Indications and outcome of tracheostomy in Ilorin, North Central Nigeria: 10 years review

Background: The study aims to highlight common indications as well as outcome of treatment among patients with tracheostomy in Ilorin, North-Central Nigeria. Methods: A review of clinical records of all patients with tracheostomy over a period of ten years (2002-2011), using the Theatre, Ward, ICU and the emergency register after approval from the ethical review committee. Data retrieved included; demographic profile, primary diagnosis, indication for tracheostomy, surgical technique, hospital admission and care outcome of management. All information retrieved input and analysed using an SPSS version 17.0 and data analyzed descriptively. Results: Seventy-six patients had complete data for analysis, age range from 1-89yrs, and mean age of 41.9yrs. There are 48males and 28 females with M:F ratio of 1.6:1. Majority of the patients were in the 3rd­5th decade. About 47.4% had temporary tracheostomy. The commonest indication for tracheostomy is upper airway obstruction secondary to aerodigestive tract tumors in 60.5%, then trauma in 26.3%. The complications are higher among the under tens'. Out of the 36 temporary tracheostomy only 18 were successfully decannulated. The mean hospital stay was 22±2days. Overall 15% mortality was recorded. Conclusion: Common reason for tracheostomy is essentially same earlier documentation in developing countries, common among males, emergency type still most common, neoplasm, prolonged intubation and trauma are the commonest indications, its complication is still high among the under tens'. The outcome is good with 15% mortality due to the primary disease and not from tracheostomy

Tracheostomy Decannulation: Suprastomal Granulation Tissue in Perspective

Background: Suprastomal granulation tissue is a complication of tracheostomy which maymake decannulation difficult and presents a therapeutic challenge to the Otorhinolaryngologists. The aims of this study therefore were to evaluate tracheostomy in black African population; determine the prevalence of suprastomal granulation tissue and provide updated information on it that will enable the otorhinolaryngologists to better understand and manage the lesion. Methods: We reviewed case files of patients who had tracheostomy between 1993 and 2007 at University College Hospital; Ibadan; Nigeria for essential clinical data.Results: Of the 256 patients who had tracheostomy; 133(51.95) had prior orotracheal intubation for 10 21days. Suprastomal granulation tissue complicated 16 (6.25) cases; this accounted for 88.89of cases of failed decannulation. Indications for tracheostomy in these patients included severe head injury in 12 (75); tetanus in 3 (18.75)] and intubation granuloma in 1(6.25) of these cases. Sixteen (4.3) cases had stomal infection. Conclusion: This study showed that the prevalence of suprastomal granulation is high among our patients. There is a need for good surgical tracheostomy technique to prevent this complication and stomal infection should be promptly treated while cuffed orotracheal intubation for more than two weeks in unconscious and tetanus patients should be avoided

An evaluation of open tracheostomy in oral and maxillofacial surgery

This study was carried out to evaluate the indications; utilisation and the overall impact of tracheostomy on the practice of Oral and Maxillofacial Surgery at the University College Hospital; Ibadan; Nigeria. In a retrospective study of a total of 381 patients operated under general anaesthesia by the Department of Oral and Maxillofacial Surgery within the study period; 41 patients (10.8) were tracheostomised. There were 26 males and 15 females with a ratio of 1.7:1 and the mean age was 28.9 years (SD = 12.25; range of 5 - 65 years). Indications for tracheostomy were orofacial tumours 70.7 (n=29); trauma 19.5 (n=8); temporomandibular joint (TMJ) ankylosis 7.3 (n=3) and post operative airway obstruction 2.4 (n=1). Orofacial tumours account for a major part of the indication for tracheostomy as a surgical airway intervention which is safe and with low morbidity

Use and care of an endotracheal / tracheostomy tube cuff - are intensive care unit staff adequately informed? : intensive care

Background. There is an apparent high incidence of tracheal stenosis in the Bloemfontein area. The aim of this study was to determine intensive care unit (ICU) staff knowledge of the use and care of endotracheal and tracheostomy tube cuffs. Methods. One hundred and twelve qualified nurses; working in 11 different ICUs; were asked to complete an anonymous questionnaire regarding endotracheal / tracheostomy tube cuffs. Results. The results highlight the following three areas of concern: (i) there was an overall misconception in 38of the respondents that the function of the cuff was to secure the tube in position in the trachea to prevent selfextubation; (ii) accurate regulation of cuff pressure was not routine practice in any of the ICUs; and (iii) only half of the respondents felt their training regarding cuff care management was sufficient. Conclusions. ICU staff had misconceptions regarding the function and care of endotracheal / tracheostomy tube cuffs. The concept of a higher cuff pressure for better stabilisation of the tube is probably an important factor that could have caused the increase in tracheal stenosis in the Bloemfontein area. Critical care nursing needs to emphasise the use of current techniques; discourage routine cuff deflation; and encourage collaboration with ICU physicians on standards of care. A protocol that could be used in the ICUs regarding the use and care of an endotracheal / tracheostomy tube cuff is proposed