Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 9.506
Filter
Add filters

Year range
1.
BMJ Open ; 13(1): e065698, 2023 Jan 31.
Article in English | MEDLINE | ID: mdl-36720577

ABSTRACT

OBJECTIVES: To explore the experience of caring for children with tracheostomies from the perspectives of parents and health professional caregivers. DESIGN: Qualitative semistructured interview study. SETTING: One region in England covered by a tertiary care centre that includes urban and remote rural areas and has a high level of deprivation. PARTICIPANTS: A purposive sample of health professionals and parents who care for children who have, or have had, tracheostomies and who received care at the tertiary care centre. INTERVENTION: Interviews undertaken by telephone or video link. PRIMARY AND SECONDARY OUTCOME MEASURES: Qualitative reflexive thematic analysis with QSR Nvivo 12. RESULTS: This paper outlines key determinants and mediators of the experiences of caregiving and the impact on psychological and physical health and quality of life of parents and their families, confidence of healthcare providers and perceived quality of care. For parents, access to care packages and respite care at home as well as communication and relationships with healthcare providers are key mediators of their experience of caregiving, whereas for health professionals, an essential influence is multidisciplinary team working and support. We also highlight a range of challenges focused on the shared care space, including: a lack of standardisation in access to different support teams, care packages and respite care, irregular training and updates, and differences in health provider expertise and experiences across departments and shift patterns, exacerbated in some settings by limited contact with children with tracheostomies. CONCLUSIONS: Understanding the experiences of caregiving can help inform measures to support caregivers and improve quality standards. Our findings suggest there is a need to facilitate further standardisation of care and support available for parent caregivers and that this may be transferable to other regions. Potential solutions to be explored could include the development of a paediatric tracheostomy service specification, increasing use of paediatric tracheostomy specialist nurse roles, and addressing the emotional and psychological support needs of caregivers.


Subject(s)
Quality of Life , Tracheostomy , Humans , Child , Health Personnel , Parents , Qualitative Research
2.
Med J Malaysia ; 78(1): 35-38, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36715189

ABSTRACT

INTRODUCTION: The COVID-19 pandemic is unprecedented. Amongst those who contracted COVID-19, a number required intubation and prolonged ventilation. This increased the number of ventilated patients in the hospital and increased the requirement for tracheostomy of severe COVID-19 patients. Our objective is to study the outcome of patients with COVID-19 who underwent tracheostomy. MATERIALS AND METHODS: This study is a novel retrospective study in a tertiary centre in Malaysia. Case notes of COVID- 19 patients who underwent tracheostomy in Hospital Ampang were collected using the electronic Hospital Information System. Data were analysed using the SPSS system. RESULTS: From a total of 30 patients, 15 patients survived. All patients underwent either open or percutaneous tracheostomy. The median age is 53 (range: 28-69) with a significant p-value of 0.02. Amongst comorbidities, it was noted that diabetes mellitus was significant with a p-value of 0.014. The median time from the onset of COVID-19 to tracheostomy is 30 days. The median duration of intensive care unit (ICU) stay is 30.5 days, with the median duration of hospital length of stay of 44 days (p = 0.009 and <0.001, respectively). No complications that contributed to patient death were found. Survivors had a median of 29.5 days from tracheostomy to oxygen liberation. CONCLUSION: Tracheostomy in COVID-19 patients that requires prolonged ventilation is unavoidable. It is a safe procedure and mortality is not related to the procedure. Mortality is primarily associated with COVID-19.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Respiration, Artificial , Retrospective Studies , Tracheostomy/methods , Tertiary Care Centers , Pandemics
3.
Medicine (Baltimore) ; 102(3): e31630, 2023 Jan 20.
Article in English | MEDLINE | ID: mdl-36701710

