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1.
Rev. cienc. cuidad ; 19(2): 84-98, 2022.
Article in Spanish | LILACS, BDENF, COLNAL | ID: biblio-1373532

ABSTRACT

Objetivo: Determinar las complicaciones detalladas de traqueotomías asociadas a intuba-ciones prolongadas en el adulto. Metodología: Revisión sistemática de los 5 años anteriores con base en los lineamientos PRISMA. Se recurrió a las bases de datos Scopus, Web of Sci-ence, Taylor and Francis y el Portal Regional de la Biblioteca Virtual en Salud. Además, se seleccionó la información a través de palabras clave, tales como: traqueotomía, intubación prolongada, UCI, adulto, complicaciones. Las publicaciones estaban en idioma español e inglés. La información se catalogó según criterios de inclusión y exclusión. Análisis: 24 artículos fueron elegidos. El momento de la traqueotomía (TQ) por intubación prolongada sigue siendo incierto. La TQ temprana demostró mayores beneficios que la TQ tardía. La TQ percutánea demostró menores tasas de estancia en la UCI y en los hospitales, con menos com-plicaciones. La hemorragia y la desaturación fueron complicaciones registradas asociadas a TQ tardía. Conclusión: La TQ percutánea fue la que se eligió en la mayoría de casos por ser eficaz, rápida y segura; además, disminuye la estancia hospitalaria y en la UCI, con menos complicaciones. Se debe precisar que en la mayoría de las publicaciones, al menos uno de estos beneficios no alcanzó significancia estadística. La complicación con mayor frecuencia fue la hemorragia en el sitio de punción


Objective: To determine the detailed complications of tracheotomies associated with pro-longed intubation in adults. Methodology: Systematic review of the previous 5 years based on PRISMA guidelines. The databases Scopus, Web of Science, Taylor and Francis and the Regional Portal of the Virtual Health Library were used to select information through key-words tracheotomy, prolonged intubation, ICU, adult, complications; the publications were in Spanish and English. The information was catalogued according to inclusion and exclusion criteria. Analysis: 24 articles were selected. The timing of tracheostomy (TQ) for prolonged intubation remains uncertain. Early TQ showed greater benefits than late TQ. Percutane-ous TQ demonstrated lower rates of ICU stay, hospital stay, and complications. Hemorrhage and desaturation were mostly reported complications associated with late TQ. Conclusion: Percutaneous TQ was the TQ of choice in most cases because it is effective, fast and safe, decreases hospital stay, ICU and complication rate, most publications at least one of these benefits did not reach statistical significance. The most frequent complication was bleeding at the puncture site


Objetivo: Determinar as complicações detalhadas da traqueostomia associadas à entubação prolongada em adultos. Metodologia: Revisão sistemática dos 5 anos anteriores com base nas diretrizes do PRISMA. As bases de dados Scopus, Web of Science, Taylor e Francis e o Portal Regional da Biblioteca Virtual em Saúde foram usadas para selecionar informações usando palavras-chave traqueostomia, intubação prolongada, UTI, adulto, complicações; as publicações foram em espanhol e inglês. As informações foram catalogadas de acordo com critérios de inclusão e exclusão. Análise: 24 artigos foram selecionados. O momento da traqueostomia (TQ) para entubação prolongada permanece incerto. O TQ precoce demon-strou maior benefício do que o TQ tardio. A TQ percutânea demonstrou taxas mais baixas de internação na UTI, internação hospitalar e complicações. A hemorragia e a dessaturação foram as complicações mais comumente relatadas associadas à TQ tardia. Conclusão: O TQ percutâneo foi o TQ de escolha na maioria dos casos, pois é eficaz, rápido e seguro, diminui a permanência hospitalar, a UTI e a taxa de complicações, a maioria das publicações pelo menos um desses benefícios não alcançou significância estatística. A complicação mais fre-qüente era o sangramento no local da punção


Subject(s)
Tracheotomy , Respiration, Artificial , Adult , Intensive Care Units , Intubation
2.
Arch. argent. pediatr ; 119(4): 279-284, agosto 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1281012

ABSTRACT

La decanulación es el proceso de retirar la cánula de traqueotomía de forma definitiva, una vez que la patología original que motivó la traqueotomía se haya resuelto o mejorado significativamente.La predicción del éxito de decanulación es difícil debido a la influencia de varios factores. No existe un protocolo universalmente aceptado. Existen diversos protocolos y la elección depende, en gran medida, de cada institución y de la situación individual de cada paciente. Sin embargo, para lograr la decanulación exitosa deben tenerse en cuenta varios criterios esenciales que deben cumplirse independientemente del protocolo elegido.Se señalan las características que debe reunir el paciente apto para la decanulación y se presentan recomendaciones sobre los pasos necesarios para lograr el retiro de la cánula de traqueotomía en el niño de manera segura y minimizando el riesgo de fracaso.


