennifer Magill
- Department of Otorhinolaryngology, The Royal London Hospital, Whitechapel Road, London, E1 1FR, United Kingdom.
| | - Michelle Wyatt
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Richard Hewitt
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Colin Butler
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Joanne Cooke
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
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12
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Lanini B, Binazzi B, Romagnoli I, Chellini E, Pianigiani L, Tofani A, Molino Lova R, Corbetta L, Gigliotti F. Tracheostomy decannulation in severe acquired brain injury patients: The role of flexible bronchoscopy. Pulmonology 2023; 29 Suppl 4:S80-S85. [PMID: 34219041 DOI: 10.1016/j.pulmoe.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Subjects with severe acquired brain injury (sABI) require long-term mechanical ventilation and, as a consequence, the tracheostomy tube stays in place for a long time. In this observational study, we investigated to what extent the identification of late tracheostomy complications by flexible bronchoscopy (FBS) might guide clinicians in the treatment of tracheal lesions throughout the weaning process and lead to successful decannulation. SUBJECTS AND METHODS One hundred and ninety-four subjects with sABI admitted to our rehabilitation unit were enrolled in the study. All subjects received FBS and tracheal lesions were treated either by choosing a more suitable tracheostomy tube, or by laser therapy, or by steroid therapy, or by a combination of the above treatments. RESULTS Overall, 122 subjects (63%) were decannulated successfully. Our subjects received 495 FBSs (2.55 per subject) and as many as 270 late tracheostomy complications were identified. At least one complication was found in 160 subjects (82%). In only 11 subjects, late tracheostomy complications did not respond to the treatment and were the cause of decannulation failure. CONCLUSIONS In conclusion, in sABI patients FBS is able to guide successful tracheostomy weaning in the presence of late tracheostomy complications that could get in the way decannulation.
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Affiliation(s)
- B Lanini
- Pulmonary Rehabilitation Unit, Fondazione Don Carlo Gnocchi, Florence, Italy.
| | - B Binazzi
- Pulmonary Rehabilitation Unit, Fondazione Don Carlo Gnocchi, Florence, Italy
| | - I Romagnoli
- Pulmonary Rehabilitation Unit, Fondazione Don Carlo Gnocchi, Florence, Italy
| | - E Chellini
- Pulmonary Rehabilitation Unit, Fondazione Don Carlo Gnocchi, Florence, Italy
| | - L Pianigiani
- Pulmonary Rehabilitation Unit, Fondazione Don Carlo Gnocchi, Florence, Italy
| | - A Tofani
- Pulmonary Rehabilitation Unit, Fondazione Don Carlo Gnocchi, Florence, Italy
| | - R Molino Lova
- Pulmonary Rehabilitation Unit, Fondazione Don Carlo Gnocchi, Florence, Italy
| | - L Corbetta
- Unit of Interventional Pulmonology, University of Florence, Florence, Italy
| | - F Gigliotti
- Pulmonary Rehabilitation Unit, Fondazione Don Carlo Gnocchi, Florence, Italy
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13
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Lloyd AM, Behzadpour HK, Rana MS, Espinel AG. Factors associated with tracheostomy decannulation in infants with bronchopulmonary dysplasia. Int J Pediatr Otorhinolaryngol 2023; 175:111754. [PMID: 37847941 DOI: 10.1016/j.ijporl.2023.111754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/05/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Premature infants represent a unique subset of patients who may require tracheostomy. Bronchopulmonary dysplasia (BPD) is among one of the most common sequelae of prematurity contributing to the need for prolonged ventilation requiring tracheostomy after other airway options have been exhausted. Our objective is to understand socioeconomic barriers to decannulation and identify factors that accelerate safe decannulation, focusing on patients with BPD. METHODS An existing internal database from a tertiary pediatric hospital of patients undergoing tracheostomy prior to one year old was reviewed. Data from January 1, 2005 through December 31, 2020 was used to compare patients who were successfully decannulated to those who were not. A further subset of infants with BPD were identified and analyzed. Of those decannulated, survival analysis was used to identify factors associated with decreased time to decannulation. RESULTS We identified 303 infants who underwent tracheostomy at less than one year old with 125 of those infants having a diagnosis of BPD. Of the 125 infants with BPD, 44 (35.2 %) were decannulated and 81 (64.8 %) were not. There was no significant difference in sex, race, ethnicity, insurance status, comorbidities, or presence of syndromes between those patients with BPD who were decannulated and those who were not. Those who were not decannulated had a significantly longer length of hospital stay, prolonged ventilator requirements after tracheostomy, and were more likely to be discharged home on the ventilator (p = 0.030; 0.020; 0.002, respectively). Of the 44 decannulated patients, mean and median time to decannulation were 37.9 and 27.8 months respectively (range 10.8-160.6 months). There was an inverse association with decannulation and both Black race (HR: 0.30) and neurological comorbidity (HR: 0.37) on multivariate analysis. Black race, presence of syndrome, and length of ventilator dependence were significantly associated with increased time to decannulation. Time to decannulation from time off the ventilator was not significantly influenced by sex, race, ethnicity, state of residence, or insurance status, but was significantly influenced by age (95 % CI: -6.9, -0.1; P = 0.044). While time from discharge to first follow up visit did not significantly impact time to decannulation, every additional follow up visit increased time to decannulation by 3.78 months when adjusting for confounding variables. CONCLUSION In infants with BPD under one year requiring tracheostomy, socioeconomic factors were not found to influence likelihood of decannulation, however Black race, presence of underlying syndrome, and increased length of ventilator dependence were associated with prolonged timing. Children with more frequent follow up visits similarly had an increased time to decannulation, illustrating a vital point in the process. Ventilator weaning protocols and standardized decannulation protocols in patients with BPD, along with caregiver education, can safely expedite and facilitate decannulation.
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Affiliation(s)
- Ashley M Lloyd
- Division of Otolaryngology, George Washington University Hospital, Washington, DC, USA.
| | - Hengameh K Behzadpour
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Md Sohel Rana
- Department of Surgery, Children's National Hospital, Washington, DC, USA
| | - Alexandra G Espinel
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
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14
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Obayashi J, Fukumoto K, Yamoto M, Miyake H, Nomura A, Kanai R, Nemoto Y, Tsukui T. Safety evaluation of a stepwise tracheostomy decannulation program in pediatric patients. Pediatr Surg Int 2023; 39:260. [PMID: 37658905 DOI: 10.1007/s00383-023-05549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE In the event of failed tracheostomy decannulation, patients might have a tragic course of events. We retrospectively evaluated our stepwise tracheostomy decannulation program and examined its safety. METHODS A 12-year retrospective study of pediatric patients was conducted. The decannulation program was performed on patients who had airway patency by laryngobronchoscopy and whose cannula could be capped during the day. A stepwise decannulation program was performed: continuous 48-h capping trial during hospitalization (Phase 1), removal of the tracheostomy tube for 48 h during hospitalization (Phase 2), and outpatient observation (Phase 3). If a persistent tracheocutaneous fistula existed, the fistula was closed by surgery (Phase 4). RESULTS The 77 patients in the study underwent 86 trials. The age at the first time of the decannulation program was 6.5 ± 3.6 years. Sixteen trials failed (18.6%): 8 trials in Phase 1, 2 trials in Phase 2, 4 trials in Phase 3, and 2 trials in Phase 4. Most decannulation failures were due to desaturation in Phase 1/2 and dyspnea in Phase 3/4. The time to reintubation after decannulation was 15-383 days in Phase 3/4. CONCLUSIONS Patients could fail at every phase of the program, suggesting that a stepwise decannulation program contributes to safety.
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Affiliation(s)
- Juma Obayashi
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan.
| | - Koji Fukumoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Masaya Yamoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Akiyoshi Nomura
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Risa Kanai
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Yuri Nemoto
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
| | - Takafumi Tsukui
- Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan
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15
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Cui W, Xiang J, Deng X, Qin Z. Difficult tracheostomy decannulation related to nasogastric tube syndrome: A case report. Int J Surg Case Rep 2023; 110:108734. [PMID: 37660494 PMCID: PMC10509863 DOI: 10.1016/j.ijscr.2023.108734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Nasogastric tube syndrome (NGTS) is a rare but potentially life-threatening complication. Patients receiving both tracheostomy and indwelling nasogastric tube (NGT) are not uncommon, however difficult tracheostomy decannulation due to NGTS has not been reported. CASE PRESENTATION A 65-year-old woman was hospitalized with cervical spine stenosis and cervical spinal cord injury after a fall. The surgeon planned neck surgery, but unanticipated tracheotomy had to perform due to emergency airway during anesthesia induction. She then suffered from acute respiratory distress syndrome and underwent a series of treatments including indwelling NGT. About 2 weeks later, tracheostomy decannulation was planned. Following tracheostomy-tube-occlusion test, however, she experienced severe inspiratory difficulty. Severe supraglottic swelling was found, and the opening of glottis was completely covered by swollen tissue. Three weeks post-tracheostomy, the airway patency test failed again, and NGT was removed. Finally, the tracheostomy tube was successfully removed at 5 weeks after tracheotomy. CLINICAL DISCUSSION This patient developed difficult tracheostomy decannulation due to upper airway obstruction, and NGTS was considered as the main cause. Although vocal cord paralysis and post-cricoid ulcer did not occur in this case, we suggest that severe periglottic swelling may also be a symptom of NGTS. In this patient, upper airway edema gradually relieved after NGT removal, and the artificial airway was also removed 2 weeks later. Therefore, removal of NGT is the primary measure to deal with NGTS. CONCLUSIONS Attention should be paid to the effect of NGTS on decannulation in patients receiving long-term tracheotomy and NGT insertion.
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Affiliation(s)
- Wei Cui
- Department of Spine, Sichuan Province Orthopedic Hospital, Chengdu 610041, China
| | - Jilin Xiang
- Anesthesiology Department, Sichuan Province Orthopedic Hospital, Chengdu 610041, China
| | - Xuangeng Deng
- Department of Spine, Sichuan Province Orthopedic Hospital, Chengdu 610041, China
| | - Zhijun Qin
- Intensive Care Unit, Sichuan Province Orthopedic Hospital, Chengdu 610041, China.
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16
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Zens T, Ochoa B, Eldredge RS, Molitor M. Pediatric venoarterial and venovenous ECMO. Semin Pediatr Surg 2023; 32:151327. [PMID: 37956593 DOI: 10.1016/j.sempedsurg.2023.151327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is an invaluable resource in the treatment of critically ill children with cardiopulmonary failure. To date, over 36,000 children have been placed on ECMO and the utilization of this life saving treatment continues to expand with advances in ECMO technology. This article offers a review of pediatric ECMO including modes and sites of ECMO cannulation, indications and contraindications, and cannulation techniques. Furthermore, it summarizes the basic principles of pediatric ECMO including circuit maintenance, nutritional support, and clinical decision making regarding weaning pediatric ECMO and decannulation. Finally, it gives an overview of common pediatric ECMO complications including overall mortality and long-term outcomes of ECMO survivors. The goal of this article is to provide a comprehensive review for healthcare professionals providing care for pediatric ECMO patients.