ABSTRACT

RATIONALE: Polyhydramnios may develop when the fetus cannot swallow amniotic fluid or the amount of fetal urine increases. Occasionally, unpredictable fetal abnormalities can be diagnosed postnatally. Bilateral vocal cord paralysis in the fetus may cause polyhydramnios, which could be related to impaired prenatal swallowing. PATIENT CONCERN: A 36-year-old multipara underwent an emergent cesarean section because of polyhydramnios and active labor at 35 + 5 weeks of gestation and gave birth to a girl. DIAGNOSIS: The neonate cried feebly and exhibited cyanosis as well as very weak response to stimuli. Chest retraction and stridor were observed. Laryngoscopic examination revealed no movement in both the vocal cords, and bilateral vocal cord paralysis was diagnosed. INTERVENTIONS: When the baby was 40 days old, she underwent tracheostomy to alleviate the persistent stridor and oral feeding difficulties. OUTCOMES: She was discharged at the age of 60 days while in the tracheostomy state. LESSONS: Securing the airway of neonates with bilateral vocal cord paralysis, tracheoesophageal fistula, or muscular dystrophy, which can be detected after delivery in pregnant women with idiopathic polyhydramnios, is important. Therefore, pregnant women with idiopathic polyhydramnios must be attended to by experts, such as neonatologists, anesthesiologists, or otolaryngologists, who can secure the airway.


Subject(s)
Polyhydramnios , Vocal Cord Paralysis , Adult , Female , Humans , Infant , Infant, Newborn , Pregnancy , Cesarean Section , Polyhydramnios/diagnosis , Polyhydramnios/therapy , Respiratory Sounds , Vocal Cord Paralysis/complications , Vocal Cord Paralysis/congenital , Vocal Cord Paralysis/surgery , Tracheostomy
4.
Turk Kardiyol Dern Ars ; 51(1): 72-75, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36689292

ABSTRACT

The presence of ST-segment elevation on the electrocardiogram alerts physicians in patients with chest pain. Emergency coronary angiography is usually performed in these patients. However, there are many conditions that cause ST-segment elevation on the electrocardiogram, such as pericarditis, hyperkalemia, Brugada syndrome, hypothermia, and early repolarization. Pneumothorax is a rare complication of tracheostomy and its symptoms are sudden chest pain and dyspnea. Also, it has been known that pneumothorax may cause ST-segment changes on the electrocardiogram. We presented a transient inferolateral ST-segment elevation on the electrocardiogram due to an iatrogenic left-sided pneumothorax after an urgent tracheostomy in a patient with metastatic hypopharynx cancer and normal coronary angiogram.


Subject(s)
Neoplasms , Pneumothorax , Humans , Hypopharynx , Tracheostomy/adverse effects , Chest Pain/etiology , Electrocardiography
5.
Nursing (Ed. brasileira. Online) ; 25(295): 9179-9190, dez. 2022.
Article in English, Portuguese | LILACS (Americas), BDENF | ID: biblio-1412692

ABSTRACT

Objetivo: refletir as necessidades básicas de saúde ao paciente com traqueostomia por câncer de cabeça e pescoço no contexto da pandemia pelo coronavírus, utilizando a Teoria das Necessidades Básicas. Método: estudo teórico-reflexivo. Foram utilizados documentos do Ministério da Saúde e da Organização Pan-Americana de Saúde, assim como uma revisão da literatura na base de dados da PUBMED para que a literatura científica associasse com os documentos consultados. Resultados: as necessidades básicas de saúde afetadas foram: Psicobiológicas de oxigenação e ambiente; Psicossociais de segurança e comunicação e Psicoespirituais de religião, seguidas dos enunciados das Intervenções de Enfermagem (NIC) como oxigenoterapia, aumento da segurança do paciente, estímulo a rituais religiosos. Conclusão: a construção do saber científico na Enfermagem torna-se imperioso, para que as necessidades de saúde afetadas ao paciente com traqueostomia na pandemia da COVID-19 sejam atendidas, para promoção da saúde e da vida.(AU)


Objective: to reflect the basic health needs of patients with tracheostomy for head and neck cancer in the context of the coronavirus pandemic, using the Theory of Basic Needs. Method: This is a reflective study, carried out through a critical reading of official documents from national and international health agencies and other conceptual sources on the subject.Results: the basic health needs affected were: Psychobiological oxygenation and environment; Psychosocial security; communication and health education and Psychospirituals of religion, followed by nursing interventions of NIC activities, oxygen therapy, environmental control, increased safety, improved communication in speech deficits; encouraging religious rituals and facilitating an efficient decision-making process. Conclusion: the construction of scientific knowledge in Nursing becomes imperative, so that the health needs affected by the patient with tracheostomy in the COVID-19 Pandemic are met, to promote health and life.(AU)