Decannulation is the process of removing the tracheotomy cannula permanently, once the original pathology that led to the tracheotomy has been resolved or significantly improved. The prediction of decannulation success is difficult due to the influence of several factors. There is no universally accepted decannulation protocol. There are several protocols and the choice depends, largely, on each institution and the individual situation of each patient. However, in order to achieve successful decannulation, several essential criteria must be taken into account, which must be fulfilled regardless of the chosen protocol.We indicate the characteristics that the patient must meet for decannulation, and we present recommendations on the necessary steps to achieve the removal of the tracheotomy cannula in a child safely and minimizing the risk of failure.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Tracheotomy , Device Removal/methods , Pediatrics , Guidelines as Topic , Cannula
3.
Braz. j. otorhinolaryngol. (Impr.) ; 87(1): 74-79, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1153589

ABSTRACT

Abstract Introduction: Upper airway obstruction, secondary to neoplasms presenting with stridor, is traditionally treated by tracheostomy. However, this common procedure can potentially have an impact on the long-term outcome, with tumor implantation into the tracheostomized wound leading to peristomal recurrence after laryngectomy, with the risk of stomal recurrence. Objective: To describe our clinical experience with tumor debulking as an alternative treatment choice of tracheotomy in patients with advanced larynx cancer at a tertiary referral center. Methods: A retrospective chart review of 87 subjects who had advanced larynx cancer (T3/4) with airway obstruction from our institutional database was conducted. Medical records including demographics, daily notes during hospitalization, and operative notes were used for clinical data of patients. The strategy for maintaining the airway patency was tracheotomy (emergency or awake) and tumor debulking (laser or coblation). Endophytic and exophytic laryngeal tumors were also noted. Results: In 41/87 (47.1%) patients, a tracheotomy was performed as an initial treatment (11 were emergency, 30 were planned) to maintain airway patency. Tumor debulking was performed in 28 exophytic and 18 endophytic lesions by laser or coblation (17 and 29 patients, respectively). Tracheotomy was performed in 5 patients (4 endophytic, 1 exophytic) who could not tolerate debulking surgery due to aspiration, edema and dyspnea. Three of the them who required subsequent tracheotomy was in the laser group and two in the coblation group. The success rate of laser debulking was 82.35% (14/17) and 93.1% (27/29) for coblation. Conclusion: Tumor debulking is a safe and effective method to avoid awake tracheotomy in patients suffering from airway obstruction due to advanced larynx cancer.


Resumo Introdução: A obstrução das vias aéreas superiores com estridor, secundária a neoplasias, é tradicionalmente tratada com traqueotomia. No entanto, este procedimento comum pode potencialmente ter um impacto sobre o desfecho a longo prazo, com a implantação do tumor na ferida cirúrgica da traqueotomia, o que leva à recorrência peristomal após laringectomia, com o risco de recorrência do estoma. Objetivo: Descrever nossa experiência clínica com a redução do volume tumoral como tratamento alternativo à traqueotomia em pacientes com câncer avançado de laringe em um centro de referência terciário. Método: Foi realizada uma revisão retrospectiva de prontuários de 87 indivíduos com câncer avançado de laringe (T3/T4) com obstrução das vias aéreas em nosso banco de dados institucional. Registros médicos incluindo dados demográficos, anotações diárias durante a hospitalização e anotações operacionais foram utilizados como dados clínicos dos pacientes. A estratégia para manter a patência das vias aéreas foi a traqueotomia (emergência ou em pacientes acordados) e redução do volume tumoral (por laser ou coblation). Tumores endofíticos e exofíticos da laringe também foram anotados. Resultados: Uma traqueotomia foi realizada como tratamento inicial em 41/87 (47,1%) pacientes (11 foram de emergência, 30 foram eletivas) para manter a patência das vias aéreas. A redução do volume tumoral foi realizada em 28 lesões exofíticas e 18 endofíticas por laser ou coblation (17 e 29 pacientes, respectivamente). A traqueotomia foi realizada em 5 pacientes (4 endofíticos, 1 exofítico) que não podiam tolerar a cirurgia de redução de volume devido à aspiração, edema e dispneia. Três deles que necessitaram de uma traqueotomia subsequente estavam no grupo de laser e dois no grupo coblation. A taxa de sucesso da redução tumoral foi de 82,35% (14/17) para o laser e 93,1% (27/29) para coblation. Conclusão: A redução do volume tumoral é um método seguro e eficaz para evitar a traqueotomia com paciente acordado, nos casos de obstrução das vias aéreas devido ao câncer de laringe avançado.