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Affiliation(s)
- Tiffany Zens
- Phoenix Children's Hospital, Department of Surgery, Divison of Pediatric Surgery, Phoenix, AZ, United States
| | - Brielle Ochoa
- Phoenix Children's Hospital, Department of Surgery, Divison of Pediatric Surgery, Phoenix, AZ, United States
| | - R Scott Eldredge
- Phoenix Children's Hospital, Department of Surgery, Divison of Pediatric Surgery, Phoenix, AZ, United States
| | - Mark Molitor
- Phoenix Children's Hospital, Department of Surgery, Divison of Pediatric Surgery, Phoenix, AZ, United States.
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17
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Ledl C, Frank U, Ullrich YY. [Tracheostomy managment and tube weaning within a framework of dysphagia intervention]. Nervenarzt 2023; 94:694-701. [PMID: 37219566 DOI: 10.1007/s00115-023-01489-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/24/2023]
Abstract
Persistent dysphagia is a major predictor of prolonged ventilation weaning and unsuccessful attempts at decannulation. Due to the high incidence of dysphagia in tracheotomized patients, tracheal cannula management and dysphagia treatment must be coordinated. A central element of tracheal cannula management in dysphagia treatment is the establishment of physiological airflow. This enables voluntary clearing functions, such as coughing and throat clearing and significantly reduces aspiration. A distinction is made between spontaneous and staged decannulation pathways with expansion of cuff unblocking times and occlusion training. Other therapeutic measures include secretion and saliva management, cough function training with improvement of strength and sensitivity, pharyngeal electrical stimulation, adaptation of tracheal tubes to optimize respiratory and swallowing function, control and treatment of airway stenosis, and standardization of processes for quality assurance.
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Affiliation(s)
- Christian Ledl
- Schön Klinik Bad Aibling Harthausen, Kolbermoorer Str. 72, 83043, Bad Aibling, Deutschland.
| | - Ulrike Frank
- Department Linguistik, Swallowing Research Lab, Universität Potsdam, Potsdam, Deutschland
| | - Ylva Y Ullrich
- Schön Klinik Bad Aibling Harthausen, Kolbermoorer Str. 72, 83043, Bad Aibling, Deutschland
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18
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Dubey YV, Prasad BK. A Study of Difficulty in Decannulation of Tracheostomized Head Injury Patients. Indian J Otolaryngol Head Neck Surg 2023; 75:817-824. [PMID: 37275027 PMCID: PMC10235311 DOI: 10.1007/s12070-023-03504-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/14/2023] [Indexed: 02/07/2023] Open
Abstract
A prospective observational study was done with the aim to analyze the difficulties during decannulation of tracheostomized head injury patients and to devise a sound protocol for decannulation. It was done over 2 years in a tertiary care Army Hospital with 40 tracheostomized head injury cases in the age group of 10-70 years. Once the indication of tracheostomy was over, their Glasgow Coma Scale score, airway adequacy, phonation, swallowing, cough reflex, and lung pathology were assessed. Fit patients were decannulated if they tolerated tube capping for 3 days. Data was statistically analyzed. Road traffic accident was the cause of head injury in 90% cases. 45% patients had traumatic brain injury. All the cases required ventilatory support. 80% patients required neurosurgery. Tracheostomy was done between 5th to 10th day. Decannulation could be achieved in 75% patients. Factors like neurological status, duration of ventilatory need, number of days on T piece, cough reflex, suction requirement, phonation, consistency of tracheal secretion, lung condition, and three days? capping of tracheostomy tube were significantly associated with outcome of decannulation trial (p <0.05). Factors like mode of injury, neurosurgical intervention, absence of phonation, and downsizing of tube did not affect the outcome significantly (p >0.05). The factors like strong cough reflex, thin minimal tracheal secretion, aspiration free swallowing, better GCS score, early weaning from ventilator and younger age favour early successful decannulation. Gradual downsizing of tube or presence of phonation are not essential prerequisites for decannulation. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03504-y.
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19
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Zaga CJ, Berney S, Hepworth G, Cameron TS, Baker S, Giddings C, Howard ME, Bellomo R, Vogel AP. Tracheostomy clinical practices and patient outcomes in three tertiary metropolitan hospitals in Australia. Aust Crit Care 2023; 36:327-335. [PMID: 35490111 DOI: 10.1016/j.aucc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/24/2022] [Accepted: 03/06/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND There is a paucity of literature in Australia on patient-focused tracheostomy outcomes and process outcomes. Exploration of processes of care enables teams to identify and address existing barriers that may prevent earlier therapeutic interventions that could improve patient outcomes following critical care survival. OBJECTIVES The objectives of this study were to examine and provide baseline data and associations between tracheostomy clinical practices and patient outcomes across three large metropolitan hospitals. METHODS We performed a retrospective multisite observational study in three tertiary metropolitan Australian health services who are members of the Global Tracheostomy Collaborative. Deidentified data were entered into the Global Tracheostomy Collaborative database from Jan 2016 to Dec 2019. Descriptive statistics were used for the reported outcomes of length of stay, mortality, tracheostomy-related adverse events and complications, tracheostomy insertion, airway, mechanical ventilation, communication, swallowing, nutrition, length of cannulation, and decannulation. Pearson's correlation coefficient and one-way analyses of variance were performed to examine associations between variables. RESULTS The total cohort was 380 patients. The in-hospital mortality of the study cohort was 13%. Overall median hospital length of stay was 46 days (interquartile range: 31-74). Length of cannulation was shorter in patients who did not experience any tracheostomy-related adverse events (p= 0.036) and who utilised nonverbal communication methods (p = 0.041). Few patients (8%) utilised verbal communication methods while mechanically ventilated, compared with 80% who utilised a one-way speaking valve while off the ventilator. Oral intake was commenced in 20% of patients prior to decannulation. Patient nutritional intake varied prior to and at the time of decannulation. Decannulation occurred in 83% of patients. CONCLUSIONS This study provides baseline data for tracheostomy outcomes across three large metropolitan Australian hospitals. Most outcomes were comparable with previous international and local studies. Future research is warranted to explore the impact of earlier nonverbal communication and interventions targeting the reduction in tracheostomy-related adverse events.
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Affiliation(s)
- Charissa J Zaga
- Department of Speech Pathology, Division of Allied Health, Austin Health Melbourne, Australia; Tracheostomy Review and Management Service, Austin Hospital, Melbourne, Australia; Institute of Breathing and Sleep, Austin Health, Melbourne, Australia; Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia.
| | - Sue Berney
- Institute of Breathing and Sleep, Austin Health, Melbourne, Australia; Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Australia; Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Australia
| | - Tanis S Cameron
- Tracheostomy Review and Management Service, Austin Hospital, Melbourne, Australia
| | - Sonia Baker
- Department of Speech Pathology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Charles Giddings
- Department of Ear, Nose and Throat Surgery, Monash Health, Melbourne, Australia
| | - Mark E Howard
- Institute of Breathing and Sleep, Austin Health, Melbourne, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Health, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, Australia; Department of Neurodegeneration, Hertie Institute for Clinical Brian Research, Tübingen, Germany; Redenlab, Mebourne, Australia
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20
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Böschen E, Wendt A, Müller-Stöver S, Piechnik L, Fuchs H, Lund M, Steindor M, Große-Onnebrink J, Keßler C, Grychtol R, Rothoeft T, Bieli C, van Egmond-Fröhlich A, Stehling F. Tracheostomy decannulation in children: a proposal for a structured approach on behalf of the working group chronic respiratory insufficiency within the German-speaking society of pediatric pulmonology. Eur J Pediatr 2023:10.1007/s00431-023-04966-6. [PMID: 37121990 DOI: 10.1007/s00431-023-04966-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023]
Abstract
The number of children with tracheostomies with and without home mechanical ventilation has grown continuously in recent years. For some of these children, the need for tracheostomy resolves and the child can be weaned from the tracheal cannula. Choosing the optimal time point for decannulation after elaborated prior diagnostic work-up needs careful consideration. The decannulation process requires an interdisciplinary team; however, these specialized structures for the experienced care of these children with tracheostomy are not available in all areas. The Working Group on Chronic Respiratory Insufficiency in the German Speaking Pediatric Pneumology Society (GPP) developed these recommendations to guide through a decannulation process. Initial evaluation of decannulation feasibility starts in the outpatient clinic with a detailed history, examination, and a speaking valve trial and is followed by an inpatient workup including sleep study, airway endoscopy and possibly modifications of the tracheal cannula. Downsizing the tracheal cannula allows a stepwise controlled weaning prior to removal of the tracheal cannula. After shrinking of the tracheostomy, the final surgical closure is performed. Conclusion: An algorithm with diagnostic and therapeutic procedures for a safe and successful decannulation process is proposed. What is Known: • In children tracheostomy decannulation is a complex process that requires careful preparation and surveillance. What is New: • This statement of the German speaking society of pediatric pulmonology provides an expert practice guidance on the decannulation procedure and the value of one-way speaking valves.
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Affiliation(s)
- Eicke Böschen
- Department of Respiratory Care, Pediatric Pulmonology and Sleep Medicine, Childrens Hospital, Altonaer Kinderkrankenhaus, Bleickenallee 38, 22763, Hamburg, Germany.
| | - Anke Wendt
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité, Berlin, Germany
| | - Sarah Müller-Stöver
- Department of Respiratory Care, Pediatric Pulmonology and Sleep Medicine, Childrens Hospital, Altonaer Kinderkrankenhaus, Bleickenallee 38, 22763, Hamburg, Germany
| | - Lydia Piechnik
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité, Berlin, Germany
| | - Hans Fuchs
- Center for Pediatrics, Department of Neonatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Madeleine Lund
- Department of Respiratory Care, Pediatric Pulmonology and Sleep Medicine, Childrens Hospital, Altonaer Kinderkrankenhaus, Bleickenallee 38, 22763, Hamburg, Germany
| | - Mathis Steindor
- Department of Pediatric Pulmonology and Sleep Medicine, Childrens Hospital, University of Duisburg-Essen, Essen, Germany
| | | | - Christina Keßler
- Department of General Pediatrics, University Hospital Munster, Munster, Germany
| | - Ruth Grychtol
- Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Tobias Rothoeft
- Department of Neonatology and Pediatric Intensive Care, University Childrens Hospital, Ruhr-University, Bochum, Germany
| | - Christian Bieli
- Department of Paediatric Pulmonology, University Childrens Hospital, Zurich, Switzerland
| | | | - Florian Stehling
- Department of Pediatric Pulmonology and Sleep Medicine, Childrens Hospital, University of Duisburg-Essen, Essen, Germany
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21
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Dawson C, Nankivell P, Pracy JP, Capewell R, Wood M, Weblin J, Parekh D, Patel J, Skoretz SA, Sharma N. Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study. Dysphagia 2023; 38:657-666. [PMID: 35841455 PMCID: PMC9287536 DOI: 10.1007/s00455-022-10496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 07/01/2022] [Indexed: 11/03/2022]
Abstract
To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding.
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Affiliation(s)
- C Dawson
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK.