Objetivo: reflejar las necesidades básicas de salud de los pacientes traqueostomizados por cáncer de cabeza y cuello en el contexto de la pandemia del coronavirus, utilizando la Teoría de las Necesidades Básicas. Método: Se trata de un estudio reflexivo, realizado a través de una lectura crítica de documentos oficiales de organismos de salud nacionales e internacionales y otras fuentes conceptuales sobre el tema. Resultados: las necesidades básicas de salud afectadas fueron: Oxigenación psicobiológica y medio ambiente; seguridad psicosocial; comunicación y educación para la salud y Psicoespirituales de la religión, seguidas de las intervenciones de enfermería de las actividades NIC, oxigenoterapia, control ambiental, aumento de la seguridad, mejora de la comunicación en los déficits del habla; fomentar los rituales religiosos y facilitar un proceso eficiente de toma de decisiones. Conclusión: la construcción del conocimiento científico en Enfermería se torna imperativa, para que sean atendidas las necesidades de salud afectadas por el paciente con traqueotomía en la Pandemia del COVID-19, para promover la salud y la vida.(AU)


Subject(s)
Patients , Tracheostomy , Needs Assessment , Pandemics , Standardized Nursing Terminology
7.
Crit Care Med ; 51(2): 310-318, 2023 02 01.
Article in English | MEDLINE | ID: mdl-36661455

ABSTRACT

OBJECTIVE: The optimal timing of tracheostomy in nonneurologically injured mechanically ventilated critically ill adult patients is uncertain. We conducted a systematic review of randomized controlled trials to evaluate the effect of early versus late tracheostomy or prolonged intubation in this population. DATA SOURCES: We searched MEDLINE, Embase, CENTRAL, CINAHL, and Web of science databases for randomized controlled trials comparing early tracheostomy (<10 d of intubation) with late tracheostomy or prolonged intubation in adults. DATA SELECTION: We selected trials comparing early tracheostomy (defined as being performed less than 10 d after intubation) with late tracheostomy (performed on or after the 10th day of intubation) or prolonged intubation and no tracheostomy in nonneurologically injured patients. The primary outcome was overall mortality. Secondary outcomes included ventilator-associated pneumonia, duration of mechanical ventilation, ICU, and hospital length of stay. DATA EXTRACTION: Two reviewers screened citations, extracted data, assessed the risk of bias, and classification of Grading of Recommendations, Assessment, Development, and Evaluation independently. DATA SYNTHESIS: Our search strategy yielded 8,275 citations, from which nine trials (n = 2,457) were included. We did not observe an effect on the overall mortality of early tracheostomy compared with late tracheostomy or prolonged intubation (risk ratio, 0.91, 95% CI, 0.82-1.01; I2 = 18%). Our results were consistent in all subgroup analyses. No differences were observed in ICU and hospital length of stay, duration of mechanical ventilation, incidence of ventilator-acquired pneumonia, and complications. Our trial sequential analysis showed that our primary analysis on mortality was likely underpowered. CONCLUSION: In our systematic review, we observed that early tracheostomy, as compared with late tracheostomy or prolonged intubation, was not associated with a reduction in overall mortality. However, we cannot exclude a clinically relevant reduction in mortality considering the level of certainty of the evidence. A well-designed trial is needed to answer this important clinical question.


Subject(s)
Pneumonia, Ventilator-Associated , Respiration, Artificial , Humans , Adult , Length of Stay , Pneumonia, Ventilator-Associated/epidemiology , Pneumonia, Ventilator-Associated/etiology , Tracheostomy/methods , Critical Illness/therapy
8.
Otolaryngol Pol ; 76(5): 1-13, 2022 Jun 22.
Article in English | MEDLINE | ID: mdl-36622125

