dalla LETTERATURA INTERNAZIONALE
Aggiornato a domenica, 17. agosto 2008
Interact Cardiovasc Thorac Surg. 2008 Aug 4. [Epub ahead of print]
A rapid bail-out technique for reinsertion of a displaced tracheostomy tube in difficult situations. Balacumaraswami L, Fernando S, Van Tornout FA. John Radcliffe Hospital, Oxford, UK. Safe and rapid repositioning of a displaced tracheostomy tube is vital to protect the airway and to avoid a potentially life threatening situation. This article describes a simple bail-out technique to avert prolonged airway compromise. This is particularly useful in patients with obesity, large goitre or maxillofacial injuries. Keywords: Tracheostomy; Maloney dilator. PMID: 18682430 [PubMed - as supplied by publisher]
Am J
Speech Lang Pathol. 2008 Aug;17(3):265-76.
Preparation, clinical support, and confidence of speech-language pathologists managing clients with a tracheostomy in australia. Ward E, Agius E, Solley M, Cornwell P, Jones C. Division of Speech Pathology, Therapies Building, The University of Queensland, St. Lucia, 4072 Australia. E-mail: liz.ward@uq.edu.au. PURPOSE: To describe the preparation and training, clinical support, and confidence of speech-language pathologists (SLPs) in relation to tracheostomy client care in Australia. METHOD: A survey was sent to 90 SLPs involved in tracheostomy management across Australia. The survey contained questions relating to preparation and training, clinical support, and confidence. RESULTS: The response rate was high (76%). The majority of SLPs were pursuing a range of professional development activities, had clinical support available, and felt confident providing care of clients with tracheostomies. Despite these findings, 45% of SLPs were not up-to-date with evidence-based practice, less than 30% were knowledgeable of the advances in tracheostomy tube technology, and only 16% felt they worked as part of an optimal team. Only half were confident and had clinical support for managing clients who were ventilated. Most (88%) believed additional training opportunities would be beneficial. CONCLUSIONS: The current data highlight issues for health care facilities and education providers to address regarding the training and support needs of SLPs providing tracheostomy client care.
Anaesthesia.
2008 Aug;63(8):891-2.
Second redo percutaneous tracheostomy following complicated revision surgical tracheostomy. Kinnear J, Lee M, Higgins D. Publication Types:
Chest. 2008 Aug;134(2):288-94. Epub 2008 Apr 10.
Tracheostomy tube malposition in patients admitted to a respiratory acute care unit following prolonged ventilation. Schmidt U, Hess D, Kwo J, Lagambina S, Gettings E, Khandwala F, Bigatello LM, Stelfox HT. Department of Anesthesia & Critical Care, Massachusetts General Hospital, Gray 4, 55 Fruit St, Boston, MA 02114. uschmidt@partners.org. BACKGROUND: Tracheostomy tube malposition is a barrier to weaning from mechanical ventilation. We determined the incidence of tracheostomy tube malposition, identified the associated risk factors, and examined the effect of malposition on clinical outcomes. METHODS: We performed a retrospective study on 403 consecutive patients with a tracheostomy who had been admitted to an acute care unit specializing in weaning from mechanical ventilation between July 1, 2002, and December 31, 2005. Bronchoscopy reports were reviewed for evidence of tracheostomy tube malposition (ie, > 50% occlusion of lumen by tissue). The main outcome parameters were the incidence of tracheostomy tube malposition; demographic, clinical, and tracheostomy-related factors associated with malposition; clinical response to correct the malposition; the duration of mechanical ventilation; the length of hospital stay; and mortality. RESULTS: Malpositioned tracheostomy tubes were identified in 40 of 403 patients (10%). The subspecialty of the surgical service physicians who performed the tracheostomy was most strongly associated with malposition. Thoracic and general surgeons were equally likely to have their patients associated with a malpositioned tracheostomy tube, while other subspecialty surgeons were more likely (odds ratio, 6.42; 95% confidence interval, 1.82 to 22.68; p = 0.004). Malpositioned tracheostomy tubes were changed in 80% of cases. Malposition was associated with prolonged mechanical ventilation posttracheostomy (median duration, 25 vs 15 d; p = 0.009), but not with increased hospital length of stay or mortality. CONCLUSION: Tracheostomy tube malposition appears to be a common and important complication in patients who are being weaned from mechanical ventilation. Surgical expertise may be an important factor that impacts this complication. PMID: 18403659 [PubMed - in process]
Crit Care Med.
2008 Aug 1. [Epub ahead of print]
The effect of tracheostomy timing during critical illness on long-term survival. Scales DC, Thiruchelvam D, Kiss A, Redelmeier DA. From the Department of Critical Care (DCS), Sunnybrook Health Sciences Centre; Interdepartmental Division of Critical Care (DCS), University of Toronto; Institute for Clinical Evaluative Sciences (DCS, DT, AK, DAR); Department of Medicine (DAR), Sunnybrook Health Sciences Centre; and Clinical Epidemiology Program (DCS, AK, DAR), Department of Health Policy, Management and Evaluation, University of Toronto, ON, Canada. BACKGROUND:: Tracheostomy is common in intensive care unit patients, but the appropriate timing is controversial. OBJECTIVE:: To determine whether earlier tracheostomy is associated with greater long-term survival. DESIGN:: Retrospective cohort analysis. SETTING:: Acute care hospitals in Ontario, Canada (n = 114). PATIENTS:: All mechanically-ventilated intensive care unit patients who received tracheostomy between April 1, 1992 and March 31, 2004, excluding extreme cases (<2 or >/=28 days) and children (<18 yrs). MEASUREMENTS:: For crude analyses, tracheostomy timing was classified as early (</=10 days) vs. late (>10 days) with mortality measured at multiple follow-up intervals. Proportional hazards analyses considered tracheostomy as a time-dependent variable to adjust for measurable confounders and possible survivor treatment bias. We used stratification, propensity-score, and instrumental variable analyses to adjust for patient differences. RESULTS:: A total of 10,927 patients received tracheostomy during the study, of which one-third (n = 3758) received early and two-thirds late (n = 7169). Patients receiving early tracheostomy had lower unadjusted 90-day (34.8% vs. 36.9%; p = 0.032), 1 yr (46.5% vs. 49.8%; p = 0.001), and study mortality (63.9% vs. 67.2%; p < 0.001) than patients receiving late tracheostomy. Multivariable analyses treating tracheostomy as a time-dependent variable showed that each additional delay of 1 day was associated with increased mortality (hazard ratio 1.008, 95% confidence interval 1.004-1.012), equivalent to an increase in 90-day mortality from 36.2% to 37.6% per week of delay (relative risk increase 3.9%; number needed to treat = 71 patients to save one life per week delay). LIMITATIONS:: This analysis provides guidance regarding timing but not patient selection for tracheostomy. CONCLUSIONS:: Physicians performing early tracheostomy should not anticipate a large potential survival benefit. Future research should concentrate on identifying which patients will receive the most benefit.
Intensive
Care Med. 2008 Aug;34(8):1498-502. Epub 2008 Apr 17.