- University of Birmingham Institute of Clinical Sciences, Birmingham, UK.
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada.
| | - P Nankivell
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK
| | - J P Pracy
- Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK
| | - R Capewell
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK
| | - M Wood
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK
| | - J Weblin
- Department of Therapy Services, Queen Elizabeth Hospital Birmingham NHSFT, Birmingham, UK
| | - D Parekh
- Centre for Translational Inflammation and Fibrosis Research, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - J Patel
- Department of Anaesthetics and Critical Care, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - S A Skoretz
- School of Audiology and Speech Sciences, University of British Columbia, Vancouver, Canada
- Department of Critical Care Medicine, University of Alberta, Edmonton, Canada
- Centre for Heart Lung Innovation, St. Paul's Hospital, Providence Health Care, Vancouver, Canada
| | - N Sharma
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham, UK
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22
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Bhasarkar A, Dolma K. Utility of Early Tracheostomy in Critically Ill Covid-19 Patients: A Systematic Review. Indian J Otolaryngol Head Neck Surg 2023; 75:1-11. [PMID: 37362113 PMCID: PMC10016177 DOI: 10.1007/s12070-022-03280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/11/2022] [Indexed: 03/17/2023] Open
Abstract
COVID 19 has proven itself to be an agent of cataclysm and caused an uproar worldwide due to consistent strain on the finite resources available to tackle the situation. With the rapidly mutating viral nature, resultant disease is becoming more severe over time, causing significant numbers of critical cases needing invasive ventilatory support. Available literature dictates that tracheostomy might reduce the stress over healthcare infrastructure. Our systematic review is aimed towards understanding the influence of tracheostomy timing, over the course of the illness, by analyzing the relevant literature, thus aiding in decision making while managing critical COVID 19 patients. With predefined inclusion and exclusion criteria, PubMed data was explored using search terms like 'timing', 'tracheotomy'/'tracheostomy' and 'COVID'/'COVID-19'/'SARS CoV2' and 26 articles were finalised for formal review. 26 studies (3527 patients) were systematically reviewed. 60.3% and 39.5% patients underwent percutaneous dilational tracheostomy and open surgical tracheostomy respectively. We report 7.62%, 21.3%, 56% and 46.53% as approximate estimates, of complication rate, mortality rate, rate of mechanical ventilation weaning and rate of decannulation following tracheostomy in COVID 19 patients, respectively taking into account underestimation of the data. Provided that appropriate preventive measures and safety guidelines are strictly followed, moderately early tracheostomy (between 10 and 14 days of intubation) can prove quite efficacious in management of critical COVID 19 patients. Also, early tracheostomy was associated with early weaning and decannulation, thus reducing the enormous competition for intensive care unit beds.
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Affiliation(s)
- Ashwin Bhasarkar
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Kunzes Dolma
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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23
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Rehorn W, Herkenrath S, Treml M, Hagmeyer L, Bayarassou AH, Randerath W. Decannulation/Weaning Potential and Success in Home Intensive Care. Respiration 2023; 102:110-119. [PMID: 36521450 DOI: 10.1159/000528273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The number of patients receiving home long-term ventilation has risen considerably in recent decades owing to medical advancements. Experts believe that the potential for ventilator weaning or tracheostoma removal is currently insufficiently exploited. OBJECTIVE The objective of this study was to investigate the characteristics, prognosis, and decannulation/weaning potential of patients under home intensive care. METHODS In this retrospective analysis of 607 patients on home intensive care, decannulation/weaning status and survival were documented for a 2-year period after initial assessment. At the time of hospital discharge, when clinicians had deemed the weaning process concluded, an independent expert noninvasively assessed the long-term decannulation/weaning. Comparative analyses based on specific criteria, such as ventilation and decannulation/weaning status, age, and underlying diseases, were performed. Potential predictors of survival were identified via multivariable logistic regression. RESULTS Eighteen percent of patients were decannulated/weaned within 2 years after hospital discharge and had better mean survival than patients not decannulated/weaned (552 vs. 420 days, p < 0.001). More than half of these patients were identified to have decannulation/weaning potential based on the assessment of the independent expert. Patients with neuromuscular and neurological diseases had the best survival (546 and 501 days), patients with postsurgical conditions and cardiological diseases the worst (346 and 323 days). Underlying disease and decannulation/weaning status were significant predictors of 2-year survival. CONCLUSION Successful decannulation/weaning of patients on long-term home intensive care is associated with better survival. Even in the absence of decannulation/weaning potential at the time of hospital discharge, patients may develop decannulation/weaning potential over time, which should therefore be assessed repeatedly.
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Affiliation(s)
- Wilhelm Rehorn
- Medical Service of the Health Insurance North Rhine, Düsseldorf, Germany
| | - Simon Herkenrath
- Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany.,Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Marcel Treml
- Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Lars Hagmeyer
- Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
| | | | - Winfried Randerath
- Clinic for Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
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24
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Chakraborty A, Majumdar HS, Das W, Chatterjee D, Sarkar K. Discontinuation of ECMO-a review with a note on Indian scenario. Indian J Thorac Cardiovasc Surg 2023; 39:1-9. [PMID: 36778721 PMCID: PMC9898693 DOI: 10.1007/s12055-022-01453-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 02/05/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) has strikingly progressed over the last 20 years in the management of adult and pediatric severe respiratory and cardiac dysfunctions refractory to conventional management. In this review, we will discuss the weaning strategies of veno-venous and veno-arterial ECMO including the bridge to recovery and bridge to transplant along with post-ECMO care. We will also discuss the futility and the management of bridge to nowhere from Indian perspectives.
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Affiliation(s)
- Arpan Chakraborty
- Cardiac Anesthesia, Critical Care and ECMO Services, Medica Superspecialty Hospital, Kolkata, India
| | - Hirak Subhra Majumdar
- Cardiac Anesthesia, Critical Care and ECMO Services, Medica Superspecialty Hospital, Kolkata, India
| | - Writuparna Das
- Cardiac Anesthesia, Critical Care and ECMO Services, Medica Superspecialty Hospital, Kolkata, India
| | - Dipanjan Chatterjee
- Cardiac Anesthesia, Critical Care and ECMO Services, Medica Superspecialty Hospital, Kolkata, India
| | - Kunal Sarkar
- Department of Cardiac Surgery, Medica Superspecialty Hospital, Kolkata, India
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25
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Nowak A, Martin S, Höhne M, Heller W, Usichenko TI, Klemm E. Tracheal airway pressure in tracheostomy tube capping trials: an experimental study. BMC Pulm Med 2022; 22:484. [PMID: 36539764 PMCID: PMC9768925 DOI: 10.1186/s12890-022-02277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Tracheostomy tube capping is a commonly used test to determine if the tracheostomy tube can be removed. The success of the capping trial depends on the patient's ability to maintain sufficient spontaneous breathing with an occluded tracheostomy tube. The impact of an occluded tracheotomy tube on airway resistance is currently unknown. The aim of this study was to investigate tracheal pressure during capping or stoma button insertion and potential determinants concerning cuff. METHODS Eight cuffed and uncuffed tracheostomy tubes and three stoma buttons of various manufacturers and sizes were inserted into the trachea model. Cuffs were completely deflated or contained atmospheric pressure. The trachea was ventilated bidirectional with a respirator in volume-controlled mode and volume flows 15-60 L/min. Tracheal pressure drop during inspiration as a parameter of pressure required to move gas through the airway was measured. RESULTS Tracheal pressure drops occurred linearly or irregularly during capping trials to a maximum of 4.2 kPa at flow rates of 60 L/min for atmospheric pressure cuffs. In tracheostomy tubes with completely deflated cuffs, pressure drop in the trachea reaches a maximum of 3.4 kPa at a flow rate of 60 L/min. For tracheostomy tubes with cuff smaller inner or outer diameters do not regularly result in lower tracheal pressure drop. The pressure drop varies between different tracheostomy tubes depending on the manufacturer. In cuffed tracheostomy tubes, we observed three phenomena: sail-like positioning, folding over, and tightening of the cuff during flow. The maximum tracheal pressure drop during stoma button insertion reaches 0.014 kPa. CONCLUSIONS The cuff is a central element for the pressure drop in the airway and thus airway resistance during spontaneous translaryngeal breathing with a capped TT. Complete deflation reduces the pressure drop in the trachea. Due to deformation of the cuff, measured pressures are irregular as the volume flow is increased. Incomplete deflated cuffs and material characteristics of tracheostomy tubes and cuffs in addition to anatomical and clinical variables may cause unsuccessful capping trials due to increased airway resistance. All stoma buttons showed that pressure drop and thus airway resistance due to stoma buttons has no clinical relevance.
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Affiliation(s)
- Andreas Nowak
- grid.4488.00000 0001 2111 7257Department of Anesthesiology and Intensive Care Medicine, Emergency Medicine and Pain Management, Dresden Friedrichstadt Hospital, Technical University Dresden Teaching Hospital, Friedrichstrasse 41, 01067 Dresden, Germany
| | - Sten Martin
- Faculty of Mechanical Engineering, University of Applied Sciences Dresden, Dresden, Germany
| | - Maik Höhne
- Faculty of Mechanical Engineering, University of Applied Sciences Dresden, Dresden, Germany
| | - Winfried Heller
- Faculty of Mechanical Engineering, University of Applied Sciences Dresden, Dresden, Germany
| | - Taras I. Usichenko
- grid.5603.0Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, Pain Medicine, University Medicine of Greifswald, Greifswald, Germany ,grid.25073.330000 0004 1936 8227Department of Anesthesia, McMaster University, Hamilton, Canada
| | - Eckart Klemm
- grid.4488.00000 0001 2111 7257Department of Otorhinolaryngology, Head and Neck Surgery, Plastic Surgery, Dresden Friedrichstadt Hospital, Technical University Dresden Teaching Hospital, Dresden, Germany
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26
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Jensen AR, Davis C, Gray BW. Cannulation and decannulation techniques for neonatal ECMO. Semin Fetal Neonatal Med 2022; 27:101404. [PMID: 36437185 DOI: 10.1016/j.siny.2022.101404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In neonates with cardiac and/or respiratory failure, extracorporeal membrane oxygenation (ECMO) continues to be an important method of respiratory and/or cardiovascular support where conventional treatments are failing. ECMO cannulation involves a complex decision-making process to choose the proper ECMO modality and cannulation strategy to match each patient's needs, unique anatomy, and potential complication profile. Initially, all ECMO support involved cannulating both the carotid artery and the internal jugular vein (IJV), known as veno-arterial (VA-ECMO) for cardiac and/or respiratory support. Rarely was cannulation through the chest used. The development of dual-lumen cannulae in the early to mid 1990s addressed the concerns about carotid artery ligation and its impact on neurological outcomes, and allowed single vascular access for veno-venous respiratory support (VV-ECMO). We present a review of cannulation and decannulation techniques for both VA and VV-ECMO in neonates.