Subject(s)
Humans , Laryngeal Neoplasms/surgery , Laryngeal Neoplasms/complications , Airway Obstruction/surgery , Airway Obstruction/etiology , Tracheotomy , Tracheostomy , Retrospective Studies , Cytoreduction Surgical Procedures , Neoplasm Recurrence, Local
4.
Acta otorrinolaringol. cir. cabeza cuello ; 49(2): 112-120, 2021. TAB, ILUS, GRAF
Article in Spanish | LILACS | ID: biblio-1253865

ABSTRACT

Resumen Introducción: actualmente los profesionales de la salud se enfrentan al manejo de las vías aéreas artificiales en grupos pediátricos, esto requiere de cuidados delicados y mucha atención para detectar, establecer y manejar situaciones apremiantes; por esta razón, existe un mayor riesgo de aparición de infecciones bacterianas traqueopulmonares. El objetivo del estudio fue analizar la caracterización de las infecciones en pacientes pediátricos portadores de cánula de traqueotomía en las diferentes publicaciones científicas. Materiales y métodos: se realizó una revisión sistemática mediante la búsqueda de la literatura existente entre los años 2015-2020 en las bases de datos Elsevier, PubMed, Google Académico y SciELO, teniendo en cuenta los criterios de inclusión artículos en idioma inglés, español y población de edad entre los 0-15 años con infección de cánula de traqueotomía en los años 2015-2020. Resultados: de 258 artículos distribuidos en las bases de datos, se seleccionaron 21 artículos que cumplían con los criterios de inclusión. Conclusiones: a pesar de que en la actualidad existan criterios clínicos, factores de riesgo y pruebas de laboratorio asociados a infecciones de la cánula postraqueotomía en pacientes pediátricos, se requiere mayor investigación para definir las guías clínicas de manejo en la toma de decisiones médicas. Asimismo, se consideró como limitación importante la cantidad de literatura existente con respecto al tema.


Abstract Introduction: Currently, health professionals face the management of artificial airways in pediatric groups, this requires delicate care and a lot of attention to detect, establish and manage pressing situations, which is why there is a greater risk of tracheo-pulmonary bacterial infections. The objective was to analyze the characterization of infections in pediatric patients with tracheostomy tubes in the different scientific publications. Method: A systematic review of the literature was carried out between the years 2015-2020 in Elsevier, PubMed, Google Academic and SciELO databases, taking into account the inclusion criteria of the population aged 0-15 years in the years 2015-2020. The amount of existing literature on the subject was considered an important limitation. Results: From 258 articles distributed in the databases, 21 articles were selected that met the inclusion criteria. Conclusions: Although there are currently clinical criteria, risk factors and laboratory tests associated with infections of the post-tracheotomy tube in pediatric patients, further research is required to define clinical guidelines for management in medical decision-making.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Bacterial Infections/etiology , Tracheitis/microbiology , Tracheotomy/adverse effects , Bronchitis/microbiology , Cannula/adverse effects , Respiration, Artificial/adverse effects , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Tracheitis/diagnosis , Tracheitis/drug therapy , Bronchitis/diagnosis , Bronchitis/drug therapy
5.
Article in Spanish | LILACS, COLNAL | ID: biblio-1349482

ABSTRACT

Los progresos en la ciencia y la tecnología en el ámbito de la salud y, en concreto, en la unidad de cuidados intensivos (UCI) hospitalarios han incrementado la supervivencia en la población que demanda atención médica; no obstante, también han generado una población que requiere cuidados y manejos específicos, en su mayoría de manera multidisciplinaria, entre ellos, los pacientes que requieren de atención a traqueotomía. La necesidad de estandarizar el proceso de decanulación es una carencia no cubierta. En esta revisión narrativa exponemos algunos criterios, protocolos o guías vertidas por los autores consultados, sin que hasta el momento exista una guía estandarizada.


Progress in science and technology in the health field, and specifically in the hospital intensive care unit, has increased survival in the population that requires medical care; however, it has also generated a population that requires specific care and management, mostly in a multidisciplinary way, including patients who require attention to a tracheostomy. The need to standardize the decannulation process is an unmet deficiency. In this narrative review, we expose some criteria, protocols or guidelines issued by the authors consulted, so far there is no standardized guide.good surgical and clinical results in the vast majority of cases.