ABSTRACT

<b>Introduction:</b> In hospitalized patients, tracheostomy tubes (TTs) are susceptible to colonization by biofilm- producing potentially pathogenic microorganisms (PPMs). Contact with TTs, which are situated in a critical region of the body with enormous microbial exposure, may lead to the emer-gence of resistant respiratory infections.</br></br> <b>Objective:</b> Our study aimed to isolate and identify Gram-positive and Gram-negative PPMs, mark their antibiotic resistance and determine the bacteriological pattern of the biofilm colonizing the TTs. </br></br> <b>Methods:</b> The study was conducted on 45 tracheostomy tubes obtained from 45 hospitalized adult patients with tracheostomy with intubation periods ranging from 1 to 28 days. Tracheal aspirates (TA) obtained from polyvinyl chloride (PVC) TTs were used for the analysis. Bacteria in biofilms were identified by standard microbiological techniques, tested for antibiotic resistance and phenotypic resistance according to the EUCAST guidelines and visualized by SEM.</br></br> <b>Results:</b> Out of 45 TTs, 100% were found to be positive in bacterial cultures with 58 PPM isolates (10 spe-cies) correlating well with the SEM findings. Overall, 72% of isolates were Gram-negative bacilli, followed by Gram-positive cocci (28%). Staphylococcus aureus was the predominant bacterium (identified in 35.5% of patients), followed by Klebsiella pneumoniae (identified in 23.8%). Among the Gram-negative PPMs, 50% of isolates were identified as multidrug-resistant (MDR), 8.6% as extremely drug-resistant (XDR) and 5.2% were pandrug-resistant (PDR).</br></br><b>Conclusions:</b> Our study showed a rapid colonization of the TT surface by biofilm- producing PPMs. Patients with tracheosto- mies, also those with non-infectious conditions, were mainly colonized with highly re-sistant bacteria.


Subject(s)
Gram-Negative Bacteria , Tracheostomy , Adult , Humans , Staphylococcus aureus , Drug Resistance, Multiple, Bacterial , Biofilms
9.
Med J (Ft Sam Houst Tex) ; (Per 23-1/2/3): 70-73, 2023.
Article in English | MEDLINE | ID: mdl-36607301

ABSTRACT

BACKGROUND: Prehospital surgical cricothyrotomies and complications from placement are an important and under-evaluated topic for both the military and civilian prehospital populations. This study uses the Department of Defense Trauma Registry to identify complications and the incidence of complications in prehospital combat surgical cricothyrotomies. METHODS: A secondary analysis of previously described prehospital-based dataset from the Department of Defense Trauma Registry (DODTR) was performed. Casualties who had a prehospital cricothyrotomy performed were isolated and assessed for documented airway injuries and surgical procedures after hospital admission. RESULTS: There were 25,8976 casualties in the original dataset, of which 251 met inclusion for this analysis. The median age was 25 and most (98%) were male. Explosives were most frequent (55%) followed by firearm (33%) mechanisms. Most were host nation partner forces (35%) and humanitarian (32%) casualties. The median injury severity score was 24. The most frequent seriously injured body region was the head/neck (61%). Most (61%) were discharged alive. Within the 251, 14% had a complication noted, most commonly requiring tracheostomy revision (5%). CONCLUSIONS: Cricothyrotomies are rarely performed, but when they are performed and the casualty survives long enough to reach a military treatment facility with surgical capabilities, the incidence of near-term and long-term complications is high. A better understanding of outcomes associated with this procedure will enable more targeted training and technology development.


Subject(s)
Emergency Medical Services , Military Personnel , Male , Humans , Adult , Female , Emergency Medical Services/methods , Airway Management/methods , Tracheostomy/adverse effects , Hospitalization
11.
Br J Oral Maxillofac Surg ; 61(1): 101-106, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36586735

ABSTRACT

The purpose of this study was to determine the relationship of early and delayed tracheostomy decannulation protocols on the length of stay, time to oral feeding and incidence of postoperative complications in patients undergoing microvascular reconstruction for oral cancer. A review of all patients who underwent surgical management of oral squamous cell carcinoma (OSCC) over the study period from 01/07/2017 to 31/06/2021 was performed. Patients who underwent elective tracheostomy as part of their microvascular reconstruction were included. Two cohorts were identified based on distinct postoperative tracheostomy decannulation protocols; early (Within 7 days) and delayed (≥7 days). Time to oral feeding, length of stay and complication rates was determined for both groups for statistical analysis. A total of 103 patients with OSCC were included in the study. The overall complication rate was 35.9% and were more likely in node positive patients (53.7% vs 23.2%; p = 0.003) and in cases where the geniohyoid muscle complex was disrupted during tumour resection (66.7% vs 31.9%; p = 0.026). Early decannulation was significantly associated with shorter length of hospital stay (10 days vs 15 days) and earlier removal of nasogastric feeding tubes (7 vs 10 days). There was no difference in the overall complication rate between the two groups (33.3% vs 37.5%; p = 0.833). Early decannulation in appropriately selected patients is recommended as it significantly reduces the length of hospital stay and aids in early resumption of oral intake. Furthermore, this approach is not associated with increased rates of complications.