Elective tracheostomy in mechanically ventilated children in Canada. Principi T, Morrison GC, Matsui DM, Speechley KN, Seabrook JA, Singh RN, Kornecki A. Critical Care Unit, Children's Hospital, London Health Sciences Centre, 800 Commissioners Road East, ON N6A5W9, London, ON, Canada. OBJECTIVE: To determine the current practice and opinions of paediatric intensivists in Canada regarding tracheostomy in children with potentially reversible conditions which are anticipated to require prolonged mechanical ventilation. DESIGN AND SETTING: Self-administered survey among paediatric intensivists within paediatrics critical care units (PCCU) across Canada. MEASUREMENTS AND RESULTS: All 16 PCCUs participated in the survey with a response rate of 81% (63 physicians). In 14 of 16 centres one to five tracheostomies were performed during 2006. Two centres did not perform any tracheostomies. The overall rate of tracheostomy is less than 1.5%. Percutaneous technique is used in 3/16 (19%) of centres. Readiness to undertake tracheostomy during the first 21[Symbol: see text]days of illness is influenced by patient diagnosis; severe traumatic brain injury 66% vs. 42% in a 2-year-old with Guillain-Barré syndrome, 48% in a 9-year-old with Guillain-Barré syndrome, and 12% in a child with isolated ARDS. In a child with ARDS 25% of respondents would never consider tracheostomy. Age does not affect timing nor keenness for tracheostomy. The majority, 81%, believe that the risks associated with the procedure do not outweigh the potential benefits. Finally, 51% believe that tracheostomy is underutilized in children. CONCLUSIONS: Elective tracheostomy is rarely performed among ventilated children in Canada. However, 51% of physicians believe it is underutilized. The role of elective tracheostomy and the percutaneous technique in children requires further investigation.
Interact Cardiovasc Thorac Surg. 2008 Aug;7(4):654-5. Epub 2008 Apr
7.
Graft repair of tracheo-innominate artery fistula following percutaneous tracheostomy. Jamal-Eddine H, Ayed AK, Al-Moosa A, Al-Sarraf N. Department of Thoracic Surgery, Chest Disease Hospital, Kuwait. Tracheo-innominate fistula (TIF) is a rare complication following percutaneous dilatational tracheostomy (PDT), occurring in < or =1% of cases. It usually develops three days to six weeks after the procedure and is fatal in the majority of cases, even after successful initial repair. We present a successfully treated case of TIF using a Goretex graft to replace the severely destroyed segment of the innominate artery.
J Pediatr Surg.
2008 Aug;43(8):1421-5.
Congenital alveolar fusion. Gupta RK, Jadhav V, Gupta A, Sanghvi B, Shah H, Parelkar S. Department of Pediatric Surgery, King Edward Memorial Hospital, Parel, Mumbai 400012, India. drrahulg78@yahoo.co.in Congenital fusion of the jaws is rare. It may be unilateral or bilateral and may involve only the soft tissues or both the hard and soft tissues. This anomaly may be seen separately or in association with other syndromes. Congenital alveolar fusion restricts mouth opening, causing problems with feeding, swallowing, and respiration. Case 1 had membranous bands between the alveoli that required tracheostomy for stabilization, followed by osteotomy for release. Postoperatively, both patients had adequate mouth opening.
Pediatr
Pulmonol. 2008 Aug;43(8):788-94.
Children with new tracheostomies: planning for family education and common impediments to discharge. Graf JM, Montagnino BA, Hueckel R, McPherson ML. Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. jgraf@bcm.edu OBJECTIVES: To describe an educational program and timeline for the discharge of children with a new tracheostomy and identify common impediments to the education and discharge process. METHODS: Retrospective pilot case series of 70 children and adolescents undergoing tracheostomy placement over a 24-month period in a large urban academic pediatric hospital. RESULTS: Eleven healthcare providers with expertise with technology dependent children identified the eight most common impediments to education and discharge for children with new tracheostomies. Length of stay, impediments to both education and discharge, and medical equipment needed at the time of discharge were extracted from hospital records. Caregivers of children with new tracheostomies needed a median of 14 days (range 5-110 days) to successfully complete a tracheostomy education program. Discharge occurred a median of 6.5 days (range 0-71 days) after education was completed. Common impediments to completing the education program included social issues (e.g., lack of sibling childcare), inter-current illness of the patient and/or language barriers. Impediments to discharge included patient's inter-current illnesses, social issues (e.g., lack of running water) and unavailability of home nursing. Our cohort of patients had a total median length of stay (LOS) of 46 days. At discharge, 55% of children required two or more medical devices (in addition to their tracheostomy) and 61% had some level of dependency on positive pressure ventilation. CONCLUSIONS: Pediatric patients with a new tracheostomy undergo lengthy initial hospitalizations and have complex educational and discharge needs. Multiple factors (both medical and social) can impede the child's transition to the outpatient setting. A structured education and discharge program may result in a shorter LOS for children with new tracheostomies. Impediments to family education and discharge should be anticipated. (c) 2008 Wiley-Liss, Inc. PMID: 18613098 [PubMed - in process]
Br J
Oral Maxillofac Surg. 2008 Jul 2. [Epub ahead of print]
Management of a temporary tracheostomy stoma. Gudka R, Coyne S, Knepil GJ. York Hospital, Wigginton Road, York, YO31 8HE, UK. PMID: 18602200 [PubMed - as supplied by publisher] Percutaneous tracheostomy: a comparison of PercuTwist and multi-dilatators techniques. Birbicer H, Doruk N, Yapici D, Atici S, Altunkan AA, Epozdemir S, Oral U. Publication Types:
Br J Anaesth.
2008 Jul;101(1):129.
Positioning the tracheal tube during percutaneous tracheostomy: another use for videolaryngoscopy. Gillies M, Smith J, Langrish C. Publication Types:
Crit Care Med.
2008 Jul;36(7):2163-73.
The difficult airway in adult critical care. Lavery GG, McCloskey BV. School of Health & Life Sciences, University of Ulster, Belfast, UK. gavin.lavery@belfasttrust.hscni.net INTRODUCTION: The difficult airway is a common problem in adult critical care patients. However, the challenge is not just the establishment of a safe airway, but also maintaining that safety over days, weeks, or longer. AIMS: This review considers the management of the difficult airway in the adult critical care environment. Central themes are the recognition of the potentially difficult airway and the necessary preparation for (and management of) difficult intubation and extubation. Problems associated with tracheostomy tubes and tube displacement are also discussed. RESULTS: All patients in critical care should initially be viewed as having a potentially difficult airway. They also have less physiological reserve than patients undergoing airway interventions in association with elective surgery. Making the critical care environment as conducive to difficult airway management as the operating room requires planning and teamwork. Extubation of the difficult airway should always be viewed as a potentially difficult reintubation. Tube displacement or obstruction should be strongly suspected in situations of new-onset difficult ventilation. CONCLUSIONS: Critical care physicians are presented with a significant number of difficult airway problems both during the insertion and removal of the airway. Critical care physicians need to be familiar with the difficult airway algorithms and have skill with relevant airway adjuncts. Publication Types:
Eur J Neurol.
2008 Jul;15(7):e66-7. Epub 2008 Apr 29.
Amelioration of pathological yawning after tracheostomy in a patient with locked-in syndrome. Chang CC, Chang ST, Chang HY, Tsai KC. Publication Types:
Intensive
Care Med. 2008 Jul 1. [Epub ahead of print]
Tracheostomy timing, enrollment and power in ICU clinical trials. Scales DC, Kahn JM. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada. PMID: 18592211 [PubMed - as supplied by publisher]
J Trauma.
2008 Jul;65(1):73-9.
Percutaneous tracheostomy in neurosurgical patients with intracranial pressure monitoring is safe. Milanchi S, Magner D, Wilson MT, Mirocha J, Margulies DR. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA. BACKGROUND: Percutaneous tracheostomy (PT) is performed routinely on neurosurgical patients in many critical care units. Some of these patients suffer from severe brain injury and require intracranial pressure (ICP) monitoring. It remains uncertain whether this procedure causes an increase in ICP or jeopardizes the cerebral perfusion pressure (CPP) in these patients. We studied the effects of PT on ICP and CPP in this group of patients. METHODS: Our study group consisted of 52 neurosurgical patients in the surgical intensive care unit of an urban, Level I Trauma Center who had ICP monitoring and underwent PT between 2001 and 2005. Data were collected from 24 hours before to 24 hours after PT. ICP, CPP, and Glasgow Coma Score (GCS) scale were measured hourly during the study period. RESULTS: There was no statistically significant change in the mean ICP over the 48-hour study period or after the procedure. There was a temporary increase in ICP during the procedure (1.60 mm Hg) which was statistically not significant. There was statistically significant increase in the mean CPP after the procedure, although this increase was clinically not significant. The risk of having a critically high ICP (>20 mm Hg) or low CPP (<60 mm Hg) values did not increase after the procedure. There was no significant change in GCS after the procedure. CONCLUSION: PT in neurosurgical patients with ICP monitor does not cause clinically significant or hazardous changes in ICP, CPP, and GCS. We therefore consider PT to be safe in neurosurgical patients. PMID: 18580518 [PubMed - indexed for MEDLINE]
Klin Padiatr.