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Affiliation(s)
- Amanda R Jensen
- Riley Hospital for Children Indiana University School of Medicine Indianapolis, IN, USA.
| | - Carl Davis
- Lead for the Paediatric & Adolescent Chest Wall Defect Service the Royal Hospital for Children, Glasgow, Scotland, United Kingdom.
| | - Brian W Gray
- Surgical Director of ECMO, Program Director, Pediatric Surgery Fellowship, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
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27
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Eswaran S, Senopher ZN, Saravanam PK. A Rare Case Report Of Benign Airway Stenosis and Challenges in its Management. Indian J Otolaryngol Head Neck Surg 2022; 74:5060-5063. [PMID: 36742703 PMCID: PMC9895637 DOI: 10.1007/s12070-021-02733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
Laryngeal stenosis following surgical intervention of larynx is a difficult condition to manage. The extensive adhesions formed between the vocal cords can obstruct the glottis and subglottis region and make decannulation unfeasible. In this report, we describe the challenges faced in the management of Glottosubglotic stenosis formed post Coblation assisted surgery for bilateral abductor cord palsy. The authors emphasize on the prevention techniques and management of laryngeal stenosis with a successful decannulation in such patients.
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Affiliation(s)
- Sudhagar Eswaran
- Department of ENT, Head and Neck Surgery, Sri Ramchandra Institute of Higher Education and Research, Chennai, India
| | - Z. Nufra Senopher
- Department of ENT, Head and Neck Surgery, Sri Ramchandra Institute of Higher Education and Research, Chennai, India
| | - Prasanna Kumar Saravanam
- Department of ENT, Head and Neck Surgery, Sri Ramchandra Institute of Higher Education and Research, Chennai, India
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28
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Liu Y, Yin S, Chen B, Shen H, Han Y, Wang J, Sheng S, Fu Z, Li X, Wang D, Zhang L, Wang Q, Liu Y. Development and validation of an online nomogram for predicting the outcome of open tracheotomy decannulation: a two-center retrospective analysis. Am J Transl Res 2022; 14:8343-8360. [PMID: 36505299 PMCID: PMC9730114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Tracheotomy decannulation is critical for patients in the intensive care unit (ICU) to recover. In this study, we developed and validated an intuitive nomogram to predict the success rate of tracheotomy decannulation. METHODS We collected the data of 627 ICU patients before open tracheotomy decannulation from two medical institutions, including 466 patients (135 success and 331 failure) from the First Affiliated Hospital of Anhui Medical University as a training cohort, and 161 patients (57 success and 104 failure) from the Second Affiliated Hospital of Anhui Medical University as an external validation cohort. A least absolute shrinkage and multivariate logistic regression analysis were performed to determine the independent risk factors and construct the nomogram. The area under the receiver operating characteristic curve (AUC) was used to assess discrimination and the calibration plots were used to assess consistency. The clinical application was assessed using decision curve analysis and the clinical impact curve. RESULTS 7 independent risk factors were eventually included in the prediction model. The AUC of the training cohort, internal validation and external validation were 0.932, 0.926, and 0.915, showing good discrimination. The model performed well in terms of calibration, decision curve analysis, and clinical impact curves. The superior performance of the model was also confirmed by external validation. CONCLUSION This nomogram can help ICU physicians identify high-risk patients for decannulation and plan their pre-decannulation treatment accordingly.
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Affiliation(s)
- Yuchen Liu
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical UniversityHefei 230022, Anhui, P. R. China,Anhui Medical UniversityHefei 230022, Anhui, P. R. China
| | - Siyue Yin
- Department of Oncology, The First Affiliated Hospital of Anhui Medical UniversityHefei 230022, Anhui, P. R. China,Anhui Medical UniversityHefei 230022, Anhui, P. R. China
| | - Bangjie Chen
- Department of Oncology, The First Affiliated Hospital of Anhui Medical UniversityHefei 230022, Anhui, P. R. China,Anhui Medical UniversityHefei 230022, Anhui, P. R. China
| | - Hailong Shen
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical UniversityHefei 230022, Anhui, P. R. China,Anhui Medical UniversityHefei 230022, Anhui, P. R. China
| | - Yanxun Han
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical UniversityHefei 230022, Anhui, P. R. China,Anhui Medical UniversityHefei 230022, Anhui, P. R. China
| | - Jianpeng Wang
- Anhui Medical UniversityHefei 230022, Anhui, P. R. China
| | - Shuyan Sheng
- Anhui Medical UniversityHefei 230022, Anhui, P. R. China
| | - Ziyue Fu
- Anhui Medical UniversityHefei 230022, Anhui, P. R. China
| | - Xiaobo Li
- Department of ENT, Second Affiliated Hospital of Anhui Medical UniversityHefei 230031, Anhui, P. R. China
| | - Dong Wang
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical UniversityHefei 230022, Anhui, P. R. China
| | - Liang Zhang
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical UniversityHefei 230022, Anhui, P. R. China
| | - Qin Wang
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical UniversityHefei 230022, Anhui, P. R. China
| | - Yehai Liu
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical UniversityHefei 230022, Anhui, P. R. China
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Kou YF, Teplitzky T, Johnson RF, Chorney SR. Assessment of socioeconomic disadvantage in laryngotracheoplasty outcomes among pediatric patients. Int J Pediatr Otorhinolaryngol 2022; 162:111326. [PMID: 36174480 DOI: 10.1016/j.ijporl.2022.111326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/10/2022] [Accepted: 09/17/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To determine whether socioeconomic disadvantage impacts outcomes after pediatric laryngotracheoplasty. STUDY DESIGN Case series with chart review. METHODS All laryngotracheoplasty procedures at a tertiary children's hospital between 2010 and 2019 were included. Primary zip code determined Area Deprivation Index (ADI), a validated socioeconomic vulnerability measure, and children were grouped based on less or more community disadvantage. Primary outcomes included complication and decannulation rates. RESULTS Eighty-four procedures were included with 69% (58/84) double-stage and 31% (26/84) single-stage reconstructions. Median age at surgery was 3.2 (IQR 2.2-4.9) years, 56% (47/84) were male, and median gestational age was 25 (IQR 24-28) weeks. Children from more disadvantaged communities represented 67% (56/84) of surgeries and were more likely to have higher grade stenosis (89% vs. 64%, P = .02). Postoperative airway complications (20% vs. 18%, P = .99), non-airway complications (14% vs. 18%, P = .75), and total length of stay (7 vs. 6 days, P = .26) were not impacted by ADI grouping. While children from higher community disadvantage were just as likely to be decannulated after double stage surgeries (76% vs. 76%, P = .99), it more often took longer than six months to achieve (90% vs. 61%, P = .04). CONCLUSIONS Community disadvantage is associated with higher grade airway stenosis and longer times to successful decannulation in children requiring expansion airway surgery. Encouragingly, ADI grouping did not impact complication and decannulation rates. Continued work is needed to understand how socioeconomic metrics influence pediatric open airway surgery.
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Affiliation(s)
- Yann-Fuu Kou
- University of Texas Southwestern Medical Center, Department of Otolaryngology - Head & Neck Surgery, United States; Children's Health Airway Management Program, Children's Medical Center of Dallas, Department of Pediatric Otolaryngology, United States.
| | - Taylor Teplitzky
- University of Texas Southwestern Medical Center, Department of Otolaryngology - Head & Neck Surgery, United States
| | - Romaine F Johnson
- University of Texas Southwestern Medical Center, Department of Otolaryngology - Head & Neck Surgery, United States; Children's Health Airway Management Program, Children's Medical Center of Dallas, Department of Pediatric Otolaryngology, United States
| | - Stephen R Chorney
- University of Texas Southwestern Medical Center, Department of Otolaryngology - Head & Neck Surgery, United States; Children's Health Airway Management Program, Children's Medical Center of Dallas, Department of Pediatric Otolaryngology, United States
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Al-Khatib T, Kurdi A, Maqbul WA, Maqboul A, Alghamdi T. Treatment of Childhood High-Grade Subglottic Stenosis (SGS) Through Laryngotracheoplasty (LTP) in a Tertiary Pediatric Center from 2013 to 2020. Indian J Otolaryngol Head Neck Surg 2022; 74:363-368. [PMID: 36213461 PMCID: PMC9535041 DOI: 10.1007/s12070-021-02767-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022] Open
Abstract
Laryngotracheal reconstruction is the most common and effective treatment in childhood subglottic stenosis (SGS). Our aim is to review the success rate of laryngotracheoplasty (LTP) in pediatric high grade SGS cases in our tertiary center. The retrospective review was conducted on children with high grade subglottic stenosis who had undergone laryngotracheoplasty over a 7-year period (2013-2020) in tertiary pediatric care. A total of 20 patients who had history of high grade SGS during the stipulated period were included. All of them had undergone LTP. Decannulation was considered the primary outcome measure of success. Surveillance bronchoscopy was performed one year post airway reconstruction to detect residual stenosis. From January 2013 to December 2020, 20 patients aged between 1 and 16 years old underwent LTP. Among them, 10 patients (50%) had Grade III SGS while 5 had Grade III SGS with glottis stenosis (25%). The remaining 5 (25%) had severe Grade IV stenosis. Decannulation was achieved in 14 patients overall (70%) including 1 with revision. These 14 patients who achieved decannulation included 7 out of the 10 patients (70%) with Grade III, 2 out of the 5 (40%) patients with Grade III with glottic involvement, and 4 out of the 5 patients (80%) with Grade IV SGS. Fifteen (80%) patients had double stage LTP while 5 patients had single stage LTP. The study suggests that LTP is a promising approach in the treatment of Complex SGS. Furthermore, pediatric SGS, which is inherently complicated, can be treated with LTP effectively.
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Affiliation(s)
- Talal Al-Khatib
- Consultant Otolaryngology, Head and Neck Surgery Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anas Kurdi
- Consultant Otolaryngology, Head and Neck Surgery Department, Almadinah Hospital, Almadinah, Saudi Arabia
| | - Wafa Abdullah Maqbul
- Associate consultant, Otolaryngology Head and Neck Surgery Department, King Abdullah Medical city, Makkah, Saudi Arabia
| | | | - Talal Alghamdi
- Medical Intern, King Abdulaziz University, Jeddah, Saudi Arabia
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Zhou T, Wang J, Zhang C, Zhang B, Guo H, Yang B, Li Q, Ge J, Li Y, Niu G, Gao H, Jiang H. Tracheostomy decannulation protocol in patients with prolonged tracheostomy referred to a rehabilitation hospital: a prospective cohort study. J Intensive Care 2022; 10:34. [PMID: 35842715 DOI: 10.1186/s40560-022-00626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/05/2022] [Indexed: 11/15/2022] Open
Abstract
Background The aim of the study was to assess the feasibility of a standardized tracheostomy decannulation protocol in patients with prolonged tracheostomy referred to a rehabilitation hospital. Methods This prospective cohort study recruited conscious patients with prolonged tracheostomy who were referred to the pulmonary rehabilitation department of a tertiary rehabilitation hospital between January 2019 and December 2021. A pulmonary rehabilitation team used a standardized tracheostomy decannulation protocol developed by the authors. The primary outcome was the success rate of decannulation. Secondary outcomes included decannulation time from referral and reintubation rate after a follow-up of 3 months. Results Of the 115 patients referred for weaning from mechanical ventilation and tracheostomy decannulation over the study period, 80.0% (92/115) were finally evaluated for tracheostomy decannulation. The mean time of tracheostomy in patients transferred to our department was 70.6 days. After assessment by a multidisciplinary team, 57 patients met all the decannulation indications and underwent decannulation. Fifty-six cases were successful, and 1 case was intubated again. The median time to decannulation after referral was 42.7 days. Reintubation after a follow-up of 3 months did not occur in any patients. Conclusions A standardized tracheostomy decannulation protocol implemented by a pulmonary rehabilitation team is associated with successful tracheostomy decannulation in patients with prolonged tracheostomy. Not every tracheostomy patient must undergo upper airway endoscopy before decannulation. Tolerance of speaking valve continuously for 4 h can be used as an alternative means for tube occlusion. A swallow assessment was used to evaluate the feeding mode and did not affect the final decision to decannulate. Trial registration: 2018bkky-121.