Subject(s)
Humans , Cannula , Tracheotomy
6.
Article in English | WPRIM | ID: wpr-812995

ABSTRACT

OBJECTIVES@#To investigate the effect of icariin (ICA) on early β-defensin-2 and T cell subsets in rats after tracheotomy.@*METHODS@#A total of 54 SPF male Sprague-Dawley rats were randomly divided into a normal control group (group A), a model group (group B), and a model+ICA treatment group (group C), with 18 rats in each group. A tracheotomy intubation model of the B and C group was prepared. After 6 h of surgery, ICA intervention was given to group C. Groups A and B were given the same amount of normal saline. Lung tissue, alveolar lavage fluid and peripheral blood were taken at 24 h, 72 h and 168 h, respectively. The expression of rat β-defensin-2 mRNA in lung tissue was detected by RT-PCR. The content of β-defensin-2 in alveolar lavage fluid and peripheral blood serum was detected by ELISA. The content of peripheral blood T cell subsets (CD3, CD4, CD8) was detected by flow cytometry, and the ratio of CD4/CD8 was calculated.@*RESULTS@#After tracheotomy, the levels of β-defensin-2 mRNA and β-defensin-2 in lung tissue from the group B were increased significantly at 24 h, then they were decreased gradually, and decreased most significantly at 168 h (0.05). The level of CD3 T cells in peripheral blood was significantly lower than that in the group A (0.05). After ICA intervention in group C: lung tissue, alveolar lavage fluid, peripheral blood serum β-defensin-2 content, and peripheral blood CD3 and CD4 T cell levels were gradually increased, significantly higher than those in the group B (<0.05). CD8 T cell level was significantly lower than that in the group A at 24 h (<0.05), the CD4/CD8 ratio was significantly higher at 168 h than those in the group A or B (both <0.01).@*CONCLUSIONS@#ICA can improve the early lung immune function in rats with tracheotomy, which might be related to up-regulation of β-defensin-2 in lung tissue and alveolar lavage fluid, concomitant with increases in CD3 and CD4 T cells and CD4/CD8 ratio in peripheral blood while reduction in CD8 cells.


Subject(s)
Animals , Flavonoids , Male , Rats , Rats, Sprague-Dawley , T-Lymphocyte Subsets , Tracheotomy , beta-Defensins
7.
Article in English | WPRIM | ID: wpr-876441

ABSTRACT

@#Objective: This study aims to investigate which, if any head and neck symptoms (trismus, dysphagia, alterations in speech or facial movements, and dyspnea) might be good predictors of outcomes (mortality, tracheostomy, discharged, decannulated) and prognosis of tetanus patients. Methods: Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Patients: Seventy-three (73) pediatric and adult patients diagnosed with tetanus and admitted at the emergency room of the Philippine General Hospital between January 1, 2013 and December 31, 2017. Demographic characteristics, incubation periods, periods of onset, routes of entry, head and neck symptoms, stage, and outcomes were retrieved from medical records and analyzed. Results: Of the 73 patients included, 53 (73%) were adults, while the remaining 20 (27%) were pediatric. The three most common head and neck symptoms were trismus (48; 66%), neck pain/ rigidity (35; 48%), and dysphagia to solids (31; 42%). Results of multivariate logistic regression analysis showed that only trismus (OR = 3.742, p = .015) and neck pain/ rigidity (OR = 4.135, p = .015) were significant predictors of decannulation. No dependent variable/symptoms had a significant effect in predicting discharge and mortality. Conclusion: Clinically diagnosed tetanus can be easily recognized and immediately treated. Most of the early complaints are head and neck symptoms that can help in early diagnosis and treatment resulting in better prognosis. In particular, trismus and neck pain/rigidity may predict the outcome of decannulation after early tracheotomy, but not of discharge and mortality.


Subject(s)
Tracheotomy , Tetanus , Trismus , Neck Pain , Muscle Rigidity
8.
Rev. Hosp. El Cruce ; (25): 28-34, Dic 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1047122

ABSTRACT

Paciente con secuela neurológica severa es dado de alta al domicilio, siendo dependiente total para AVD (Actividades de la Vida Diaria), traqueostomizado y sin posibilidad de comenzar con rehabilitación psicofísica por su contexto socioeconómico. OBJETIVO: El objetivo, es mostrar como la implementación de un programa vía Telemedicina, puede ser efectivo en pacientes seleccionados, cuando el contexto socioeconómico limita la posibilidad de continuar con su correspondiente rehabilitación. METODOLOGÍA: En consenso interdisciplinario, se creó un programa de seguimiento, evaluación y tratamiento vía Telemedicina, donde se programó un encuentro semanal, de manera virtual de 30-40 minutos durante 3 meses hasta cumplir el objetivo de decanular. RESULTADOS: Mediante este programa se logró capacitar e instruir a la familia para cuidado y el manejo domiciliario, y se logró el seguimiento sin eventos adversos. CONCLUSIONES: El programa de telekinesiología parece cumplir con el objetivo de acercar el hospital y la atención kinésica a pacientes seleccionados y a su familia, brindando una solución para la pronta rehabilitación.