2008 Jul-Aug;220(4):271-4. Epub 2007 Aug 9.
[Tracheal aplasia - An Especially Rare and Dramatic Anomaly.] [Article in German] Erler T, Wetzel U, Biolik HB, Eichhorn T, Gurski A. 1Klinik für Kinder- und Jugendmedizin, Carl-Thiem-Klinikum Cottbus, Lehrkrankenhaus des Universitätsklinikums Charitè Berlin. Tracheal agenesis (TA), aplasia or total atresia of the trachea are congenital anomalies which are still incompatible with life. Despite the many attempts of different interventions, there are yet no promising, long-term methods of treatment. Only with sufficient proportion of the proximal or distal trachea available, it is possible to place a tracheostomy, which also opens up new vistas of life for the affected child. In most cases the seldom deformation, trachealagenesis, does not get recognised before the child is born. It may there-fore be the immediate diagnosis postnatal that is decisive over the final prognosis of the child. The prepartal suspicion of a duodenal stenosis, an aphonic newborn as well as the frustrane attempts of intubation are possible guidelines of TA. In independence of peripartal and anamnestical factors, individual disciplinary decisions are necessary for further treatments. After the cancellation of intensiv care the premature infant of the case report died as consequence of postnatal diagnosed tracheal aplasia. Under circumstances, medical treatmets such as the ex utero intrapartum procedure (Exit), the temporary method of extracorporal membrane oxygenation (ECMO) or the use of cartilage tissue for the plastic trachea reconstruction can provide advanced medical opportunities.
:
Otolaryngol Head Neck Surg. 2008 Jul;139(1):172-3.
An unusual case of tracheal stenosis following percutaneous tracheostomy. Rourke TJ, van Gijn D, Norris A, Odutoye B, Lee M. Department of Otolaryngology, St Georges Hospital, London, UK. tomrourke@doctors.org.uk PMID: 18585587 [PubMed - in process]
Br J Anaesth.
2008 Jun 13. [Epub ahead of print]
New approach to anaesthetizing a patient at risk of pulmonary aspiration with a Montgomery T-tube in situ. Wouters KM, Byreddy R, Gleeson M, Morley AP. Department of Anaesthesia, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK. We describe our airway management in a patient requiring emergency laparotomy with a Montgomery T-tube in situ. This uncuffed silicone T-tube acts as both stent and tracheostomy after laryngotracheal surgery, and entails various difficulties for the anaesthetist. Several anaesthetic techniques have been described for T-tube insertion. The management of patients with a T-tube in situ, at risk of pulmonary aspiration, has not been addressed. Below, we present some possible approaches to this problem and describe how we successfully carried out an awake fibreoptic intubation via the tracheal limb of the T-tube. This technique might be considered for patients in similar circumstances, but knowledge of relevant internal and external tube diameters, and appropriate tracheal tube size selection, is crucial. PMID: 18552345 [PubMed - as supplied by publisher]
Br J Hosp
Med (Lond). 2008 Jun;69(6):364.
Endotracheal tube or laryngeal mask for airway control during percutaneous dilatational tracheostomy. Sabir N, Vaughan D. Department of Anaesthetics, Northwick Park Hospital, Harrow, Middlesex HA1 3UJ. PMID: 18646428 [PubMed - in process]
Crit Care Med.
2008 Jun;36(6):1742-8.
Comment in:
Eur J
Cardiothorac Surg. 2008 Jun;33(6):1076-9; discussion 1080-1. Epub
2008 Mar 6.
Is post-sternotomy percutaneous dilatational tracheostomy a predictor for sternal wound infections? Ngaage DL, Cale AR, Griffin S, Guvendik L, Cowen ME. Castle Hill Hospital, Kingston-Upon-Hull, East Yorkshire HU16 5JQ, United Kingdom. dngaage@yahoo.com OBJECTIVE: Early post-sternotomy tracheostomy is not infrequently considered in this era of percutaneous tracheostomy. There is, however, some controversy about its association with sternal wound infections. METHODS: Consecutive patients who had percutaneous tracheostomy following median sternotomy for cardiac operation at our institution from March 1998 through January 2007 were studied, and compared to contemporaneous patients. We identified risk factors for tracheostomy, and investigated the association between percutaneous tracheostomy and deep sternal wound infection (mediastinitis) by multivariate analysis. RESULTS: Of 7002 patients, 100 (1.4%) had percutaneous tracheostomy. The procedure-specific rates were: 8.6% for aortic surgery, 2.7% for mitral valve repair/replacement (MVR), 1.1% for aortic valve replacement (AVR), and 0.9% for coronary artery bypass grafting (CABG). Tracheostomy patients differed vastly from other patients on account of older age, severe symptoms, preoperative support, lower ejection fraction, more comorbidities, more non-elective and complex operations and higher EuroScore. Risk factors for tracheostomy were New York Heart Association class III/IV (OR 6.01, 95% CI 2.28-16.23, p<0.0001), chronic obstructive pulmonary disease (OR 1.84, 95% CI 1.01-3.37, p=0.05), preoperative renal failure (OR 3.57, 95% CI 1.41-9.01, p=0.007), prior stroke (OR 3.08, 95% CI 1.75-5.42, p<0.0001), ejection fraction<0.30% (OR 2.73, 95% CI 1.23-6.07, p=0.01), and bypass time (OR 1.008, 95% CI 1.004-1.012, p<0.0001). The incidences of deep (9% vs 0.7%, p<0.0001) and superficial sternal infections (31% vs 6.5%, p<0.0001) were significantly higher among tracheostomy patients. Multivariate analysis identified percutaneous tracheostomy as a predictor for deep sternal wound infection (OR 3.22, 95% CI 1.14-9.31, p<0.0001). CONCLUSIONS: Tracheostomy, often performed in high-risk patients, may further complicate recovery with sternal wound infections, including mediastinitis, therefore, patients and timing should be carefully selected for post-sternotomy tracheostomy.
Eur J
Cardiothorac Surg. 2008 Jun;33(6):1069-75. Epub 2008 Mar 4.
The role of airway stenting in pediatric tracheobronchial obstruction. Antón-Pacheco JL, Cabezalí D, Tejedor R, López M, Luna C, Comas JV, de Miguel E. Pediatric Airway Unit and Division of Pediatric Surgery, Pediatric Institute of the Heart, Doce de Octubre, University Hospital, Madrid, Spain. janton.hdoc@salud.madrid.org OBJECTIVE: Tracheobronchial obstruction is infrequent in the pediatric age group but it is associated with significant morbidity and mortality. The purpose of this study is to review the results of a single institution experience with endoscopic stent placement in children with benign tracheobronchial obstruction, and with special concern on safety and clinical effectiveness. MATERIALS AND METHODS: Twenty-one patients with severe airway stenosing disease in which stent placement was performed between 1993 and 2006. Inclusion criteria according to the clinical status were: failure to wean from ventilation, episode of apnea, frequent respiratory infections (>3 pneumonia/year), and severe respiratory distress. Additional criteria for stent placement were: failure of surgical treatment, bronchomalacia, and tracheomalacia refractory to previous tracheostomy. Selection of the type of stent depended on the site of the lesion, the patient's age, and the stent availability when time of presentation. The following variables were retrospectively evaluated: age, type of obstruction, associated malformations, stent properties, technical and clinical success, complications and related reinterventions, outcome and follow-up period. RESULTS: Thirty-three stents were placed in the trachea (n=18) and/or bronchi (n=15) of 21 patients with a median age of 6 months (range, 9 days-19 years). Etiology of the airway obstruction included severe tracheomalacia and/or bronchomalacia in 19 cases (90%), and postoperative tracheal stenosis in two. Twelve children had a total of 20 balloon-expandable metallic stents placed, and 10 had 13 silicone-type stents (one patient had both). In nine patients (42%) more than one device was placed. Stent positioning was technically successful in all but one patient. Clinical improvement was observed in 18 patients (85%) but complications occurred in five of them (27%). Eight patients died during follow-up but only in one case it was related to airway stenting. Thirteen patients (62%) are alive and in good condition with a mean follow-up of 39 months (1-13.8 years). CONCLUSIONS: Although the results were based on a small series, placement of stents in the pediatric airway to treat tracheobronchial obstruction seems to be safe and effective. Stenting is a satisfactory therapeutic option when other procedures have failed or are not indicated.