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Sun GH, Chen SW, MacEachern MP, Wang J. Successful decannulation of patients with traumatic spinal cord injury: A scoping review. J Spinal Cord Med 2022; 45:498-509. [PMID: 33166214 PMCID: PMC9246262 DOI: 10.1080/10790268.2020.1832397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Context: Patients with spinal cord injury (SCI) often require tracheostomy as an immediate life-saving measure. Successful decannulation, or removal of the tracheostomy, improves patient quality of life, function, and physical appearance and is considered an important rehabilitative milestone for SCI patients.Objective: We sought to synthesize the existing published literature on SCI patients undergoing decannulation.Methods: Ovid MEDLINE, Embase, Web of Science, CINAHL, and Cochrane Central Register of Controlled Trials were systematically searched through July 2, 2019 using appropriate keywords and MeSH terms pertaining to tracheostomy and SCI. Searches were human-subject only without language restrictions. Published literature discussing the outcomes of SCI patients who underwent decannulation were screened using inclusion/exclusion criteria determined a priori and reviewed.Results: Twenty-six publications were eligible for review and synthesis out of 1,493 unique articles. Over half of the studies were retrospective case series or reports. The research was nearly all published within the fields of physical medicine and rehabilitation, neurology, and pulmonary/critical care. Three themes emerged from review: (1) interdisciplinary or multidisciplinary tracheostomy team management to optimize decannulation processes, (2) non-invasive intermittent positive-pressure ventilatory support instead of tracheostomy-based ventilator support, and (3) wide variation in the reporting of post-decannulation clinical outcomes.Conclusion: Published research lacks a consistent taxonomy for reporting post-decannulation outcomes in SCI patients. Non-invasive ventilation research could benefit many SCI patients but has been studied in depth primarily by a single authorship group. Further investigation into the socioeconomic and fiscal impact on tracheostomies on SCI patients is warranted.
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Affiliation(s)
- Gordon H. Sun
- Department of Perioperative Services, Rancho Los Amigos National Rehabilitation Center, Downey, California, USA,Correspondence to: Gordon H. Sun, 7601 E. Imperial Highway, Downey, CA90242, USA.
| | - Stephanie W. Chen
- Department of Pediatrics, Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Mark P. MacEachern
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Jing Wang
- Aiken Regional Medical Center, Aiken, South Carolina, USA
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Sánchez-Guerrero JA, Cebrià I Iranzo MÀ, Ferrer-Sargues FJ, Périé S. Feasibility of face mask spirometry during decannulation in head and neck surgery: prospective cohort study. Clin Otolaryngol 2022; 47:521-528. [PMID: 35510380 PMCID: PMC9324810 DOI: 10.1111/coa.13938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 04/03/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze the relationship between spirometric parameters measured with a face mask versus a mouthpiece, as well as the feasibility of face mask spirometric evaluation in a head and neck surgery (HNS) decannulation context. Furthermore, we examine peak inspiratory flow (PIF) cut-off values before and after decannulation. DESIGN Prospective cohort study. SETTING Otolaryngology HNS Department of a University teaching hospital. PARTICIPANTS Twenty-four patients were selected. A maximal flow-volume loop was conducted before (with mouthpiece) and after (with mouthpiece and face mask) decannulation. MAIN OUTCOME MEASURES Recorded outcomes were forced vital capacity (FVC), forced expiratory volume in the first second, peak expiratory flow, PIF, forced expiratory flow at 50% of FVC and forced inspiratory flow at 50% of FVC. Spearman correlation coefficients between spirometric parameters measured with a face mask versus a mouthpiece were calculated. Wilcoxon test was used to check differences between mouthpiece and face mask values. RESULTS Correlation between mouthpiece and face mask spirometric values was moderate to high (r = 0.46 to 0.95). All parameters measured by spirometry were significantly lower with a face mask than those obtained with a mouthpiece (p < 0.05). Before decannulation, the lowest PIF value (tested with mouthpiece) that allowed successful decannulation was 1 L/s. After decannulation, the lowest PIF value tested with mouthpiece and face mask for successful completion of the decannulation process were 0.77 and 0.56 L/s, respectively. CONCLUSION Face mask is a feasible option to perform a spirometry when face diseases hinder spirometric evaluation through a mouthpiece in an HNC surgery context.
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Affiliation(s)
- José Antonio Sánchez-Guerrero
- Department of Otolaryngology Head Neck Surgery, Faculty Medicine, Assistance Publique Hôpitaux Paris (APHP), Sorbonne University, Paris, France
| | - Maria Àngels Cebrià I Iranzo
- Department of Otolaryngology Head Neck Surgery, Faculty Medicine, Assistance Publique Hôpitaux Paris (APHP), Sorbonne University, Paris, France
| | - Francisco José Ferrer-Sargues
- Department of Otolaryngology Head Neck Surgery, Faculty Medicine, Assistance Publique Hôpitaux Paris (APHP), Sorbonne University, Paris, France
| | - Sophie Périé
- Department of Otolaryngology Head Neck Surgery, Faculty Medicine, Assistance Publique Hôpitaux Paris (APHP), Sorbonne University, Paris, France
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You P, Dimachkieh A, Yu J, Buchanan E, Rappazzo C, Raynor T, Arjmand E, Bedwell J, Weber RS, Kupferman ME, Chelius DC. Decannulation protocol for short term tracheostomy in pediatric head and neck tumor patients. Int J Pediatr Otorhinolaryngol 2022; 153:111012. [PMID: 34990925 DOI: 10.1016/j.ijporl.2021.111012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/30/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND While the majority of pediatric tracheostomies are performed in the setting of chronic and complex medical comorbidities, perioperative tracheostomies following head and neck tumor ablation are generally short-term. Deliberate planning is required for decannulation in this setting and no published protocols currently exist. Our study outlines a management strategy for short-term tracheostomy in pediatric patients following head and neck surgery. METHODS A retrospective study of pediatric head and neck tumor patients undergoing tracheostomy was performed at a quaternary children's hospital from February 1, 2016 to December 31, 2018. Charts were reviewed for demographics, surgical operation, relevant tracheostomy-related complications, and time to decannulation. RESULTS Eleven patients with a mean age of 10.4 years (st.dev. 6.7, range: 0.5-23) underwent tracheostomy during their primary ablative/reconstructive surgery. Trans-tracheal pressure monitoring helped direct the need for tracheostomy downsizing and readiness for capping trials. All patients were decannulated before hospital discharge after a mean of 12.8 days (st.dev. 2.5, range: 9-18) and were discharged after a mean of 14.8 days (st.dev. 2.5, range: 11-20). CONCLUSION Pediatric head and neck surgery patients can be quickly and safely decannulated with an instructive protocol and multidisciplinary care.
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Affiliation(s)
- Peng You
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Amy Dimachkieh
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Justin Yu
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA
| | - Edward Buchanan
- Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Department of Plastic Surgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Tiffany Raynor
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Ellis Arjmand
- Department of Surgery, Children's Hospital New Orleans, New Orleans, LA, USA
| | - Joshua Bedwell
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel C Chelius
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA; Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
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Grewal M, DiDonna B, Sharma R, Long S, Sturm J, Troob S, Hills S. Lessons learned from safe tracheostomy aftercare taskforce implemented during COVID-19 pandemic. Am J Otolaryngol 2022; 43:103240. [PMID: 34560595 PMCID: PMC8443539 DOI: 10.1016/j.amjoto.2021.103240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/10/2021] [Indexed: 12/05/2022]
Abstract
Purpose At the height of the COVID-19 pandemic, our institution instituted a Safe Tracheostomy Aftercare Taskforce (STAT) team to care for the influx of patients undergoing tracheostomies. This review was undertaken to understand this team's impact on outcomes of tracheostomy care. Methods We compared retrospective data collected from patients undergoing tracheostomies at our institution from February to June 2019, prior to creation of the STAT team, to prospectively collected data from tracheostomies performed from February to June 2020, while the STAT team was in place and performed statistical analysis on outcomes of care such as decannulation prior to discharge, timely tube change, and post-discharge follow-up. Results We found that the STAT team significantly increased rate of decannulation prior to discharge (P < 0.0005), performance of timely trach tube change when indicated (P < 0.05), and rates of follow-up for tracheostomy patients after discharge from the hospital (P < 0.0005). Conclusion The positive impact of the STAT team on outcomes of patient care such as decannulation prior to discharge, timely tube change, and post-discharge follow-up makes a strong case for its continuation even in non-pandemic times.
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Escudero C, Sassi FC, de Medeiros GC, de Lima MS, Cardoso PFG, de Andrade CRF. Decannulation: a retrospective cohort study of clinical and swallowing indicators of success. Clinics (Sao Paulo) 2022; 77:100071. [PMID: 35759922 PMCID: PMC9240975 DOI: 10.1016/j.clinsp.2022.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/04/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the clinical and swallowing indicators related to a successful decannulation process during the hospital stay. METHODS A retrospective cohort clinical study. The study sample comprised a heterogeneous patient population who had submitted to a tracheostomy procedure in a tertiary hospital. Patients were divided into two groups (decannulated vs. non-decannulated) and compared not only in terms of demographic and clinical data but also the results of a swallowing assessment and intervention outcome. RESULTS Sixty-four patients were included in the present study: 25 (39%) who had been successfully decannulated, and 39 (61%) who could not be decannulated. Between-group comparisons indicated that both groups presented similar clinical and demographic characteristics. The groups also presented similar swallowing assessment results prior to intervention. However, significant differences were observed regarding the time to begin swallowing rehabilitation. The decannulated group was assessed nine days earlier than the non-decannulated group. Other significant differences included the removal of the alternate feeding method (72.0% of decannulated patients vs. 5.1% of non-decannulated patients) and the reintroduction of oral feeding (96.0% of decannulated patients vs. 41.0% of non-decannulated patients) and functional swallowing level at patient disclosure. The non-decannulated patient group presented higher death rates at disclosure. CONCLUSION The results of the present study indicated that the following parameters were associated with a successful decannulation process: early swallowing assessment, swallowing rehabilitation, and improvement in the swallowing functional level during the hospital stay. The maintenance of low swallowing functional levels was found to be negatively associated with successful decannulation.