Patient with a severe neurological sequela is discharged home, being totally dependent on DLA (Daily Life Activities), tracheostomized and unable to start with psychophysical rehabilitation due to its socioeconomic context. OBJECTIVE: The objective is to show how the implementation of a program via Telemedicine can be effective in selected patients, when patient´s recovery is limited due to its socioeconomic context. METHODS: By interdisciplinary consensus, a evaluation, monitorization and treatment program was created, and patient was followed-up via Telemedicine. We scheduled a virtual meeting weekly 30-40 min. for the time of 3 months to achieve the goal of decannulation. RESULTS: Through this program, the family was trained and instructed for home care and patient management, and follow-up was achieved without adverse events. CONCLUSIONS: The Telekinesiology program seems to accomplish the objective of bringing the hospital and physiotherapist care to selected patients and their family, providing a solution for prompt rehabilitation.


Subject(s)
Tracheotomy , Telemedicine , Kinesiology, Applied
9.
Article in Chinese | WPRIM | ID: wpr-772339

ABSTRACT

Currently, enhanced recovery after surgery (ERAS) has been widely accepted by surgery and anesthesiology all over the world, and applied in colorectal surgery, gynecology, liver surgery, breast surgery, urology and spinal surgery. But ERAS are rarely used in the field of interventional bronchoscopy. In recent years, more and more researchers have begun to explore the application of ERAS in bronchoscopic interventional therapy. This article discussed that preoperative preparation, anesthesia, intraoperative operation, postoperative observation and other aspects can influence interventional bronchoscopy.
.


Subject(s)
Anesthesia , Methods , Bronchoscopy , Methods , Humans , Length of Stay , Outcome Assessment, Health Care , Perioperative Care , Methods , Recovery of Function , Tracheal Neoplasms , General Surgery , Tracheotomy , Methods
10.
Article in English | WPRIM | ID: wpr-785600

ABSTRACT

Emergency physicians in the field are sometimes confronted with cases wherein patients cannot be intubated and ventilated. In some cases, cricothyrotomy, the method of choice for securing an emergency airway, may not have a successful outcome. We report a rare case of a 35-year-old male patient with avulsion of the larynx and a comminuted fracture of the jawbone, due to entrapment in a dung excavator. Prehospital tracheotomy was successfully performed. In cases with crush injuries to the larynx, anatomic structures, including the ligamentum conicum, are destroyed. In addition, massive subcutaneous emphysema blurs the anatomical key structures; hence, only a tracheotomy can prevent a lethal outcome.


Subject(s)
Adult , Emergencies , Emergency Medical Services , Fractures, Cartilage , Fractures, Comminuted , Humans , Larynx , Male , Methods , Subcutaneous Emphysema , Tracheotomy
11.
Anon.
Cuad. Hosp. Clín ; 59(1): 73-74, 2018. ilus
Article in Spanish | LILACS | ID: biblio-972867

ABSTRACT

OBJETIVO: Analizar las complicaciones a largo plazo de los pacientes críticos que requirieron traqueotomía percutánea (TP) con el método de dilatación con balón. DISEÑO: Estudio observacional, prospectivo, de cohorte. ÁMBITO: Dos unidades de cuidados intensivos (UCI) polivalentes. PACIENTES: Adultos ventilados mecánicamente ingresados en UCI con indicación de TP. INTERVENCIÓN: En todos los pacientes se realizó TP mediante Ciaglia Blue Dolphin® con guía endoscópica. Los pacientes decanulados vivos fueron evaluados clínicamente, así como mediante laringotraqueoscopia y tomografía axial computarizada cervical al cabo de al menos 6 meses tras la decanulación. VARIABLES: Complicaciones intraoperatorias, postoperatorias y tardías. Mortalidad intra-UCI y hospitalaria. RESULTADOS: Se incluyeron 114 pacientes. Las complicaciones intraoperatorias más frecuentes fueron la hemorragia leve (n=20) y la dificultad para insertar la cánula (n=19). Dos pacientes tuvieron complicaciones intraoperatorias graves (1,7 por ciento) (Hemorragia e imposibilidad de finalización de la técnica, en un caso, y falsa vía y desaturación, en otro). Todos los pacientes decanulados vivos (n=52) fueron revisados a los 221 ±28 días tras la decanulación. Ningún paciente presentaba síntomas. La tomografía axial computarizada y la laringotraqueoscopia mostraron estenosis traqueal severa (>50 por ciento) en 2 pacientes (3,7 por ciento), ambos con periodos de canulación superiores a 100 días. CONCLUSIONES: La TP usando la técnica Ciaglia Blue Dolphin® con guía endoscópica es un procedimiento seguro. La estenosis traqueal grave es una complicación tardía que, aunque infrecuente, debe ser tenida en cuenta por su falta de expresividad clínica. Debería considerarse la evaluación de aquellos pacientes críticos que han sido traqueotomizados y han permanecido canulados durante periodos prolongados de tiempo.