Subject(s)
Carcinoma, Squamous Cell , Mouth Neoplasms , Humans , Carcinoma, Squamous Cell/surgery , Length of Stay , Mouth Neoplasms/surgery , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Retrospective Studies , Tracheostomy/methods
13.
Med J (Ft Sam Houst Tex) ; (Per 23-1/2/3): 70-73, 2023.
Article in English | MEDLINE | ID: mdl-36580527

ABSTRACT

BACKGROUND: Prehospital surgical cricothyrotomies and complications from placement are an important and under-evaluated topic for both the military and civilian prehospital populations. This study uses the Department of Defense Trauma Registry to identify complications and the incidence of complications in prehospital combat surgical cricothyrotomies. METHODS: A secondary analysis of previously described prehospital-based dataset from the Department of Defense Trauma Registry (DODTR) was performed. Casualties who had a prehospital cricothyrotomy performed were isolated and assessed for documented airway injuries and surgical procedures after hospital admission. RESULTS: There were 25,8976 casualties in the original dataset, of which 251 met inclusion for this analysis. The median age was 25 and most (98%) were male. Explosives were most frequent (55%) followed by firearm (33%) mechanisms. Most were host nation partner forces (35%) and humanitarian (32%) casualties. The median injury severity score was 24. The most frequent seriously injured body region was the head/neck (61%). Most (61%) were discharged alive. Within the 251, 14% had a complication noted, most commonly requiring tracheostomy revision (5%). CONCLUSIONS: Cricothyrotomies are rarely performed, but when they are performed and the casualty survives long enough to reach a military treatment facility with surgical capabilities, the incidence of near-term and long-term complications is high. A better understanding of outcomes associated with this procedure will enable more targeted training and technology development.


Subject(s)
Emergency Medical Services , Military Personnel , Male , Humans , Adult , Female , Emergency Medical Services/methods , Airway Management/methods , Tracheostomy/adverse effects , Hospitalization
14.
Int J Pediatr Otorhinolaryngol ; 164: 111427, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36577200

ABSTRACT

BACKGROUND: Up to half of all children who have a tracheostomy will develop a persistent tracheo-cutaneous fistula (TCF) after decannulation. Surgical closure of the TCF is technically easy but post-operative complications can be immediate and life-threatening. These include air leak from the tracheal repair leading to massive surgical emphysema or pneumothorax. We reviewed our experience of TCF closure to try to identify potential risk factors for complications. METHOD: Retrospective case record review of all children (0-16 years) who underwent surgical TCF closure between January 2010 and December 2021 following development of a persistent TCF after decannulation of a tracheostomy. RESULTS: We identified 67 children. They ranged in age from 14 months to 16 years (median 3 years 10 months) at the time of the TCF closure. Major medical comorbidities were present in 90%. Pre-operative pulse oximetry with the fistula occluded was used in 29 children (43%). An underwater leak test was performed in 28 (42%). A non-suction drain was used in 29 children (43%). Prophylactic antibiotics were prescribed for 30 children (45%). Post-operative complications occurred in 15 children (22%). Life-threatening air leak occurred in the immediate post-operative period in 2 children (3%). Respiratory distress occurred in 3 children (4%) in the recovery area immediately after surgery. None required re-tracheostomy. Three children suffered post-operative pneumonia (4%), and wound infections occurred in 8 children (12%). We were unable to show a significant association between patient or surgical factors and complications. DISCUSSION: Complications for TCF closure are unfortunately common and it is unclear from the available evidence how best to prevent them. Further research is required.


