Early vs. late tracheostomy for the ICU patients: experience in a referral hospital

The aim of this study is to present our experience with elective surgical tracheostomy for intensive care unit [ICU] patients who needed prolonged translaryngeal intubation in order to evaluate the proper timing and advantages of early vs. late tracheostomy and to stress upon the risks associated with delayed tracheostomy. Medical records of all patients, who underwent elective tracheostomy for prolonged intubation from September 2006 to August 2010 at Jordan University hospital, were reviewed. A total of 106 patients [74 males] were included; their age ranged from 2 months to 90 yr with mean age of 46.5 yr. The mean time at which tracheostomy was done after initial tracheal intubation was 23 days [range 3-7 weeks]. Trauma was the most frequent cause of ICU admission 38 [35.8%], followed by post-surgery causes 14 [13.2%]. An early tracheostomy showed less complication vs late procedure. The length of stay in the ICU for patients who had an early tracheostomy was 26 days while this period for patients who had late tracheostomy was 47 days. Mortality rate among patients who had early tracheostomy was 17.1% while for late tracheostomy patients, it was 36.1%. Proper assessment and early tracheostomy is recommended for patients who require prolonged tracheal intubation in the ICU

Use of dexmedetomidine as the main anesthetic agent in patients with laryngo-tracheomalacia. A case report

The successful use of Dexmedetomidine as the main anesthetic agent for three pediatric patients with tracheomalacia presenting for different kinds of urgent operations is described. Patients were kept spontaneously breathing without intubation during their whole procedures. Surgical conditions were adequate, and hemodynamic and respiratory profiles were within baseline limits