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Affiliation(s)
- Carina Escudero
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fernanda Chiarion Sassi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Gisele Chagas de Medeiros
- Divisão de Fonoaudiologia do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maíra Santilli de Lima
- Divisão de Fonoaudiologia do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo Francisco Guerreiro Cardoso
- Departamento Cardiopneumologia, Disciplina de Cirurgia Torácica da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Claudia Regina Furquim de Andrade
- Divisão de Fonoaudiologia do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
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Park SJ, Han SA, Kwon TK, Sung MW, Kwon SK. Primary versus modified secondary closure techniques for persistent tracheocutaneous fistula in pediatric patients. Pediatr Surg Int 2022; 38:123-131. [PMID: 34302512 DOI: 10.1007/s00383-021-04967-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed at compating two closure techniques for tracheocutaneous fistulas (TCFs) in pediatric patients. METHODS A total of 106 consecutive pediatric patients who underwent closure of a persistent TCF between April 2007 and February 2021 at a tertiary pediatric hospital were evaluated, and 103 pediatric patients aged between 12 months and 18 years were included. The clinical characteristics, perioperative outcomes, and postoperative outcomes were compared between TCF closure by primary closure (Group 1) and a modified secondary healing technique (Group 2). RESULTS Of the 103 patients, 58 were classified into Group 1, and 45 into Group 2. The mean age at tracheostomy and TCF closure was significantly younger in Group 2, and the interval between decannulation to TCF closure was significantly shorter in Group 2. Procedural time and hospital stay were significantly shorter in Group 2 than Group 1. Group 2 had a significantly lower complication rate, need for revision surgery, and recannulation rate than Group 1. CONCLUSIONS Modified secondary healing was more efficient in terms of procedural time and hospital stay, and safer (i.e., fewer complications). It is an effective surgical technique for closing a persistent TCF in younger patients more quickly after decannulation compared to primary closure.
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Affiliation(s)
- Sung Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sun A Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myung-Whun Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Wan R, Shin H, Docherty C, Bhatti H, Spector C, Thai B, Muller A, Martin A, Gile K, Liu A, Ong A. Tracheostomy dislodgement: Are obese patients at increased risk? Am J Surg 2021:S0002-9610(21)00722-4. [PMID: 34872713 DOI: 10.1016/j.amjsurg.2021.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/12/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obesity is a risk factor for tracheostomy-related complications. We aimed to investigate whether obesity was associated with a risk of unplanned tracheostomy dislodgement or decannulation (DD). METHODS Retrospective review of patients undergoing tracheostomy at a single institution from 2013 to 2019 was performed. The primary outcome was unplanned DD within 42 days. Obesity was assessed by body mass index (BMI) and skin-to-trachea distance (STT) measured on computed tomographic images. RESULTS 25 (12%) episodes of unplanned DD occurred in 213 patients within 42 days. BMI ≥35 kg/m2 was associated with STT ≥80 mm (p < 0.0001). On multivariate analysis, STT ≥80 mm but not BMI was an independent predictor of unplanned DD (hazard ratio = 8.34 [95% confidence interval 2.85-24.4]). CONCLUSIONS STT ≥80 mm was a better predictor of unplanned DD than BMI. Assessment of STT in addition to BMI may be useful to identify patients that would benefit from extended length tracheostomy tubes.
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Veder LL, Joosten KFM, Zondag MD, Pullens B. Indications and clinical outcome in pediatric tracheostomy: Lessons learned. Int J Pediatr Otorhinolaryngol 2021; 151:110927. [PMID: 34592656 DOI: 10.1016/j.ijporl.2021.110927] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/13/2021] [Accepted: 09/18/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Indications for tracheostomy have changed over the last decades and clinical outcome varies depending on the indication for tracheostomy. By gaining more insight in the characteristics and outcome of the tracheostomized pediatric population, clinical care can be improved and a better individual prognosis can be given. Therefore, we studied the outcome of our pediatric tracheostomy population in relation to the primary indication over the last 16 years. METHODS We retrospectively included children younger than 18 years of age with a tracheostomy tube in the Erasmus Medical Center, Sophia children's hospital. The primary indication for tracheostomy, gender, age at tracheostomy, age at decannulation, comorbidity, mortality, closure of a persisting tracheocutaneous fistula after decannulation, surgery prior to decannulation and the use of polysomnography were recorded and analyzed. RESULTS Our research group consisted of 225 children. Reasons for a tracheostomy were first divided in two major diagnostic groups: 1) airway obstruction group (subgroups: laryngotracheal obstruction and craniofacial anomalies) and 2) pulmonary support group (subgroups: cardio-pulmonary diseases and neurological diseases). Children in the airway obstruction group were younger when receiving a tracheostomy (3.0 months vs. 31.0 months, p < 0.05), they were tracheostomy dependent for a longer time (median 21.5 months vs. 2.0 months, p < 0.05) and they required surgery more often (74.5% vs. 8.3%, p < 0.05) than the children in the pulmonary support group. The decannulation rate of children with a laryngotracheal obstruction is high (74.8%), but low in all other subgroups (craniofacial anomalies; 38.5%, cardio-pulmonary diseases; 34.6% and neurological diseases; 52.9%). Significantly more children (36.7%) died in the pulmonary support group due to underlying comorbidity, mainly in the cardio-pulmonary diseases subgroup. Surgery for a persisting tracheocutaneous fistula was performed in 34 (37.8%) children, with a significant relationship between the duration of the tracheostomy and the persistence of a tracheocutaneous fistula. No cannula related death occurred during this study period. CONCLUSION Main indications for a tracheostomy were airway obstruction and pulmonary support. Children in the airway obstruction group were younger when receiving a tracheostomy and they were tracheostomy dependent for a longer period. Within the airway obstruction group, the decannulation rate for children with laryngotracheal stenosis was high, but low for children with craniofacial anomalies. In the pulmonary support group, the decannulation rate was low and the mortality rate was high. Surgery for a persisting tracheocutaneous fistula was frequently needed.
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Affiliation(s)
- L L Veder
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - K F M Joosten
- Department of Pediatric Intensive Care, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M D Zondag
- Department of Pediatric Intensive Care, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - B Pullens
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
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Zaga CJ, Sweeney JM, Cameron TS, Campbell MC, Warrillow SJ, Howard ME. Factors associated with short versus prolonged tracheostomy length of cannulation and the relationship between length of cannulation and adverse events. Aust Crit Care 2021; 35:535-542. [PMID: 34742631 DOI: 10.1016/j.aucc.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Tracheostomy management and care is multifaceted and costly, commonly involving complex patients with prolonged hospitalisation. Currently, there are no agreed definitions of short and prolonged length of tracheostomy cannulation (LOC) and no consensus regarding the key factors that may be associated with time to decannulation. OBJECTIVES The aims of this study were to identify the factors associated with short and prolonged LOC and to examine the number of tracheostomy-related adverse events of patients who had short LOC versus prolonged LOC. METHODS A retrospective observational study was undertaken at a large metropolitan tertiary hospital. Factors known at the time of tracheostomy insertion, including patient, acuity, medical, airway, and tracheostomy factors, were analysed using Cox proportional hazards model and Kaplan-Meier survival curves, with statistically significant factors then analysed using univariate logistic regression to determine a relationship to short or prolonged LOC as defined by the lowest and highest quartiles of the study cohort. The number of tracheostomy-related adverse events was analysed using the Kaplan-Meier survival curve. RESULTS One hundred twenty patients met the inclusion criteria. Patients who had their tracheostomy performed for loss of upper airway were associated with short LOC (odds ratio [OR]: 2.30 (95% confidence interval [CI]: 1.01-5.25) p = 0.049). Three factors were associated with prolonged LOC: an abdominal/gastrointestinal tract diagnosis (OR: 5.00 [95% CI: 1.40-17.87] p = 0.013), major surgery (OR: 2.51 [95% CI: 1.05-6.01] p = 0.038), and intubation for >12 days (OR: 0.30 [95% CI: 0.09-0.97] p = 0.044). Patients who had one or ≥2 tracheostomy-related adverse events had a high likelihood of prolonged LOC (OR: 5.21 [95% CI: 1.95-13.94] p = ≤0.001 and OR: 12.17 [95% CI: 2.68-55.32] p ≤ 0.001, respectively). CONCLUSION Some factors that are known at the time of tracheostomy insertion are associated with duration of tracheostomy cannulation. Tracheostomy-related adverse events are related to a high risk of prolonged LOC.
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Affiliation(s)
- Charissa J Zaga
- Department of Speech Pathology, Austin Health, Melbourne, Australia; Tracheostomy Review and Management Service, Austin Health, Melbourne, Australia; Institute of Breathing and Sleep, Austin Health, Melbourne, Australia.
| | - Joanne M Sweeney
- Department of Speech Pathology, Austin Health, Melbourne, Australia; Tracheostomy Review and Management Service, Austin Health, Melbourne, Australia
| | - Tanis S Cameron
- Tracheostomy Review and Management Service, Austin Health, Melbourne, Australia
| | - Matthew C Campbell
- Department of Ear Nose and Throat Surgery Department, Austin Health, Melbourne, Australia
| | | | - Mark E Howard
- Institute of Breathing and Sleep, Austin Health, Melbourne, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia
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41
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Ferro A, Kotecha S, Auzinger G, Yeung E, Fan K. Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients. Br J Oral Maxillofac Surg 2021; 59:1013-1023. [PMID: 34294476 PMCID: PMC8130586 DOI: 10.1016/j.bjoms.2021.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/07/2021] [Indexed: 01/04/2023]
Abstract
A systematic review and meta-analysis of the entire COVID-19 Tracheostomy cohort was conducted to determine the cumulative incidence of complications, mortality, time to decannulation and ventilatory weaning. Outcomes of surgical versus percutaneous and outcomes relative to tracheostomy timing were also analysed. Studies reporting outcome data on patients with COVID-19 undergoing tracheostomy were identified and screened by 2 independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Outcome data were analysed using a random-effects model. From 1016 unique studies, 39 articles reporting outcomes for a total of 3929 patients were included for meta-analysis. Weighted mean follow-up time was 42.03±26 days post-tracheostomy. Meta-analysis showed that 61.2% of patients were weaned from mechanical ventilation [95%CI 52.6%-69.5%], 44.2% of patients were decannulated [95%CI 33.96%-54.67%], and cumulative mortality was found to be 19.23% [95%CI 15.2%-23.6%] across the entire tracheostomy cohort. The cumulative incidence of complications was 14.24% [95%CI 9.6%-19.6%], with bleeding accounting for 52% of all complications. No difference was found in incidence of mortality (RR1.96; p=0.34), decannulation (RR1.35, p=0.27), complications (RR0.75, p=0.09) and time to decannulation (SMD 0.46, p=0.68) between percutaneous and surgical tracheostomy. Moreover, no difference was found in mortality (RR1.57, p=0.43) between early and late tracheostomy, and timing of tracheostomy did not predict time to decannulation. Ten confirmed nosocomial staff infections were reported from 1398 tracheostomies. This study provides an overview of outcomes of tracheostomy in COVID-19 patients, and contributes to our understanding of tracheostomy decisions in this patient cohort.