Subject(s)
Cutaneous Fistula , Respiratory Tract Fistula , Tracheal Diseases , Child , Humans , Tracheostomy/adverse effects , Retrospective Studies , Tracheal Diseases/etiology , Tracheal Diseases/surgery , Respiratory Tract Fistula/surgery , Respiratory Tract Fistula/complications , Trachea , Cutaneous Fistula/surgery , Cutaneous Fistula/complications , Postoperative Complications/surgery , Postoperative Complications/etiology
15.
Medicina (B Aires) ; 82(6): 836-844, 2022.
Article in Spanish | MEDLINE | ID: mdl-36571521

ABSTRACT

INTRODUCTION: Tracheostomy (TCT) is the most frequently performed surgical procedure among COVID-19 patients. In Argentina, survival and decannulation rates are unknown. The main objectives of this study were to evaluate mortality and decannulation rates after 90 days of the percutaneous TCT performance. Secondarily, airway injury rate, days on invasive mechanical ventilation (IMV) and days of hospitalization in the intensive care unit (ICU) were also evaluated. METHODS: This observational analytic prospective cohort study included patients over 18 years old with SARS-CoV-2 who were admitted into the ICU requiring IMV and percutaneous TCT in the period covering from 1 February 2021 to 31 July 2021. RESULTS: the mortality rate in 95 patients was 66.3%. Among the survivors, 67% were decannulated. The youngest patients were the ones who survived [mean 50.6 (SD 10.2) years versus mean 58.9 (SD 13.4) years; p = 0.001] and presented lower Charlson index scores [median 1 (IQR 0-2) versus 2 (1-3) points; p = 0.007]. Patients who were tracheostomized ten days before the start of IMV were fewer days on IMV and had a shorter stay in the ICU, p < 0.01 and p = 0.01, respectively. Charlson Index was identified as an independent factor of mortality for both decannulation mortality at 90 days. DISCUSSION: In our cohort of patients, those who were younger and presented less c omorbidities benefited from TCT. Charlson Index could be used as a prognostic marker among this patient population.


Introducción: La traqueostomía (TQT) es el procedimiento quirúrgico más frecuentemente realizado en pacientes COVID-19. La tasa de supervivencia y decanulación en Argentina se desconoce. El objetivo principal de este estudio fue evaluar la mortalidad y la tasa de decanulación al día 90 de realizada la TQT percutánea. Secundariamente se evaluó la tasa de lesión en la vía aérea, días de ventilación mecánica invasiva (VMI) y días de internación en unidad de cuidados intensivos (UCI). Métodos: Estudio observacional analítico de cohorte prospectiva que incluyó 95 pacientes mayores de 18 años infectados por SARS-CoV-2 ingresados de forma consecutiva a la UCI con requerimiento de VMI y TQT percutánea en el periodo comprendido entre 1 de febrero al 31 de julio del 2021. Resultados: La mortalidad fue del 66.3%. De los supervivientes se logró decanular al 67%. Los supervivientes fueron más jóvenes [media 50.6 (DE 10.2) años versus media 58.9 (DE 13.4) años; p = 0.001] y presentaron puntajes más bajos de índice de Charlson [mediana 1 (RIQ 0-2) versus 2 (1-3) puntos; p = 0.007]. Los pacientes TQT antes del día 10 desde el inicio de VMI tuvieron menos días de VMI y menor estadía en UCI, p < 0.01 y p = 0.01 respectivamente. El índice de Charlson se identificó como factor independiente de mortalidad a los 90 días y de decanulación a los 90 días. Discusión: En nuestra cohorte de pacientes fueron los más jóvenes y con menos comorbilidades los que se beneficiaron con la TQT. El índice de Charlson podría utilizarse como marcador pronóstico en esta población de pacientes.


Subject(s)
COVID-19 , Humans , Adolescent , Tracheostomy , Prospective Studies , Dilatation , SARS-CoV-2 , Respiration, Artificial , Intensive Care Units
16.
Int J Pediatr Otorhinolaryngol ; 164: 111408, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36549017

ABSTRACT

OBJECTIVE: Determine the efficacy of a team-based approach to reduce tracheostomy-related skin breakdown by creating a standardized intraoperative dressing and nursing wound care protocol. METHODS: Prospective data collection of pediatric tracheostomy outcomes before and after interventions consisting of intraoperative wound dressing and standardized nursing wound care bundles. RESULTS: Before intervention, the incidence of skin breakdown within the first-week post-tracheostomy was 52% (13/25). Among patients who received an intraoperative wound dressing and nursing wound care bundles, the incidence of skin breakdown was reduced to 6.1% (3/49). CONCLUSION: The adoption of intraoperative wound dressings and nursing wound care bundles has nearly eliminated the incidence of skin breakdown in the first week post-tracheostomy among patients 0-12 years of age.


