ABSTRACT
Tracheotomy is one of the oldest interventions in medical sciences. It is a procedure that is frequently used in patients who have been admitted to the intensive care unit. Over the last twenty years, the use of the dilation technique has increased in frequency. We believe that the timing of a tracheostoma placement should be evaluated individually for every patient and should always be weighed against the potential risks of an operative intervention. This is illustrated with case reports of four patients with respiratory problems; in the case of one of these patients, the decision was made not to perform tracheotomy, which nonetheless resulted in a favourable clinical outcome.
Subject(s)
Clinical Decision-Making , Dilatation/methods , Intensive Care Units , Tracheotomy , Adolescent , Adult , Aged , Female , Hospitalization , Humans , Learning , Male , Retrospective Studies , Treatment OutcomeSubject(s)
Analgesia, Epidural/adverse effects , Antihypertensive Agents/adverse effects , Carcinoma/surgery , Hypotension/chemically induced , Liver Neoplasms/surgery , Aged , Analgesia, Epidural/methods , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Anesthetics, Local/administration & dosage , Anesthetics, Local/adverse effects , Antihypertensive Agents/therapeutic use , Bupivacaine/administration & dosage , Bupivacaine/adverse effects , Carcinoma/secondary , Cardiotonic Agents/administration & dosage , Dobutamine/administration & dosage , Enalapril/adverse effects , Enalapril/therapeutic use , Female , Humans , Hypertension/complications , Hypertension/drug therapy , Hypotension/drug therapy , Liver Neoplasms/secondary , Metoprolol/adverse effects , Metoprolol/therapeutic use , Morphine/administration & dosage , Morphine/adverse effects , Naloxone/administration & dosage , Narcotic Antagonists/administration & dosage , Norepinephrine/administration & dosage , Thoracic Vertebrae , Time Factors , Vasoconstrictor Agents/administration & dosageABSTRACT
In a randomised crossover trial, we compared a wire-guided cricothyrotomy technique (Minitrach) with a catheter-over-needle technique (Quicktrach). Performance time, ease of method, accuracy in placement and complication rate were compared. Ten anaesthesiology and 10 ENT residents performed cricothyrotomies with both techniques on prepared pig larynxes. The catheter-over-needle technique was faster than the wire-guided (48 compared to 150 s, p < 0.001) and subjectively easier to perform (VAS-score 2.1 vs. 5.6, p < 0.001). Correct positioning of the cannula could be achieved in 95% and 85%, respectively (NS). There was one complication in the catheter-over-needle group compared to five in the wire-guided group. We conclude that the wire-guided minitracheotomy kit is unsuitable for emergency cricothyrotomies performed by inexperienced practitioners. On the other hand, the catheter-over-needle technique appears to be quick, safe and reliable.
Subject(s)
Cricoid Cartilage/surgery , Thyroid Cartilage/surgery , Tracheotomy/methods , Animals , Clinical Competence , Cross-Over Studies , Emergencies , Swine , Time Factors , Tracheotomy/adverse effects , Tracheotomy/instrumentationSubject(s)
Borrelia Infections/complications , Borrelia burgdorferi , Encephalomyelitis, Acute Disseminated/complications , Borrelia Infections/cerebrospinal fluid , Borrelia Infections/diagnosis , Brain/microbiology , Brain/pathology , DNA, Bacterial/analysis , Encephalomyelitis, Acute Disseminated/cerebrospinal fluid , Encephalomyelitis, Acute Disseminated/diagnosis , Encephalomyelitis, Acute Disseminated/microbiology , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Postmortem Changes , RNA, Messenger/biosynthesis , Reverse Transcriptase Polymerase Chain Reaction/methods , Time FactorsABSTRACT
We assessed the peri-operative, early and late complications in 100 percutaneous tracheostomies performed with the Blue Rhino trade mark kit. The success rate was 98%. Peri-operative complications occurred in 30 patients. Six major complications occurred; these included bleeding which required surgical exploration (n = 3), and pneumothoraces (n = 2) and one false passage. Cannula insertion was made easier by blunt dissection of the cervical tissues anterior to the trachea. The median duration of the procedure was 8.5 min, which is significantly longer than other authors' results. Only one major complication occurred while the patient was cannulated (serious bleeding requiring exploration). Finally, in a single patient a tracheal stenosis occurred as a major late complication which eventually was treated by a successful tracheal resection. Percutaneous tracheostomy with the Blue Rhino trade mark kit is safe with a low incidence of major complications.
Subject(s)
Dilatation/methods , Tracheostomy/methods , Adolescent , Adult , Aged , Aged, 80 and over , Blood Loss, Surgical , Critical Care/methods , Dilatation/adverse effects , Dilatation/instrumentation , Female , Humans , Male , Middle Aged , Tracheostomy/adverse effects , Tracheostomy/instrumentationSubject(s)
Tracheostomy/methods , Adult , Dilatation/methods , Female , Humans , Male , Middle Aged , Rotation , Trachea/injuriesSubject(s)
Atrial Flutter/therapy , Critical Care , Electric Countershock , Prone Position , Humans , Male , Middle Aged , Pulmonary Gas ExchangeABSTRACT
BACKGROUND: Prospective evaluation of the percutaneous tracheostomy by the guide wire dilating forceps (GWDF) technique. METHODS: In 50 selected patients percutaneous tracheostomy with fiberscopic control was performed and evaluated. RESULTS: Most percutaneous tracheostomies were performed without any adverse effect. No life-threatening complications or deaths were related to the procedure. The procedure was successful in 49 of 50 patients (98%). In 1 patient the procedure was converted to an open tracheostomy because significant bleeding occurred. Five perioperative complications, including this significant bleeding and four minor complications, occurred in 50 patients (10%). Early complications occurred in 6 of 48 patients (13%), including one significant bleeding and five minor complications. A subglottic stenosis occurred in 2 of 36 successfully decannulated patients (6%). In one case this was certainly due to prolonged endotracheal intubation. CONCLUSIONS: The GWDF technique is a safe and efficient bedside alternative to open tracheostomy. Fiberscopic control is recommended to increase the safety of the procedure. Although studies of late complications are necessary, it appears to be justifiable to consider percutaneous tracheostomy for patients who require tracheostomy.