Subject(s)
Postoperative Complications , Tracheotomy
12.
Chinese Journal of Burns ; (6): 782-785, 2018.
Article in Chinese | WPRIM | ID: wpr-777672

ABSTRACT

Airway edema, stenosis, obstruction and even asphyxia are easy to occur in patients with extensive burn, deep burn of head, face, and neck area, inhalation injuries, etc., which threaten life. Timely tracheotomy and intubation is an important treatment measure, but lack of knowledge and improper handling in some hospitals resulted in airway obstruction. The technique of percutaneous tracheotomy and intubation provides convenience for emergency treatment of critical burns and mass burn. The Burn and Trauma Branch of Chinese Geriatrics Society organized some experts in China to discuss the indications, timing, methods, extubation, and precautions of tracheotomy and intubation for burn patients. The (2018 ) .


Subject(s)
Airway Obstruction , Burn Units , Burns , Therapeutics , China , Consensus , Humans , Intubation, Intratracheal , Methods , Practice Guidelines as Topic , Reference Standards , Smoke Inhalation Injury , Therapeutics , Tracheotomy , Methods
13.
Chinese Journal of Burns ; (6): E006-E006, 2018.
Article in Chinese | WPRIM | ID: wpr-773054

ABSTRACT

Airway edema, stenosis, obstruction and even asphyxia are easy to occur in patients with extensive burn, deep burn of head, face, and neck area, inhalation injuries, etc., which threaten life. Timely tracheotomy and intubation is an important treatment measure, but lack of knowledge and improper handling in some hospitals resulted in airway obstruction. The technique of percutaneous tracheotomy and intubation provides convenience for emergency treatment of critical burns and mass burn. The Chinese Geriatrics Society organized some experts in China to discuss the indications, timing, methods, extubation, and precautions of tracheotomy and intubation for burn patients. The (2018 ) .


Subject(s)
Airway Obstruction , Burns , Therapeutics , China , Consensus , Edema , Emergency Treatment , Female , Humans , Intubation , Neck , Practice Guidelines as Topic , Reference Standards , Reference Standards , Tracheotomy
14.
Article in Korean | WPRIM | ID: wpr-715127

ABSTRACT

The paper describes a minimally invasive tracheostomy technique that uses an intercartilaginous incision without resection of the tracheal cartilage and discusses its feasibility. A total of 20 adult cadavers (13 males and 7 females) were included in this study. The distance from the arch of the cricoid cartilage to the thyroid isthmus, maximal displacement of the thyroid isthmus, number of tracheal rings underneath the thyroid isthmus, and maximally opened distance resulting from an intercartilaginous incision were measured. The mean distance from the arch of the cricoid cartilage to the thyroid isthmus was 21.4±5.0 mm. The thyroid isthmus mainly overlaid the 3rd and 4th tracheal rings. The mean maximal displacement of the thyroid isthmus was 9.0±2.8 mm. Minimally invasive tracheostomy via an intercartilaginous incision is a feasible technique. A skin incision 2 cm below the cricoid cartilage enables exposure of the thyroid isthmus and anular ligament between the 2nd and 3rd tracheal rings. The intercartilaginous incision allows sufficient space for the tracheostomy tube. An intercartilaginous incision without resection of a tracheal ring can be a good alternative tracheostomy technique, especially for patients who require transient tracheostomy.