J Trauma.
2008 Jun;64(6):1543-7.
Cricothyrotomy in air medical transport. McIntosh SE, Swanson ER, Barton ED. University of Utah Health Sciences Center, Salt Lake City, Utah, USA. scott.mcintosh@hsc.utah.edu BACKGROUND: Airway management is an essential skill for air medical transport (AMT) providers. The endpoint of airway maneuvers is a cricothyrotomy which may be live-saving if other measures fail. We reviewed cricothyrotomy cases in our AMT program to evaluate the success rate and the circumstances surrounding the procedure. METHODS: This was a retrospective review of cases in which a cricothyrotomy was performed at the University of Utah AirMed flight program during the years of 1995 to 2004. Data included incidence, indications, complications, neurologic outcome, and success rates of the procedure. RESULTS: Of the 14,994 transports during the study period, 17 cricothyrotomies were performed. Airway obstruction by blood and/or vomit was the most frequent indication (47%) followed by airway edema/distorted anatomy (24%). The total number of cricothyrotomies decreased during the study period. Seven (41%) patients survived with a reasonable neurologic outcome. The remaining 10 patients died during initial treatment or subsequent hospitalization. Success rate of the procedure in our series was 100%. These results were compared with those of other cricothyrotomy studies. CONCLUSION: Cricothyrotomy has become less common as an emergency rescue technique. However, AMT personnel have a high success rate when performing the cricothyrotomy procedure. This rate is as high as or higher than other emergency personnel. PMID: 18545121 [PubMed - indexed for MEDLINE]
Middle East J Anesthesiol. 2008 Jun;19(5):1055-67.
Comparison of percutaneous dilatational tracheostomy with surgical tracheostomy. Türkmen A, Altan A, Turgut N, Yildirim G, Ersoy A, Koksal C, Ayşe M, Kamali S. SB Okmeydani Education and Research Hospital. aygenturkmen@tnn.net RATIONALE: Tracheostomy is done mostly in critically ill patients, many of whom may not survive. We still do not know the long term complications oftracheostomy itself; tracheal and subglottic stenosis, and tracheomalacia. OBJECTIVES: To compare the complications of surgical tracheostomy (ST) versus percutaneous dilatational tracheostomy (PDT) by means of MRI control up to 1 month after closed tracheostomy. RESULTS: There was no death related to tracheostomy. In both groups there were two preoperative complications: one minor hemorrhage and one subcutaneous empysema in the ST group, and one minor bleeding and one puncture ofendotracheal tube cuff in the PDT group. When the early and the late postoperative complications of the two groups were compared, it was observed that in the ST group, five early (one minor bleeding, three stomal infections and one accidental decannulation), and two late (one peristomal granuloma and one persistent stoma) postoperative complications had occurred. In the PDT group, four early (minor bleeding) and two late postoperative complications (two minor bleeding) were observed. MRI of two patients in the PDT group demonstrated tracheal stenosis. CONCLUSIONS: PDT is as safe and as effective as ST. Although the early and late postoperative complication rates were not significant in the PDT group, we believe that further investigations with larger groups are necessary to find long-term outcome following PDT. MRI scanning provides an excellent non-invasive method of assessing the tracheal lumen. PMID: 18637605 [PubMed - in process]
J Neurol Sci.
2008 May 15;268(1-2):95-101. Epub 2007 Dec 31.
Survival rate of patients with amyotrophic lateral sclerosis in Wakayama Prefecture, Japan, 1966 to 2005. Kihira T, Yoshida S, Okamoto K, Kazimoto Y, Ookawa M, Hama K, Miwa H, Kondo T. Department of Neurology, Wakayama Medical University, Wakayama City, Japan. tkihira@wakayama-med.ac.jp To investigate longitudinal changes in the survival rate of patients with amyotrophic lateral sclerosis in Wakayama Prefecture, Japan, we made a retrospective hospital-based study of 454 patients diagnosed with motor neuron disease (MND) at Wakayama Medical University (WMU) Hospital between 1966 and 2005. Of the 454 patients, 240 who were born and who lived in Wakayama Prefecture were diagnosed with definite or probable ALS during this period, according to the El Escorial criteria. The clinical data of the 240 patients, including sex, birth date, birthplace, address, age at onset, initial symptoms, date when respiratory support was applied (tracheostomy, noninvasive positive pressure ventilation, or mandatory artificial ventilation), and date of death were reviewed retrospectively. The age at onset of patients who developed initial symptoms before 1990 was 53.4+/-10.6 (mean+/-S.D.) and that in 1990 or thereafter was 64.8+/-10.3, respectively, showing a significant difference (p<0.0001). Clinical duration was determined from onset to either date of death or initiation of respiratory support in this study. Survival rate was compared using the Kaplan-Meier method according to age at onset, sex, initial symptoms and year of onset. Mean age at onset shifted towards older age according to a later year of onset, due to the overwhelming senility rate in Wakayama Prefecture. Older onset patients had a significantly poorer survival rate than younger onset patients when it was compared based on 10-year age groups (log rank, p<0.0001). Male patients had a poorer survival rate than female patients (p<0.0001). ALS patients with bulbar palsy onset showed shorter clinical durations than those with lower leg onset (p<0.0071, Breslow-Gehan-Wilcoxon test). Patients over 70 years old more frequently showed bulbar palsy onset compared to those younger than 69 (p=0.003). In a comparison of year of onset before and after 1990, ALS patients after 1990 had characteristics of older age onset and shorter clinical duration, and more frequently showed bulbar palsy onset compared with those before 1990. These findings indicated that younger onset patients with ALS decreased after 1990 in Wakayama Prefecture and this might partly explain the recent decline of ALS incidence in Wakayama Prefecture. The shift of the mean age at onset to older age might be due to exogenous factors, including changes in lifestyle, food, and drinking water in this area. Bulbar palsy onset and age at onset were expected as predictors of the survival rate. Publication Types:
Anesteziol Reanimatol. 2008 May-Jun;(3):22-5.
[Submental tracheal intubation is an alternative to tracheostomy at oral surgery] [Article in Russian] [No authors listed] A prospective study was performed in 17 patients who had undergone submental tracheal intubation in facial injury, tumors of the upper jaw, and congenital and acquired deformities of the facial skeleton. The time required for intubation, and the adequacy of gas exchange and ventilation during tracheal intubation and an operation was estimated. Submental intubation was successfully carried out in all the patients. The mean time spent on tracheal intubation was 5-6 min. At surgery, there was no chance extubation or endotracheal tube damage, the parameters of ventilation and gas exchange remained to be within the normal range. A submental scar was minimal. There was inflammation and formation of a bad scar or bleeding at the site of intubation in none case. Submental orotracheal intubation is a safe and simple procedure for airway patency and it may be used as an alternative to tracheostomy in maxillofacial injury, tumors of the upper jaw, and congenital and acquired deformities of the facial skeleton. Publication Types:
Br J Anaesth.