Subject(s)
Pressure Ulcer , Tracheostomy , Wound Healing , Child , Humans , Bandages , Data Collection , Skin , Tracheostomy/adverse effects
17.
BMJ Case Rep ; 15(12)2022 Dec 21.
Article in English | MEDLINE | ID: mdl-36543367

ABSTRACT

A man in his 20s sustained complete tracheal transection after being injured by a sandbag pile falling on his neck. An oral endotracheal tube (ETT) was inserted by rapid sequence induction in view of respiratory distress. CT revealed that the ETT did not traverse the distal tracheal segment; however, there were rebreathing bag movements, and normal capnograph and oxygen saturation, which were misleading clinical findings. We describe the successful airway management in this challenging case.


Subject(s)
Intubation, Intratracheal , Trachea , Male , Humans , Trachea/diagnostic imaging , Trachea/surgery , Airway Management , Tracheostomy , Dyspnea
18.
BMC Pulm Med ; 22(1): 484, 2022 Dec 21.
Article in English | MEDLINE | ID: mdl-36539764

ABSTRACT

BACKGROUND: Tracheostomy tube capping is a commonly used test to determine if the tracheostomy tube can be removed. The success of the capping trial depends on the patient's ability to maintain sufficient spontaneous breathing with an occluded tracheostomy tube. The impact of an occluded tracheotomy tube on airway resistance is currently unknown. The aim of this study was to investigate tracheal pressure during capping or stoma button insertion and potential determinants concerning cuff. METHODS: Eight cuffed and uncuffed tracheostomy tubes and three stoma buttons of various manufacturers and sizes were inserted into the trachea model. Cuffs were completely deflated or contained atmospheric pressure. The trachea was ventilated bidirectional with a respirator in volume-controlled mode and volume flows 15-60 L/min. Tracheal pressure drop during inspiration as a parameter of pressure required to move gas through the airway was measured. RESULTS: Tracheal pressure drops occurred linearly or irregularly during capping trials to a maximum of 4.2 kPa at flow rates of 60 L/min for atmospheric pressure cuffs. In tracheostomy tubes with completely deflated cuffs, pressure drop in the trachea reaches a maximum of 3.4 kPa at a flow rate of 60 L/min. For tracheostomy tubes with cuff smaller inner or outer diameters do not regularly result in lower tracheal pressure drop. The pressure drop varies between different tracheostomy tubes depending on the manufacturer. In cuffed tracheostomy tubes, we observed three phenomena: sail-like positioning, folding over, and tightening of the cuff during flow. The maximum tracheal pressure drop during stoma button insertion reaches 0.014 kPa. CONCLUSIONS: The cuff is a central element for the pressure drop in the airway and thus airway resistance during spontaneous translaryngeal breathing with a capped TT. Complete deflation reduces the pressure drop in the trachea. Due to deformation of the cuff, measured pressures are irregular as the volume flow is increased. Incomplete deflated cuffs and material characteristics of tracheostomy tubes and cuffs in addition to anatomical and clinical variables may cause unsuccessful capping trials due to increased airway resistance. All stoma buttons showed that pressure drop and thus airway resistance due to stoma buttons has no clinical relevance.


Subject(s)
Trachea , Tracheostomy , Humans , Intubation, Intratracheal , Ventilators, Mechanical , Equipment Design
19.
Anesth Prog ; 69(4): 37-39, 2022 12 01.
Article in English | MEDLINE | ID: mdl-36534773

ABSTRACT

Prior to a scheduled operation for a 45-year-old male patient with tongue cancer, a tracheotomy performed under intravenous sedation to prevent asphyxia due to extensive bleeding resulted in pneumomediastinum and subcutaneous emphysema. The planned operations were postponed until reduction of the pneumomediastinum was confirmed. During operation, airway pressure was kept low to prevent tension pneumomediastinum along with a sufficient depth of anesthesia, controlled analgesia, and continuous administration of muscle relaxants. Postoperatively, sedation was used to avoid stress and complications with the vascular anastomosis site. In this case, air leakage into the soft tissues was one of the possible causes of the event associated with increased airway pressure. Although the incidence of such complications is relatively low, caution should be exercised after tracheostomy.