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Affiliation(s)
- A. Ferro
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, SE1 9RT London, United Kingdom
| | - S. Kotecha
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, SE1 9RT London, United Kingdom
| | - G. Auzinger
- Liver Intensive Care Unit, Department of Critical Care, King's College Hospital NHS Foundation Trust, Denmark Hill, SE1 9RT London, United Kingdom
| | - E. Yeung
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, SE1 9RT London, United Kingdom
| | - K. Fan
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, SE1 9RT London, United Kingdom,Corresponding author at: King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom. Tel.: +4420 3299 5754
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Livneh N, Mansour J, Kassif Lerner R, Feinmesser G, Alon E. Early vs. late tracheostomy in ventilated COVID-19 patients - A retrospective study. Am J Otolaryngol 2021; 42:103102. [PMID: 34120008 PMCID: PMC8180451 DOI: 10.1016/j.amjoto.2021.103102] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/02/2021] [Accepted: 05/31/2021] [Indexed: 12/23/2022]
Abstract
Background Tracheostomy is one of the most common surgical procedures performed on ventilated COVID-19 patients, yet the appropriate timing for operating is controversial. Objectives Assessing the effect of early tracheostomy on mortality and decannulation; elucidating changes in ventilation parameters, vasopressors and sedatives dosages immediately following the procedure. Methods A retrospective cohort of 38 ventilated COVID-19 patients, 19 of them (50%) underwent tracheostomy within 7 days of intubation (early tracheostomy group) and the rest underwent tracheostomy after 8 days or more (late tracheostomy group). Results Decannulation rates were significantly higher while mortality rates were non-significantly lower in the early tracheostomy group compared with the late tracheostomy group (58% vs 21% p < 0.05; 42% vs 74% p = 0.1, respectively). Tidal volume increased (446 ml vs 483 ml; p = 0.02) while PEEP (13 cmH20 vs 11.6 cmH2O, p = 0.04) decreased at the immediate time following the procedure. No staff member participating in the procedures was infected with SARS-CoV-2 virus. Conclusion Early tracheostomy might offer improved outcomes with higher decannulation rates and lower mortality rates in ventilated COVID-19 patients, yet larger scale studies are needed. Most likely, early exposure to COVID-19 patients with appropriate personal protective equipment during open tracheostomy does not put the surgical team at risk.
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Affiliation(s)
- Nir Livneh
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Jobran Mansour
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reut Kassif Lerner
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Gilad Feinmesser
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Alon
- Department of Otolaryngology Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Mannini A, Hakiki B, Liuzzi P, Campagnini S, Romoli A, Draghi F, Macchi C, Carrozza MC. Data-driven prediction of decannulation probability and timing in patients with severe acquired brain injury. Comput Methods Programs Biomed 2021; 209:106345. [PMID: 34419756 DOI: 10.1016/j.cmpb.2021.106345] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES From a rehabilitation perspective, removal of tracheostomy in patients with severe acquired brain injuries (sABI) is a crucial step. Predictive parameters for a successful decannulation are currently still a focus of the research for sABI patients, especially for those presenting a disorder of consciousness. For this reason, we adopted a data-driven approach predicting decannulation probability and timing using ensemble learning models in patients in intensive rehabilitation units. METHODS 327 patients, 186 of which were successfully decannulated during their intensive rehabilitative stay, were recruited in a non-concurrent retrospective study. Decannulation probability and timing were predicted using data available within one week from admission at the rehabilitation unit. Two predictive models were trained and cross-validated independently, with the first being an ensemble of a Support Vector Machine and Random Forests and the second an Adaptive Boosting with a Support Vector Regression as weak learner. Confusion matrix, accuracy and AUC were considered as evaluation metrics for the classifier and median absolute error was considered for the regressor. To quantify the advantages in the clinical practice of using the latter prediction, we compared timing estimation with a timing guess (median) calculated on available data. The comparison was based on a Wilcoxon signed rank test. RESULTS Decannulation probability was successfully predicted with an accuracy of 84.8% (AUC = 0.85) and timing with a median absolute error of 25.7 days [IQR = 25.6]. This resulted in a significant improvement with respect to the weaning time guess (p<0.05) with an effect size of 71.7%. Furthermore, dichotomizing the regression prediction with a threshold (3 months from the event), resulted in a prediction accuracy of 77.5% (AUC = 0.82) on the test set. DISCUSSIONS A model capable of providing a prediction on decannulation probability and timing was developed and cross-validated, built on data taken at admission to the intensive rehabilitation unit. Translated in clinical practice, this information can support the clinical decision process and provide a mean to improve both in-hospital and domiciliary care organization.
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Affiliation(s)
- Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy; the BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera 56025, PI, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy
| | - Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy; the BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera 56025, PI, Italy.
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy; the BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera 56025, PI, Italy
| | - Annamaria Romoli
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy
| | - Francesca Draghi
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, via di Scandicci 269, Firenze 50134, FI, Italy; Dep. of Experimental and Clinical Medicine, University of Florence, Piazza S. Marco 4, Firenze 50121, FI, Italy
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Kenkere D, Karunasagar A. Clinical Approach to Decision-Making in Nasogastric Tube Weaning and Tracheostomy Tube Decannulation. J Maxillofac Oral Surg 2021; 20:510-1. [PMID: 34408382 DOI: 10.1007/s12663-021-01534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022] Open
Abstract
Extensive resections for advanced malignancies of the oral cavity quite often require patients to have a tracheostomy tube and nasogastric tube for prolonged periods leading to dependence. Timely and safe removal of these tubes would help hasten the recovery and rehabilitation of these patients. A simple bedside protocol for evaluation and weaning of nasogastric tube and tracheostomy tube is outlined in this communication. This would help health care workers in resource-poor settings make safe clinical decisions and improve care.
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Abstract
Over the last few decades, tracheostomy has been increasingly performed in children with various complex and chronic conditions. We have seen a dramatic change in indications for tracheostomy in pediatric patients due to better survival of premature infants and those suffering from severe congenital anomalies. There is no consensus about the timing of tracheostomy in pediatric patients. Although percutaneous tracheostomy has become the standard of care for adults, there is not sufficient evidence to start performing it routinely in pediatric patients. The indications, preoperative considerations, and different procedures for tracheostomy in children are reviewed. Surgical tracheostomy is described step by step placing an emphasis on safety measures to minimize complications. There is also a great variability in tracheostomy care protocols in the literature. Post-operative tracheostomy care is discussed for the early and late post-operative periods. There is no general consensus on decannulation protocols, but prevailing expert opinion is presented. There is growing evidence in support for an interdisciplinary approach to pediatric tracheostomized patients. The focus of this paper is the review of the literature regarding safety improvement strategies from the surgical and post-operative point of view.
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Affiliation(s)
- Alvaro E Pacheco
- Department of Otolaryngology, Hospital Dr. Luis Calvo Mackenna, Clínica Universidad de Los Andes, Santiago, Chile.
| | - Eduardo Leopold
- Division of Pediatric Surgery Pediatric Airway and Chest Wall Center Hospital de Niños Luis Calvo Mackenna University of Chile Santiago, Chile.
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Muhle P, Suntrup-Krueger S, Burkardt K, Lapa S, Ogawa M, Claus I, Labeit B, Ahring S, Oelenberg S, Warnecke T, Dziewas R. Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients - a prospective evaluation. Neurol Res Pract 2021; 3:26. [PMID: 33966636 PMCID: PMC8108459 DOI: 10.1186/s42466-021-00124-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/22/2021] [Indexed: 12/16/2022] Open
Abstract
Background Removal of a tracheostomy tube in critically ill neurologic patients is a critical issue during intensive care treatment, particularly due to severe dysphagia and insufficient airway protection. The “Standardized Endoscopic Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients” (SESETD) is an objective measure of readiness for decannulation. This protocol includes the stepwise evaluation of secretion management, spontaneous swallowing, and laryngeal sensitivity during fiberoptic endoscopic evaluation of swallowing (FEES). Here, we first evaluated safety and secondly effectiveness of the protocol and sought to identify predictors of decannulation success and decannulation failure. Methods A prospective observational study was conducted in the neurological intensive care unit at Münster University Hospital, Germany between January 2013 and December 2017. Three hundred and seventy-seven tracheostomized patients with an acute neurologic disease completely weaned from mechanical ventilation were included, all of whom were examined by FEES within 72 h from end of mechanical ventilation. Using regression analysis, predictors of successful decannulation, as well as decannulation failure were investigated. Results Two hundred and twenty-seven patients (60.2%) could be decannulated during their stay according to the protocol, 59 of whom within 24 h from the initial FEES after completed weaning. 3.5% of patients had to be recannulated due to severe dysphagia or related complications. Prolonged mechanical ventilation showed to be a significant predictor of decannulation failure. Lower age was identified to be a significant predictor of early decannulation after end of weaning. Transforming the binary SESETD into a 4-point scale helped predicting decannulation success in patients not immediately ready for decannulation after the end of respiratory weaning (optimal cutoff ≥1; sensitivity: 64%, specifity: 66%). Conclusions The SESETD showed to be a safe and efficient tool to evaluate readiness for decannulation in our patient collective of critically ill neurologic patients. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-021-00124-1.
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Affiliation(s)
- Paul Muhle
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany. .,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany.
| | - Sonja Suntrup-Krueger
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Karoline Burkardt
- Raphaelsklinik Muenster, Department of General Surgery, Loerstraße 23, 48143, Muenster, Germany
| | - Sriramya Lapa
- University Hospital Frankfurt, Department of Neurology, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Mao Ogawa
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Inga Claus
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Bendix Labeit
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Sigrid Ahring
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Stephan Oelenberg
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Tobias Warnecke
- University Hospital Muenster, Department of Neurology with Institute for Translational Neurology, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Rainer Dziewas
- Klinikum Osnabrück, Department of Neurology, Am Finkenhügel 1, 49076, Osnabrück, Germany
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Karlic KJ, Espinosa NM, Fleming BE, Helman JL, Krawcke KA, Thatcher AL. The low value of pre- decannulation capped overnight ICU monitoring for pediatric patients. Int J Pediatr Otorhinolaryngol 2021; 143:110634. [PMID: 33588356 DOI: 10.1016/j.ijporl.2021.110634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/10/2020] [Accepted: 01/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the value of pre-decannulation capped overnight ICU monitoring for assessing decannulation-readiness in pediatric patients. METHODS This study included all pediatric patients, age 18 and under, with a tracheostomy attempting decannulation at the University of Michigan between 2013 and 2018. Patients who underwent major airway reconstruction immediately prior to decannulation were excluded. Descriptive and comparative statistics were calculated to compare the sub-group of patients who underwent pre-decannulation capped overnight ICU monitoring to those who did not. RESULTS 125 pediatric patients attempted decannulation for a total of 126 attempts with 105 attempts being eligible for inclusion. 75 eligible attempts included pre-decannulation capped overnight ICU monitoring, while 30 did not. Subsequent rates of successful decannulation were 97.33% (73/75) and 100.00% (30/30), respectively (P = 0.366; 95% CI -8.818-9.260). The pre-decannulation capped overnight ICU monitoring passing rate was 98.67% (74/75) despite a complication rate of 5.33% (4/75). Post-decannulation, 98.08% (102/104) of decannulated patients were monitored inpatient for a minimum of 24 h DISCUSSION: With similar rates of successful decannulation among both sub-groups and previous research demonstrating sufficient ambulatory testing accurately predicts successful decannulation, pre-decannulation capped overnight ICU monitoring is a low-value, high-cost test that can be safely discontinued without compromising patient care. Notably, our study excluded patients undergoing open airway reconstruction immediately prior to decannulation. The 24-h monitoring post-decannulation serves as a safety net for individuals who ultimately fail decannulation.