2008 May;100(5):663-6. Epub 2008 Mar 27.
Role of routine chest radiography after percutaneous dilatational tracheostomy. Kumar VM, Grant CA, Hughes MW, Clarke E, Hill E, Jones TM, Dempsey GA. Critical Care Unit, University Hospital Aintree, Liverpool, UK. BACKGROUND: The role of routine chest radiography (CXR) after percutaneous dilatational tracheostomy (PDT) has been questioned. METHODS: We performed a prospective observational study, on a mixed medical/surgical critical care unit in a university teaching hospital. We studied all patients undergoing PDT as part of their critical care management from November 1, 2003 until July 31, 2007. All PDTs were performed under bronchoscopic guidance. After PDT, we reviewed the immediate post-procedural films to assess the utility of routine postoperative CXR. For the purposes of CXR review, we considered a procedure to be either uncomplicated or technically difficult. Clinically relevant CXR findings were new barotrauma (pneumothorax, pneumomediastinum) or a significant change in consolidation from the pre-procedure film. RESULTS: A total of 384 patients underwent PDT during the study period. Of these, 345 had immediate post-procedural CXRs available for review. There were 252 PDTs (73%) documented as uncomplicated. There were 93 (27%) technically difficult procedures, with 107 adverse events recorded. In 82 (24%) procedures, these difficulties were described as minor procedural complications [multiple attempts at needle insertion (> or = 3), minor bleeding or tracheal ring fracture]. Significant complications (mal-placement in the anterior mediastinum and major bleeding) were documented in 12 (3.5%) patients. New abnormalities were noted on 8 (2.3%) immediate post-procedural CXRs. In only one patient was there a new CXR change in an uncomplicated PDT. CONCLUSIONS: Immediate CXR after uncomplicated PDT performed under bronchoscopic guidance rarely reveals unexpected radiological abnormalities. The role of CXR after PDT appears to be restricted to those patients undergoing technically difficult and complicated procedures. A change in practice to this effect will lead to reductions in both medical costs and exposure of staff and patients to ionizing radiation. PMID: 18369239 [PubMed - indexed for MEDLINE]
Int
J Oral Maxillofac Surg. 2008 May;37(5):484-6. Epub 2008 Mar 14.
How to do a safe tracheostomy. Thiruchelvam JK, Cheng LH, Drewery H. Chase Farm Hospital, UK. jkthir@yahoo.co.uk A new technique of surgical tracheostomy is described. Prior to performing the tracheostomy, the endotracheal tube (ETT) is advanced further down the trachea so that the end of the tube is positioned just above the carina. Using the flexible endoscope within the ETT the positioning can be done with precision. This manoeuvre avoids the cuff of the ETT being perforated as it is well below the site of the tracheal window. Following the creation of an opening in the trachea, the patient continues to have a definitive airway. In this controlled environment, time is taken to obtain haemostasis at the tracheostomy site, place a rescue stitch and also suction above the cuff of the ETT. A study was carried out in a series of 15 patients by recording various measurements during the procedure to confirm the accuracy of this technique. PMID: 18342490 [PubMed - in process]
Anesth Analg.
2008 Apr;106(4):1330.
An unusual bleeding-related complication following percutaneous dilatational tracheostomy. Linstedt U, Langenheim KU, Braun JP. Publication Types:
Crit Care Nurs
Q. 2008 Apr-Jun;31(2):150-60.
An evidence-based evaluation of tracheostomy care practices. Dennis-Rouse MD, Davidson JE. Emergency Department, Palomar Pomerado Health, Escondido, California 92025, USA. melissarousern@aol.com Adverse outcomes related to tracheal occlusion and peritracheal skin breakdown stimulated a review of tracheostomy care. An evidence-based practice approach was taken to evaluate the problem. Organizational tracheostomy care policies were reviewed. Subcategories related to tracheostomy care were queried including securing devices, sutures and their removal, type and choice of dressings, prevention of skin breakdown, frequency of care and role delineation, and suctioning. A literature review was done. National experts were surveyed. A geographical survey was taken and vendors of tracheostomy products were interviewed. Collected evidence was scored along a continuum. Costs of supplies were evaluated. Physicians, staff, and patients were interviewed. Skin maceration on the neck was found on multiple audits. The type of tie was identified as a problem. Nurses and respiratory therapists reported difficulty providing tracheostomy care due to suturing technique and securing methods. The stocked dressing was too large to fit under sutures. Several conflicting policies existed regarding tracheostomy care, none of which identified responsibility for performing care: respiratory versus nursing or time standards for care. New supplies were trialed. A list of practice changes were agreed upon by respiratory, nursing, and medical staff. Primary responsibility for tracheostomy care was shifted to the registered nurse. Publication Types:
Masui. 2008
Apr;57(4):474-8.
[Massive subcutaneous emphysema following percutaneous tracheostomy] [Article in Japanese] Matsuura K, Nakanisi T, Nagakawa T, Katou S, Honda Y. Department of Anesthesiology, Toyama City Hospital, Toyama 939-8511. Although percutaneous dilatational tracheostomy (PDT) is fast becoming the method of choice for securing an airway in chronic ventilated patients in an intensive care unit (ICU). Subcutaneous emphysema is an unusual and sometimes lethal complication which may extend the length of stay in the ICU. We report a case of massive subcutaneous emphysema without tracheal wall laceration that occurred in the ICU after PDT. An 81-year-old woman was admitted to our ICU due to infective exacerbation of chronic obstructive airways disease. Her medical therapy included nebulized bronchodilators, steroids and empirical antibiotics. Within thirty-six hours of initial endotracheal intubation PDT was performed. Several hours following the procedure, the patient developed massive subcutaneous emphysema encompassing her entire body. No pneumothorax was identified on subsequent chest X-ray. Laryngoscopic and bronchoscopic examination showed no evidence of tracheal wall laceration. We discuss the etiology and management plan for this rare complication. Publication Types:
Arch Otolaryngol Head Neck Surg. 2008 Mar;134(3):263-7.
South Med J.