Subject(s)
Mediastinal Emphysema , Subcutaneous Emphysema , Tongue Neoplasms , Male , Humans , Middle Aged , Tracheostomy/adverse effects , Tongue Neoplasms/complications , Tongue Neoplasms/surgery , Subcutaneous Emphysema/complications , Subcutaneous Emphysema/surgery
20.
Int J Pediatr Otorhinolaryngol ; 164: 111414, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36527981

ABSTRACT

BACKGROUND: Traumatic brain injury (TBI) is a prevalent cause of disability and death in the pediatric population, often requiring prolonged mechanical ventilation. Patients with significant TBI or intracranial hemorrhage require advanced airway management to protect against aspiration, hypoxia, and hypercarbia, eventually necessitating tracheostomy. While tracheostomy is much less common in children compared to adults, its prevalence among pediatric populations has been steadily increasing. Although early tracheostomy has demonstrated improved outcomes in adult patients, optimal tracheostomy timing in the pediatric population with TBI remains to be definitively established. OBJECTIVE: This retrospective cohort analysis aims to evaluate pediatric TBI patients who undergo tracheostomy and to investigate the impact of tracheostomy timing on outcomes. DESIGN/METHODS: The Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID), collected between in 2016 and 2019, was queried using International Classification of Disease 10th edition (ICD10) codes for patients with traumatic brain injury who had received a tracheostomy. Baseline demographics, insurance status, and procedural day data were analyzed with univariate and multivariate regression analyses. Propensity score matching was performed to estimate the incidence of medical complications and mortality related to early versus late tracheostomy timing (as defined by median = 9 days). RESULTS: Of the 68,793 patients (mean age = 14, IQR 4-18) who suffered a TBI, 1,956 (2.8%) received a tracheostomy during their hospital stay. TBI patients who were tracheostomized were older (mean age = 16.5 vs 11.4 years), more likely to have injuries classified as severe TBIs and more likely to have accumulated more than one indicator of parenchymal injury as measured by the Composite Stroke Severity Scale (CSSS >1) than non-tracheostomized TBI patients. TBI patients with a tracheostomy were more likely to encounter serious complications such as sepsis, acute kidney injury (AKI), meningitis, or acute respiratory distress syndrome (ARDS). They were also more likely to necessitate an external ventricular drain (EVD) or decompressive hemicraniectomy (DHC) than TBI patients without a tracheostomy. Tracheostomy was also negatively associated with routine discharge. Procedural timing was assessed in 1,867 patients; older children (age >15 years) were more likely to undergo earlier placements (p < 0.001). Propensity score matching (PSM) comparing early versus late placement was completed by controlling for age, gender, and TBI severity. Those who were subjected to late tracheostomy (>9 days) were more likely to face complications such as AKI or deep vein thrombosis (DVT) as well as a host of respiratory conditions such as pulmonary embolism, aspiration pneumonitis, pneumonia, or ARDS. While the timing did not significantly impact mortality across the PSM cohorts, late tracheostomy was associated with increased length of stay (LOS) and ventilator dependence. CONCLUSIONS: Tracheostomy, while necessary for some patients who have sustained a TBI, is itself associated with several risks that should be assessed in context of each individual patient's overall condition. Additionally, the timing of the intervention may significantly impact the trajectory of the patient's recovery. Early intervention may reduce the incidence of serious complications as well as length of stay and dependence on a ventilator and facilitate a timelier recovery.


Subject(s)
Brain Injuries, Traumatic , Tracheostomy , Adult , Humans , Child , Adolescent , Tracheostomy/adverse effects , Retrospective Studies , Brain Injuries, Traumatic/surgery , Length of Stay , Respiration, Artificial
SELECTION OF CITATIONS
SEARCH DETAIL