Subject(s)
Adult , Cadaver , Cartilage , Cricoid Cartilage , Humans , Ligaments , Male , Skin , Thyroid Gland , Tracheostomy , Tracheotomy
15.
Rev. otorrinolaringol. cir. cabeza cuello ; 77(3): 307-310, set. 2017. ilus
Article in Spanish | LILACS | ID: biblio-902781

ABSTRACT

Mujer de 68 años que ingresa en la Unidad de Cuidados Intensivos por shock séptico. En el posoperatorio la paciente se mantiene inestable y se decide realizar traqueotomía percutánea (TP) por intubación prolongada. Al inicio la paciente presenta un enfisema subcutáneo que progresa hasta convertirse en masivo. Se realiza TC torácico donde se observa pérdida de la morfología habitual de la pared posterior traqueal con solución de continuidad. Tras revisión mediante traqueobroncoscopía se decide colocar cánula de traqueotomía larga para dejar la lesión proximal al neumotaponamiento y así evitar la fuga de aire. Desde la colocación de la nueva cánula, la paciente presenta una disminución progresiva del enfisema hasta su total resolución. La TP es un procedimiento seguro que se realiza con mucha frecuencia en los servicios de medicina intensiva, sin embargo, no está exenta de complicaciones. En la revisión de Powell y cols describen las complicaciones de la TP destacando la inserción peritraqueal, la hemorragia, las infecciones de la herida, el neumotórax y la muerte. El rango de complicaciones en la literatura oscila entre 3% y 18%. Además, no se encuentran diferencias significativas respecto a las complicaciones entre la TP y la técnica abierta.


A 68-year-old woman who enter in intensive care unit due to septic shock. In the postoperative period, the patient remained unstable and decided to perform a percutaneous tracheotomy (PT) because prolonged intubation. In the first, the patient presents subcutaneous emphysema that progresses until becoming massive. Thoracic CT is performed where loss of the usual morphology of the posterior tracheal wall with continuity solution is observed. After revision by means of tracheobroncoscopia, it is decided to place a long tracheotomy cannula to leave the lesion proximal to pneumotaponamiento and thus avoid air leakage. From the placement of the new cannula, the patient presents a progressive decrease of the emphysema until its total resolution. PD is a safe procedure that is performed very frequently in the Intensive Care Services3, however, it is not without its complications. The review of Powell et al4 describes the complications of PT emphasizing peritracheal insertion, hemorrhage, wound infections, pneumothorax, and death. The range of complications in the literature ranges from 3 to 18% 5. In addition, no significant differences were found regarding the complications between the TP and the open technique.


Subject(s)
Humans , Female , Aged , Pneumothorax/etiology , Subcutaneous Emphysema/etiology , Tracheotomy/adverse effects , Mediastinal Emphysema/etiology , Tracheotomy/methods
16.
Article in English | WPRIM | ID: wpr-158119

ABSTRACT

Vocal polyps are benign laryngeal lesions which arise from the Reinke's space abd hoarseness is the most common symptom. However, airway compromised is rarely presented in the vocal polyp. A rare case of large subglottic polyp causing dyspnea is reported. Tracheostomy was performed under local anesthesia and then the mass was resected under general anesthesia using a laryngofissure approach. The dyspnea and hoarseness disappeared after surgery immediately. The histopathological findings indicated a diagnosis of vocal cord polyp with chronic inflammatiuon. We consider that tracheostomy is the safest and most useful procedure to guarantee the upper airway in cases of large vocal polyp showing dyspnea. We hereby report a case of huge subglottic polyp in which a tracheostomy and laryngofissure was required for removing the subglottic mass successfully.


Subject(s)
Anesthesia, General , Anesthesia, Local , Diagnosis , Dyspnea , Hoarseness , Polyps , Tracheostomy , Tracheotomy , Vocal Cords
17.
Article in English | WPRIM | ID: wpr-112852

ABSTRACT

OBJECTIVES: Bilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause life-threatening respiratory problems. The aim of this study was to reduce respiratory symptoms in BVFAP patients using cricothyroid (CT) botulinum toxin (BTX) injection. METHODS: Before and 2 weeks and 4 months after bilateral BTX injection into the CT muscles under electromyography; alterations in respiratory, acoustic, aerodynamic and quality of life parameters were evaluated in BVFAP patients with respiratory distress. For the respiratory evaluation modified Borg scale and spirometry, for the voice and aerodynamic evaluations Voice Handicap Index-30 (VHI-30), GRBAS, acoustic analysis (sound pressure level, F0, jitter%, shimmer%, noise-to-harmonic ratio) and maximum phonation time and for the quality of life assessment Short Form-36 (SF-36) form were used. RESULTS: All patients were female with a mean age of 47±8.1 years. There was a mean time of 11.8±5.5 (minimum 2, maximum 23) months between BVFAP development and BTX injection. In all cases, other than one case with unknown aetiology, the cause of vocal fold paralysis was prior thyroid surgery. In total 18.6±3.1 units of BTX were applied to the CTs. In the preinjection period, and the 2nd week and 4th month after injection, the Borg dyspnea scale was 7.3/5.3/5.0, FIV1 (forced inspiratory volume in one second) was 1.7/1.7/1.8 L, peak expiratory flow (PEF) was 1.4/1.7/2.1 L/sec, maximum phonation time was 7.0/6.4/6.2 seconds and VHI-30 was 63.2/52.2/61.7 respectively. There was no significant alteration in acoustic analysis parameters. Many of the patients reported transient dysphagia within the first week. There were insignificant increases in SF-36 sub-scale values. CONCLUSION: After BTX injection, improvements in the mean Borg score, PEF and FIV1 values and SF-36 sub-scale scores showed the restricted success of this approach. This modality may be kept in mind as a transient treatment option for patients refused persistent tracheotomy or ablative airway surgeries.