2008 Mar;101(3):297-302.
Comment in:
Determinants of tracheostomy decannulation:an international survey.ABSTRACT: BACKGROUND: Although tracheostomy is probably the most common surgical procedure performed on critically ill patients, it is unknown when a tracheostomy tube can be safely removed. METHODS: We performed a cross-sectional survey of physicians and respiratory therapists with expertise in the management of tracheostomized patients at 118 medical centers to characterize contemporary opinions about tracheostomy decannulation practice and define factors that influence these practices. RESULTS: We surveyed 309 clinicians, of which 225 responded (73%). Clinicians rated patient level of consciousness, ability to tolerate tracheostomy tube capping, cough effectiveness and secretions as the most important factors in the decision to decannulate a patient. Decannulation failure was defined as the need to re-insert an artificial airway within 48 hours (45% of respondents) to 96 hours (20% of respondents) of tracheostomy removal with 2% to 5% the most frequent recommendation for an acceptable recannulation rate (44% of respondents). In clinical scenarios clinicians who worked in chronic care facilities (30%) were less likely to recommend decannulation than clinicians who worked in weaning (47%), rehabilitation (53%) or acute care facilities (55%) (p=0.015). Patients were most likely to be recommended for decannulation if they were alert and interactive (odds ratio, 4.76; 95% confidence interval (CI), 3.27 to 6.90; p<0.001), had a strong cough (odds ratio, 3.84; 95% CI, 2.66 to 5.54; p<0.001), scant thin secretions (odds ratio, 2.23; 95% CI, 1.56 to 3.19; p<0.001) and required minimal supplemental oxygen (odds ratio, 2.04; 95% CI, 1.45 to 2.86; p<0.001). CONCLUSIONS: Patient level of consciousness, cough effectiveness, secretions and oxygenation are important determinants of clinicians' tracheostomy decannulation opinions. Most surveyed clinicians defined decannulation failure as the need to re-insert an artificial airway within 48 to 96 hours of planned tracheostomy removal. PMID: 18302759 [PubMed - as supplied by publisher]
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Eur J Cardiothorac Surg. 2008 Feb 23 [Epub ahead of print] The role of airway stenting in pediatric tracheobronchial obstruction.Pediatric Airway Unit and Division of Pediatric Surgery, Pediatric Institute of the Heart, ‘Doce de Octubre’, University Hospital, Madrid, Spain. Objective: Tracheobronchial obstruction is infrequent in the pediatric age group but it is associated with significant morbidity and mortality. The purpose of this study is to review the results of a single institution experience with endoscopic stent placement in children with benign tracheobronchial obstruction, and with special concern on safety and clinical effectiveness. Materials and methods: Twenty-one patients with severe airway stenosing disease in which stent placement was performed between 1993 and 2006. Inclusion criteria according to the clinical status were: failure to wean from ventilation, episode of apnea, frequent respiratory infections (>3 pneumonia/year), and severe respiratory distress. Additional criteria for stent placement were: failure of surgical treatment, bronchomalacia, and tracheomalacia refractory to previous tracheostomy. Selection of the type of stent depended on the site of the lesion, the patient's age, and the stent availability when time of presentation. The following variables were retrospectively evaluated: age, type of obstruction, associated malformations, stent properties, technical and clinical success, complications and related reinterventions, outcome and follow-up period. Results: Thirty-three stents were placed in the trachea (n=18) and/or bronchi (n=15) of 21 patients with a median age of 6 months (range, 9 days-19 years). Etiology of the airway obstruction included severe tracheomalacia and/or bronchomalacia in 19 cases (90%), and postoperative tracheal stenosis in two. Twelve children had a total of 20 balloon-expandable metallic stents placed, and 10 had 13 silicone-type stents (one patient had both). In nine patients (42%) more than one device was placed. Stent positioning was technically successful in all but one patient. Clinical improvement was observed in 18 patients (85%) but complications occurred in five of them (27%). Eight patients died during follow-up but only in one case it was related to airway stenting. Thirteen patients (62%) are alive and in good condition with a mean follow-up of 39 months (1-13.8 years). Conclusions: Although the results were based on a small series, placement of stents in the pediatric airway to treat tracheobronchial obstruction seems to be safe and effective. Stenting is a satisfactory therapeutic option when other procedures have failed or are not indicated.
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Med Hypotheses. 2008 Feb 22 [Epub ahead of print] On the development of idiopathic subglottic stenosis.Division of Laryngology, Department of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center, 801 Welch Road, Stanford, CA 94305, United States. Idiopathic subglottic stenosis is a fibrotic narrowing of the airway at the level of the cricoid cartilage, which can result in severe dyspnea. There is an overwhelming female preponderance, and treatment usually involves dilation, tracheostomy or resection with reconstruction of the involved portion of the airway. The exact mechanism of action is unknown. Estrogen has been thought to play a role in the pathogenesis of this disease, but estrogen receptors have not been found in tissue specimens taken from afflicted individuals. A careful history taken from the patient often reveals a severe episode of coughing prior to the development of symptoms, and intraoperative examination can reveal impaction of the first tracheal ring within the lumen of the cricoid cartilage. Based on these observations, we surmise that an intermittent telescoping effect of the first tracheal ring within the lumen of the cricoid cartilage can lead to disruption of the local blood supply and trauma to the cricoid mucosa, with consequent mucosal edema, ischemia, and ultimately fibrosis. While estrogen has been shown to play a beneficial role in wound healing, abnormal wound healing may be potentiated by variations in estrogen receptor expression, and could also explain the female preponderance seen in this disease.
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Anaesthesia.
2008 Mar;63(3):302-6.
An investigation into the length of standard tracheostomy tubes in critical care patients.Leeds General Infirmary, Leeds, UK. Abhiram.Mallick@leedsth.nhs.uk A number of problems have been reported with the use of standard length tracheostomy tubes in adult critical care patients. We measured the depth from the skin surface to the tracheal wall and the angle of the tracheal stoma during percutaneous tracheostomy. In vitro measurements were also performed on standard tracheostomy tubes. Comparison of in vivo and in vitro dimensions demonstrated that standard length tracheostomy tubes are too short for the average critical care patient. We recommend that both the stomal and intratracheal lengths should be made longer by approximately 1 cm and tubes should be redesigned to an angle of 110-120 degrees to allow optimal tracheal placement.
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Masui. 2008
Feb;57(2):147-51.
[Percutaneous tracheostomy for the management of the patient with a difficult airway]
[Article in Japanese]
Anesthesia and Critical Care Service, Chiba Aoba Municipal Hospital, Chiba, Japan. BACKGROUND: In recent years, percutaneous tracheostomy has been performed in patients with adverse conditions such as short neck, obesity, coagulopathy or in emergency. METHODS: We performed percutaneous tracheostomy with Griggs' or Ciaglia's technique in five patients with difficult airways due to laryngeal tumors, a laryngeal edema, a neck cancer or a cervical injury. RESULTS: Well-trained anesthesiologists performed all procedures. In four patients, percutaneous tracheostomy was completed rapidly without any complications. The rest of patients underwent orotracheal intubation successfully with a percutaneous tracheostomy set prepared for an emergency situation. We call this setting "Stand-by PCT". CONCLUSIONS: We believe that percutaneous tracheostomy in well-trained hands can be used safely for the management of the patient with a difficult airway.
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J Laryngol Otol.
2008 Feb 20;:1-4 [Epub ahead of print]
Role of cricothyroid cannulation in head and neck surgery.Departments of Otolaryngology, Head and Neck Surgery, Ninewells Hospital, Dundee, Scotland, UK. Objectives:This paper outlines our use of cricothyroid cannulation in those patients undergoing head and neck surgery in whom a 'difficult airway' is anticipated. Audit results are presented.Materials and methods:Prospective data collection for all patients undergoing cricothyroid cannulation for management of head and neck neoplasms, over a two-year period.Results:Thirty-nine cricothyroid cannulae were sited in 32 patients. All patients with laryngeal tumours underwent the procedure while awake, prior to the anticipated difficult intubation, and the cannulae were removed within six hours. Most cannulations performed under general anaesthetic were for anticipated 'dangerous extubations' in patients with oral cavity tumours, and these cannulae remained in place for 24 hours. Tracheostomy was possibly avoided in six patients. No complications were identified.Conclusion:Cricothyroid cannulation can be a simple, safe, reliable technique which is a useful adjunct in the management of patients with a potentially difficult airway. PMID: 18289395 [PubMed - as supplied by publisher]
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Med Intensiva.
2008 Mar;32(2):91-93.
[Tracheostomy in ventilated patients. What do we do it for?]Unidad de Cuidados Intensivos y Grandes Quemados. Hospital Universitario de Getafe. CIBER Enfermedades Respiratorias. Madrid. España. fjaladosarbol@supercable.es. The tracheostomy has turned into one of the procedures most performed in the intensive care units. To this fact they have contributed the introduction of the percutaneous technique and the theoretical advantages that tracheostomy has: increase of the comfort of the patient, decrease of the dead space, improvement of the bronchial toilet and decrease in the requirement of sedation. But these advantages are not sufficient evidence for the indication of a tracheostomy. The comparative studies show that the performance of a tracheostomy, versus translaryngeal intubation, could relate to a lower mortality in the unit of intensive care, but tracheostomy does not improve other outcomes as length of stay in the unit of intensive care, length of stay in the hospital and the mortality in the hospital. More studies are needed to be able to estimate what patients would benefit from a tracheostomy and which is the optimal timing for its performance. PMID: 18275757 [PubMed - as supplied by publisher]
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Eur J Cardiothorac Surg.