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Affiliation(s)
- Kevin J Karlic
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA; Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Nico M Espinosa
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA; Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | | | - Jennifer L Helman
- Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Kelly A Krawcke
- Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Aaron L Thatcher
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 48109, USA; Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
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Kennedy A, Hart CK, de Alarcon A, Balakrishnan K, Boudewyns A, Chun R, Fayoux P, Goudy SL, Hartnick C, Hsu WC, Johnson RF, Kuo M, Peer S, Pransky SM, Rahbar R, Rickert S, Roy S, Russell J, Sandu K, Sidell DR, Smith RJ, Soma M, Spratley J, Thierry B, Thompson DM, Trozzi M, Watters K, White DR, Wyatt M, Zalzal GH, Zdanksi CJ, Zur KB, Rutter MJ. International Pediatric Otolaryngology Group (IPOG) management recommendations: Pediatric tracheostomy decannulation. Int J Pediatr Otorhinolaryngol 2021; 141:110565. [PMID: 33341719 DOI: 10.1016/j.ijporl.2020.110565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/12/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To provide recommendations to otolaryngologists, pulmonologists, and allied clinicians for tracheostomy decannulation in pediatric patients. METHODS An iterative questionnaire was used to establish expert recommendations by the members of the International Pediatric Otolaryngology Group. RESULTS Twenty-six members completed the survey. Recommendations address patient criteria for decannulation readiness, airway evaluation prior to decannulation, decannulation protocol, and follow-up after both successful and failed decannulation. CONCLUSION Tracheostomy decannulation recommendations are aimed at improving patient-centered care, quality and safety in children with tracheostomies.
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Affiliation(s)
- Aimee Kennedy
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Catherine K Hart
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Alessandro de Alarcon
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Belgium
| | - Robert Chun
- Department of Otolaryngology, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head and Neck Surgery, University Hospital of Lille, Lille, France
| | - Steven L Goudy
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA, USA
| | - Christopher Hartnick
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Wei-Chung Hsu
- Division of Pediatric Otolaryngology, National Taiwan University College of Medicine and Children's Hospital, Taipei, Taiwan
| | - Romaine F Johnson
- Children's Health Airway Management Program, UT Southwestern Medical Center, Dallas, TX, USA
| | - Michael Kuo
- Otolaryngology, Birmingham Children's Hospital, UK
| | - Shazia Peer
- Division of Otolaryngology, University of Cape Town & Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Seth M Pransky
- Pediatric Otolaryngology Head and Neck Surgery, Pediatric Specialty Partners, San Diego, CA, USA
| | - Reza Rahbar
- Division of Pediatric Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott Rickert
- Division of Pediatric Otolaryngology, Hassenfeld Children's Hospital, New York University Langone Health, New York, NY, USA
| | - Soham Roy
- Department of Otorhinolaryngology-Head and Neck Surgery, Children's Memorial Hermann Hospital, University of Texas Medical School, Houston, TX, USA
| | - John Russell
- Department of Paediatric Otolaryngology, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Kishore Sandu
- Airway Unit, Department of Otolaryngology, Lausanne University Hospital, CHUV, Switzerland
| | - Douglas R Sidell
- Department of Otolaryngology-Head & Neck Surgery, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Richard J Smith
- Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Marlene Soma
- Paediatric Otolaryngology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Jorge Spratley
- Pediatric Otorhinolaryngology, University of Porto Medical School, S. Joao Hospital Center, Porto, Portugal
| | - Briac Thierry
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Necker Children's Hospital, Paris, France
| | - Dana M Thompson
- Division of Pediatric Otolaryngology, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marilena Trozzi
- Pediatric Surgery Department, Bambino Gesu Children's Hospital, Rome, Italy
| | - Karen Watters
- Division of Pediatric Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David R White
- Division of Pediatric Otolaryngology, MUSC Shawn Jenkins Children's Hospital, Charleston, SC, USA
| | - Michelle Wyatt
- Paediatric Otolaryngology, Great Ormond Street Hospital, London, England, UK
| | - George H Zalzal
- Division of Otolaryngology, Children's National Medical Center, George Washington University, Washington DC, USA
| | - Carlton J Zdanksi
- Department of Otolaryngology/Head and Neck Surgery and Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - Karen B Zur
- Department of Otolaryngology: Head & Neck Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadephia, PA, USA
| | - Michael J Rutter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Hamill CS, Tracy MM, Staggs VS, Manimtim WM, Neff LL, Jensen DR. Tracheostomy in the pediatric trisomy 21 population. Int J Pediatr Otorhinolaryngol 2021; 140:110540. [PMID: 33290923 DOI: 10.1016/j.ijporl.2020.110540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Tracheostomy in children is often performed to alleviate airway obstruction (AO) or to facilitate long-term ventilator support due to respiratory failure of various etiologies, such as heart failure, and postoperative respiratory failure. Although many of these pathologies are common among trisomy 21 patients, tracheostomy rates among this population have not previously been reported. The aim of our study was to determine the incidence of trisomy 21 patients undergoing tracheostomy. Secondary objectives include decannulation rates and mortality associated with tracheostomy. MATERIALS AND METHODS A retrospective cohort study was conducted on pediatric trisomy 21 patients undergoing tracheostomy between 2004 and 2013. RESULTS Twenty patients underwent tracheostomy at a median age of 7.1 months (interquartile range [IQR] = 3.5,21.3). The estimated incidence of tracheostomy in trisomy 21 patients among our tracheostomy population was 1.7% (20/1173) over 10 years. The most common indications were airway obstruction (AO) (55%), cardiac/pulmonary respiratory failure (CRF) (25%), or both (20%). Overall mortality was 30%, much lower among AO patients (9%) than CRF (40%) or both (60%), (P = 0.029). Nine patients (45%) were successfully decannulated, with median duration of cannulation of 2.2 years (IQR = 1.7,3). CONCLUSIONS This study suggests a rate of tracheostomy in the pediatric trisomy 21 population approximately 3 times that of the general pediatric population. Over half in this cohort underwent tracheostomy for isolated AO, while the general pediatric tracheostomy population demonstrates a much higher prevalence of prematurity-related CRF. Overall mortality rate and decannulation rate approximated that of the general pediatric tracheostomy population, although outcomes were significantly poorer among patients trisomy 21 patients undergoing tracheostomy for CRF.
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Affiliation(s)
- Chelsea S Hamill
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Meghan M Tracy
- Division of Otolaryngology, Children's Mercy Hospital-Kansas City, Kansas City, MO, USA
| | - Vincent S Staggs
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA; Health Services and Outcomes Research, Biostatistics and Epidemiology, Children's Mercy Hospital-Kansas City, Kansas City, MO, USA
| | - Winston M Manimtim
- Department of Pediatrics, Children's Mercy Hospital-Kansas City, Kansas City, MO, USA; Division of Neonatology/Perinatal Medicine, Children's Mercy Hospital-Kansas City, Kansas City, MO, USA
| | - Laura L Neff
- Division of Otolaryngology, Children's Mercy Hospital-Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Daniel R Jensen
- Division of Otolaryngology, Children's Mercy Hospital-Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
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Sachdev A, Chaudhari ND, Singh BP, Sharma N, Gupta D, Gupta N, Gupta S, Chugh P. Tracheostomy in Pediatric Intensive Care Unit-A Two Decades of Experience. Indian J Crit Care Med 2021; 25:803-811. [PMID: 34316177 PMCID: PMC8286380 DOI: 10.5005/jp-journals-10071-23893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective To study the profile, indications, related complications, and predictors of decannulation and mortality in patients who underwent tracheostomy in the pediatric intensive care unit (PICU). Materials and methods Retrospective analysis of prospectively collected data of tracheostomies was done on patients admitted at PICU. Demographics, primary diagnosis, indication of tracheostomy, and durations of endotracheal intubation, mechanical ventilation, and tracheostomy cannulation were recorded. The indication was recorded in one of the four categories—upper airway obstruction (UAO), central neurological impairment (CNI), prolonged mechanical ventilation, and peripheral neuromuscular disorders). Results Two hundred ninety cases were analyzed. UAO (42%) and CNI (48.2%) were main indications in the halves of the study period, respectively. Decannulation was successful in 188 (64.8%) patients. Seventy-seven percentage UAO patients were decannulated successfully [OR (odds ratio); 95% CI (confidence interval), 2.647; 1.182–5.924, p = 0.018]. Age <1 year (0.378; 0.187–0.764; p = 0.007), nontraumatic, noninfectious central neurological diseases (0.398; 0.186–0.855; p = 0.018), and malignancy (0.078; 0.021–0.298; p <0.001), durations of posttracheostomy ventilation (0.937; 0.893–0.983; p = 0.008), and stay in the PICU (0.989; 0.979–0.999; p = 0.029) were predictors of unsuccessful decannulation. There were 91 (31.4%) deaths. Age <1 year (2.39 (1.13–5.05; p = 0.02), malignancy (17.55; 4.10–75.11; p <0.001), durations of posttracheostomy ventilation (1.06; 1.006–1.10; p = 0.028), and hospital stay (1.007; 1.0–1.013; p = 0.043) were independent predictors of mortality. Indication of UAO favored survivor (0.24; 0.09–0.57; p <0.001). Conclusion The indications for tracheostomy in children had changed over the years. Infancy, primary diagnosis, length of posttracheostomy ventilation, and stay in the PICU and hospital were independent predictors of decannulation and mortality. What This Adds Similar to developed countries, the age at the time of tracheostomy and indication are changing. Inability to decannulate and mortality were associated with the age of a child at the time of tracheostomy, indication, medical diagnosis, and duration of postprocedure mechanical ventilation and stay in the hospital. How to cite this article Sachdev A, Chaudhari ND, Singh BP, Sharma N, Gupta D, Gupta N, et al. Tracheostomy in Pediatric Intensive Care Unit—A Two Decades of Experience. Indian J Crit Care Med 2021;25(7):803–811.
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Affiliation(s)
- Anil Sachdev
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Bhanu P Singh
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Nikhil Sharma
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Dhiren Gupta
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Neeraj Gupta
- Department of Pediatric Intensive Care, Sir Ganga Ram Hospital, New Delhi, India
| | - Suresh Gupta
- Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, India
| | - Parul Chugh
- Department of Research, Sir Ganga Ram Hospital, New Delhi, India
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