Subject(s)
Acoustics , Botulinum Toxins , Deglutition Disorders , Dyspnea , Electromyography , Female , Humans , Laryngeal Muscles , Muscles , Paralysis , Phonation , Quality of Life , Spirometry , Thyroid Gland , Tracheotomy , Vocal Cords , Voice
18.
Article in English | WPRIM | ID: wpr-41398

ABSTRACT

OBJECTIVES: Patients with bilateral vocal fold paralysis (BVFP) theoretically have difficulty producing voiceless consonants. However, perceptual studies have revealed clear production of voiceless consonants with good articulation scores in nontracheostomized patients. The purpose of this study was to clarify the production of voiceless stops during articulation in patients with BVFP compared to normal speakers. METHODS: The perceptual, acoustic, and aerodynamic characteristics of patients with BVFP and those with normal speech were investigated with special reference to voiceless stop consonants. Test words were prepared to place the stop consonants in different phonological environments, and were all nonsense words. RESULTS: The patients with BVFP perceptually produced the three types of stops successfully. However, they acoustically varied voice onset time to produce phonetically representative stops but decreased voice onset time of /ph/ and /p/ compared to those of normal speakers. These patients may properly control air pressure to produce the three types of stop consonants similar to normal speakers. CONCLUSION: The patients with BVFP realized the distinctions between the three types of stops similar to the normal speakers. Although vocal mobility was absent in the patients with BVFP, voice onset time, vowel duration, closure duration, and air pressure were similar to those of normal speakers.


Subject(s)
Acoustics , Air Pressure , Humans , Paralysis , Tracheotomy , Vocal Cords , Voice
19.
Article in Korean | WPRIM | ID: wpr-197573

ABSTRACT

For this study, medical students, intern physicians, and resident physicians, were surveyed about the application and effectiveness for medical procedure training using cadaver. In this survey, with a target population of 170 individuals, 105 individuals (61.7%) showed positive responses to learning medical procedural using cadaver. Resident physicians group (80.8%) showed relatively positive responses compared to 4(th) year medical students (58.1%) and intern physicians (47.6%); however, this did not account for any significant statistical difference. Regarding the application of cadaver to medical procedural practices, 95 individuals (62.1%) showed positive responses. Resident physicians (74.5%) had the highest percentage of positive responses compared to intern physicians (56.7%) and 4(th) year medical students (56.6%), and there was a significant statistical difference. Suture (15.7%) was ranked first as the most suitable medical procedural to be practiced on cadaver; tracheotomy and intubation came second and third respectively. This research confirmed the application and the effectiveness of cadaver for medical procedural training and the improvement of general medical procedural ability are expected if the cadaver is applied not only to medical schools but also to intern and resident physician training.


Subject(s)
Cadaver , Education, Medical , Health Services Needs and Demand , Humans , Intubation , Learning , Schools, Medical , Students, Medical , Sutures , Tracheotomy
20.
Article in English | WPRIM | ID: wpr-49268

ABSTRACT

OBJECTIVE: To report successful cases of extubation from invasive mechanical ventilation at our institution using pulmonary rehabilitation consisting of noninvasive ventilation (NIV) in neuromuscular patients with experience of reintubation. METHODS: Patients who experienced extubation failure via the conventional weaning strategy but afterwards had extubation success via NIV were studied retrospectively. Continuous end-tidal CO₂ (ETCO₂) and pulse oxyhemoglobin saturation (SpO₂) monitoring were performed. Extubation success was defined as a state not requiring invasive mechanical ventilation via endotracheal tube or tracheotomy during a period of at least 5 days. RESULTS: A total of 18 patients with ventilatory failure who initially experienced extubation failure were finally placed under part-time NIV after extubation. No patient had any serious or long-term adverse effect from NIV, and all patients left the hospital alive. CONCLUSION: NIV may promote successful weaning in neuromuscular patients with experience of reintubation.


Subject(s)
Humans , Neuromuscular Diseases , Noninvasive Ventilation , Oxyhemoglobins , Rehabilitation , Respiration, Artificial , Retrospective Studies , Tracheotomy , Weaning
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