2008 Feb 1 [Epub ahead of print]
Deep sternal wound infection requiring revision surgery: impact on mid-term survival following cardiac surgery.Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom. Objective: To assess the impact of deep sternal wound infection on in-hospital mortality and mid-term survival following adult cardiac surgery. Methods: Prospectively collected data on 4586 consecutive patients who underwent a cardiac surgical procedure via a median sternotomy from 1st January 2001 to 31st December 2005 were analysed. Patients with a deep sternal wound infection (DSWI) were identified in accordance with the Centres for Disease Control and Prevention guidelines. Nineteen variables (patient-related, operative and postoperative) were analysed. Logistic regression analysis was used to calculate a propensity score for each patient. Late survival data were obtained from the UK Central Cardiac Audit Database. Mean follow-up of DSWI patients was 2.28 years. Results: DSWI requiring revision surgery developed in 1.65% (76/4586) patients. Stepwise multivariable logistic regression analysis identified age, diabetes, a smoking history and ventilation time as independent predictors of a DSWI. DSWI patients were more likely to develop renal failure, require reventilation and a tracheostomy postoperatively. Treatment included vacuum assisted closure therapy in 81.5% (62/76) patients and sternectomy with musculocutaneous flap reconstruction in 35.5% (27/76) patients. In-hospital mortality was 9.2% (7/76) in DSWI patients and 3.7% (167/4510) in non-DSWI patients (OR 1.300 (0.434-3.894) p=0.639). Survival with Cox regression analysis with mean propensity score (co-variate) showed freedom from all-cause mortality in DSWI at 1, 2, 3 and 4 years was 91%, 89%, 84% and 79%, respectively compared with 95%, 93%, 90% and 86%, respectively for patients without DSWI ((p=0.082) HR 1.59 95% CI (0.94-2.68)). Conclusion: DSWI is not an independent predictor of a higher in-hospital mortality or reduced mid-term survival following cardiac surgery in this population.
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Injury. 2008
Mar;39(3):375-8.
Techniques for emergency tracheostomy.Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa. PMID: 18243196 [PubMed - in process]
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Best Pract Res Clin Anaesthesiol. 2007 Dec;21(4):465-82. Respiratory care.Department of Anesthesiology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356540, Seattle, WA 98195-6540, USA. irozet@u.washington.edu PURPOSE OF THE REVIEW: Neurosurgical patients frequently develop respiratory complications, adversely affecting neurologic outcome and survival. The review summarizes current literature and management of respiratory complications associated with brain injury. MAJOR FINDINGS: Respiratory complications are commonly associated with traumatic brain injury and subarachnoid haemorrhage. Lung-protective ventilation with reduced tidal volumes improves outcome in acute lung injury, and should be applied to neurosurgical patients in the absence of increased intracranial pressure. Weaning from the mechanical ventilation should be initiated as soon as possible, although the role of neurological status in the weaning process is not clear. Prevention of pneumonia and aspiration improves survival. In patients with difficult weaning, early bedside percutaneous tracheostomy should be considered. FURTHER INVESTIGATIONS: Further studies are warranted to elucidate an optimal oxygenation and ventilation in brain-injured patients, weaning strategies, predictors of the failed weaning and extubation, respiratory support in patients with difficulties to wean, and early tracheostomy.
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Br J Anaesth.
2007 Dec;99(6):912-5. Epub 2007 Oct 12.
Intubating laryngeal mask as a ventilatory device during percutaneous dilatational tracheostomy: a descriptive study.Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Diako Hospital, Flensburg, Academic Teaching Hospital of the University of Kiel, Germany. BACKGROUND: We use an intubating laryngeal mask (ILM) in preference to an endotracheal tube (ETT) as the ventilatory device during percutaneous dilatational tracheostomy (PDT) to overcome potential problems such as difficult ventilation, accidental extubation, damage of the ETT or of the bronchoscope, and need for additional assistant to secure the airway. We report our experience with this method. METHODS: In this prospective observational study, PDT was performed using the ILM in 86 patients. The insertion of the ILM, the quality of ventilation, and the view of the tracheal puncture site were rated as: 'very good', 'good', 'difficult', and 'not possible with ILM'. RESULTS: The bronchoscope was not damaged during any case, and all PDTs were performed by two physicians, without the need for an additional assistant. PDTs with ILM were successful in 95% of the patients (n=82). The ratings were 'very good' or 'good' in 80% of cases with regards to ventilation, in 90% for identification of relevant structures and tracheal puncture site, and in 85% for the view inside the trachea during PDT. Tracheal re-intubation was required for inadequate ventilation with ILM in four patients. CONCLUSIONS: The advantages of this procedure were lack of damage to the bronchoscope, the need for two instead of three persons to perform the PDT, and the excellent view inside the trachea. We recommend the ILM as a standard device for ventilation during bronchoscope-guided PDT. PMID: 17933797 [PubMed - indexed for MEDLINE]
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Ned Tijdschr Geneeskd.
2007 Oct 20;151(42):2308-12.
[The child with a tracheostomy, past and present: different indications, different children, different care]Erasmus MC-Sophia Kinderziekenhuis, Dr. Molewaterplein 60, 3015 GJ Rotterdam. l.j.hoeve@erasmusmc.nl --Until a few decades ago, acute infectious airway obstruction was the primary indication for tracheotomy in children. Its incidence has decreased considerably due to vaccination programmes and antibiotic treatment. --Today, the primary reasons for performing tracheotomy in a child are chronic airway obstruction (laryngeal injury after intubation, craniofacial malformation, lymphangioma) and prolonged artificial ventilation. --Consequently, the percentage of children who may be decannulated after a short period has decreased. --Tracheotomised children now require longer and more intensive care than before. --Hospital discharge is possible if parents and care providers are provided thorough training and counselling; this process requires specific medical, nursing and psychosocial support. --The increasing proportion of tracheotomised children cared for at home necessitates greater involvement from family practitioners. PMID: 18064931 [PubMed - indexed for MEDLINE]
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Neurol Neurochir Pol. 2007 November-December;41(6):504-509. Percutaneous tracheostomy in patients with disorders of the central nervous system.Zak³ad Neuroanestezjologii, Akademia Medyczna w Gdañsku, ul. Dêbinki 7, 81-212 Gdañsk, phone/fax +48 58 349 23 35, e-mail: malgosiawit@tlen.pl. Background and purpose: Patients with disorders of the central nervous system frequently require maintenance of an artificial airway due to impairment of the cough reflex and swallowing, or due to the necessity to apply long-term mechanical ventilation. The technique of percutaneous tracheostomy, introduced in recent years to clinical practice globally, enables tracheostomy and establishment of an artificial airway in a bedside setting, in a quick, simple and minimally traumatic manner. It does not require the operating theatre environment and is associated with lower complication rates than the traditional surgical technique. Material and methods: In the period from March 2003 till February 2007, we performed 75 procedures of Griggs mode percutaneous tracheostomy in intravenous anaesthesia, with use of a disposable Percutaneous Tracheostomy Kit (SIMS Portex, UK). The group of patients comprised 36 women and 39 men. Mean patient age was 57.4+/-17.9 years. Results: On average, the procedure was performed on the 8th (7.8+/-2.6) day after intubation, and its average duration was 6.0+/-3.3 minutes. The most frequent complication was local bleeding from the site (13%), most of which, however, regressed spontaneously. Also observed were: puncture of the tracheal tube sealing cuff (7%), damage to the isthmus of the thyroid (3%), and extratracheal positioning of the tracheal tube (3%). In all the cases the procedure was concluded successfully. Conclusions: Griggs mode is a simple and safe technique enabling percutaneous tracheostomy in patients with pathology of the central nervous system. However, further research is needed to evaluate potential delayed complications of the procedure.
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Saudi Med J. 2007 Dec;28(12):1926. Standard surgical versus percutaneous dilatational tracheostomy in intensive care patients.[No authors listed]
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Isr Med Assoc J. 2007 Oct;9(10):717-9. Can intensive care physicians safely perform percutaneous dilational tracheostomy? An analysis of 207 cases.General Intensive Care Unit, Division of Anesthesiology and Critical Care, Soroka Medical Center, Beer Sheva, Israel. motiklein@yahoo.com BACKGROUND: Percutaneous tracheostomy has largely replaced surgical tracheostomy in the intensive care unit setting. Although it seems logical that surgeons continue to do tracheostomies, anesthesiologists and intensive care specialists are familiar with airway control and guide wire techniques and could replace surgeons in the performance of PDT. OBJECTIVES: To assess the safety and effectiveness of bedside PDT in the ICU. METHODS: We conducted a retrospective chart review of 207 patients in the ICU who underwent PDT by an intensive care physician. RESULTS: Subcutaneous emphysema without pneumothorax occurred in one patient. Four patients underwent surgical revision following PDT. Early bleeding (during the first 48 hours following the procedure) was the indication in two patients and late bleeding, on the 10th post-PDT day, in one. In one case PDT was converted to surgical tracheostomy due to inadvertent early decannulation. There was one death directly related to the procedure, due to an unrecognized paratracheal insertion of the tracheostomy tube followed by mechanical ventilation, which led to bilateral pneumothorax, pneumomediastinum and cardio-circulatory collapse. No infectious complications were seen at the stoma site or surrounding tissues. CONCLUSIONS: PDT by intensive care physicians appears to be safe and should be included in the curriculum of intensive care residency.
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J Med Assoc Thai.
2007 Aug;90(8):1512-7.
Percutaneous dilatational tracheostomy with bronchoscopic guidance: Ramathibodi experience.Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand. bss-vb@hotmail.com BACKGROUND: Tracheostomy is considered as the airway management of choice for patients in the ICU who require prolonged mechanical ventilation or airway protection. Percutaneous dilational tracheostomy (PDT) was first described in 1985 and now is a well-established procedure that can be performed at the bedside by a pulmonologist with less surgical equipment required. DESIGN: A retrospective analysis. MATERIAL AND METHOD: Twelve patients underwent PDT because of prolonged endotracheal intubation between March and December 2006. The procedures were done by using bedside percutaneous dilatation tracheostomy with guidewire dilator forceps (GWDF) technique with bronchoscopic guidance under general anesthesia in either the intensive care unit or the intermediate care unit of Department of Medicine, Ramathibodi Hospital. RESULTS: There were seven men and five women with a mean age of 55.0 +/- 11.8 years. Operative mortality was 0%. Procedure related complication was not found Operation time in each case was less than ten minutes. Bronchoscopic examination performed in one of the cases after one month of tracheostomy tube removed showed no scar at the tracheostomy site. CONCLUSION: PDT with bronchoscopic guidance is a safe and easy procedure that can be done by pulmonologist at the bedside setting. PMID: 17926978 [PubMed - indexed for MEDLINE]
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2:
Neurology.
2008 Mar 18;70(12):980; author reply 981-2.
3:
Arch Otolaryngol Head Neck Surg.
2008 Mar;134(3):263-7.
Int J Surg.
2008 Feb 6 [Epub ahead of print]
Int J Oral Maxillofac Surg. 2008 Mar 12 [Epub ahead of print]
Masui. 2008 Mar;57(3):352-4.
Nefrologia. 2008;28(1):77-81.
Curr Treat Options Neurol. 2008 Mar;10(2):86-93.
J Trauma. 2008 Mar;64(3):749-53.
Eur J Cardiothorac Surg.
2008 Mar 5 [Epub ahead of print]
Infection.
2008 Mar 10 [Epub ahead of print]
Curr Opin Otolaryngol Head Neck Surg.
2008 Apr;16(2):141-6.
Anaesth Intensive Care.
2008 Jan;36(1):69-73.
Eur J Cardiothorac Surg.
2008 Mar 4 [Epub ahead of print]
Acta Otorhinolaryngol Ital.
2007 Dec;27(6):290-3.
Cytokine. 2008
Mar 1 [Epub ahead of print]
Int J Obstet Anesth.
2008 Apr;17(2):177-81. Epub 2008 Mar 4.
Crit Care.
2008 Feb 26;12(1):R26 [Epub ahead of print]
Eur J Cardiothorac Surg.
2008 Feb 23 [Epub ahead of print]
Med Hypotheses.
2008 Feb 22 [Epub ahead of print]
Ann Thorac Surg.
2008 Mar;85(3):965-70; discussion 970-1.
Ann Thorac Surg.
2008 Mar;85(3):956-63; discussion 964.
J Laryngol Otol.
2008 Feb 20;:1-4 [Epub ahead of print]
Anaesthesia.
2008 Mar;63(3):302-6.
Best Pract Res Clin Anaesthesiol.
2007 Dec;21(4):465-82.
J Laryngol Otol.
2008 Feb 19;:1-3 [Epub ahead of print]
Eur J Surg Oncol.
2008 Feb 15 [Epub ahead of print]
Paediatr Respir Rev.
2008 Mar;9(1):45-50. Epub 2008 Feb 1.
Masui. 2008 Feb;57(2):147-51.
Med Intensiva.
2008 Mar;32(2):91-93.
Scand Cardiovasc J.
2008 Feb;42(1):77-84.
World J Surg.
2008 Feb 12 [Epub ahead of print]
Ann Otol Rhinol Laryngol.
2008 Jan;117(1):27-31.
Ann Otol Rhinol Laryngol.
2008 Jan;117(1):1-4.
Neurocrit Care.
2008 Feb 5 [Epub ahead of print]
Med J Malaysia.
2007 Aug;62(3):234-7.
Zhonghua Zhong Liu Za Zhi.
2007 Sep;29(9):707-9.
Eur J Cardiothorac Surg.
2008 Apr;33(4):673-8. Epub 2008 Feb 19.
Injury. 2008 Mar;39(3):375-8.
JSLS. 2007 Oct-Dec;11(4):474-80.
Acta Otorhinolaryngol Ital.
2006 Aug;26(4):222-4.
Eur J Anaesthesiol.
2008 Mar;25(3):257-9.
Neurol Neurochir Pol.
2007 November-December;41(6):504-509.
Ann Thorac Surg.
2008 Feb;85(2):653-4.
J Craniofac Surg.
2008 Jan;19(1):277-9.
Interact Cardiovasc Thorac Surg.
2008 Jan 23 [Epub ahead of print]
Eur J Cardiothorac Surg.
2008 Mar;33(3):440-443. Epub 2008 Jan 16.
J Bras Pneumol.
2007 Dec;33(6):687-90.
Ann Otol Rhinol Laryngol. 2008 Jan;117(1):1-4. Utilization of the LifeStat emergency airway device.Department of Otolaryngology-Head and Neck Surgery, University of California-Davis Medical Center, 2521 Stockton Blvd, Suite 7200, Sacramento, CA 95817, USA. OBJECTIVES: Management of the airway in an emergency may be a harrowing experience. The equipment necessary to perform this procedure is often inaccessible. The LifeStat emergency airway is a portable device approved by the US Food and Drug Administration in 1997 for emergency cricothyrotomy. It is small enough to secure to a keychain, thus allowing instantaneous access at all times. We present a retrospective case series to report the experience of clinicians who have used the LifeStat device. METHODS: A survey instrument was sent to a convenience sample of health-care professionals who purchased the LifeStat emergency airway. The survey queried device use, user demographics, and the success, ease, complications, and location of use. RESULTS: One thousand surveys were distributed, and 100 individuals responded. Fifteen percent (15 of 100) reported use of the device on 17 occasions. The LifeStat was used successfully in all 17 cases. Eighty-two percent (14 of 17) of emergency use was in hospitals. In all cases the device was positioned successfully on the first attempt. No complications were reported. CONCLUSIONS: The LifeStat device provides a relatively safe and effective means of performing emergency cricothyrotomy. The majority of emergency situations in which the device was deployed occurred in hospital settings.
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