La indicación de la traqueotomía condiciona las variables predictoras del tiempo hasta la decanulación en pacientes críticos / The indication of tracheotomy conditions the predictors of time to decannulation in critical patients

Objetivos: No se han podido desarrollar modelos predictores de tiempo de decanulación de pacientes traqueotomizados. El objetivo del estudio fue desarrollar variables asociadas al tiempo empleado en decanular a los pacientes, mediante la clasificación de los pacientes según la indicación de la traqueotomía (TRQ). Diseño: Estudio de cohortes prospectivo observacional. Ámbito: Dos UCI médico-quirúrgicas. Pacientes: Se incluyeron todos los pacientes traqueotomizados en UCI, excluyendo aquellos con órdenes de no resucitación, TRQ crónicas, enfermos neuromusculares o con daño cerebral. Fueron clasificados en 2 grupos: traqueotomizados por ventilación mecánica o destete prolongado (Grupo 1) y pacientes traqueotomizados por disminución del nivel de conciencia o incapacidad para manejar las secreciones respiratorias (Grupo 2). Intervenciones: Se empleó un protocolo de destete y decanulación. Variables de interés principales: Se recogieron entre otras las siguientes variables: tiempo hasta decanulación, capacidad vital y flujo espiratorio máximo, necesidades de aspiración, Glasgow (..) (AU)

Objective: Variables predicting optimal timing for tracheostomy decannulation remain unknown. We aimed to determine whether classifying patients into two groups according to their indications for tracheostomy could identify variables associated with time to decannulation. Design: A prospective, observational cohort study was carried out. Location: Two medical-surgical ICUs. Patients: We included all patients tracheostomized during ICU stay, excluding patients with do-not-resuscitate orders, tracheostomies for long-term airway control, neuromuscular disease, or neurological damage. Patients were classified into two groups: patients tracheostomized due to prolonged weaning and/or prolonged mechanical ventilation (Group 1), and patients tracheostomized due to low level of consciousness or inability to manage secretions (Group 2). Interventions: Patients were weaned and decannulated according to established protocols. Main variables: We recorded the following variables: time to tracheostomy, forced vital capacity, peak flow, suctioning requirements, Glasgow Coma Score (GCS), characteristics of respiratory secretions, and swallowing function. Statistical analyses included (..) (AU)

The indication of tracheotomy conditions the predictors of time to decannulation in critical patients.

OBJECTIVE: Variables predicting optimal timing for tracheostomy decannulation remain unknown. We aimed to determine whether classifying patients into two groups according to their indications for tracheostomy could identify variables associated with time to decannulation. DESIGN: A prospective, observational cohort study was carried out. LOCATION: Two medical-surgical ICUs. PATIENTS: We included all patients tracheostomized during ICU stay, excluding patients with do-not-resuscitate orders, tracheostomies for long-term airway control, neuromuscular disease, or neurological damage. Patients were classified into two groups: patients tracheostomized due to prolonged weaning and/or prolonged mechanical ventilation (Group 1), and patients tracheostomized due to low level of consciousness or inability to manage secretions (Group 2). INTERVENTIONS: Patients were weaned and decannulated according to established protocols. MAIN VARIABLES: We recorded the following variables: time to tracheostomy, forced vital capacity, peak flow, suctioning requirements, Glasgow Coma Score (GCS), characteristics of respiratory secretions, and swallowing function. Statistical analyses included Cox-proportional multivariate analysis with time to decannulation as the dependent variable. RESULTS: A total of 227 patients were tracheostomized in the ICUs; of these, 151 were finally included in the study. In the multivariate analysis, time to decannulation in Group 1 was associated with the male gender (HR 1.74 (1.04-2.89), p= 0.03), age>60 years (HR 0.58 (0.36-0.91), p= 0.02), high suctioning frequency (HR 0.81 (0.67-0.97), p= 0.02), low forced vital capacity (HR 0.48 (0.28-0.82), p<0.01), and low peak flow (HR 0.25 (0.14-0.46), p<0.01). In Group 2 time to decannulation was associated to GCS >13 (HR 2.73 (1.51-4.91), p<0.01), high suctioning frequency (HR 0.7 (0.54-0.91), p<0.01), and inadequate swallowing (HR 1.97 (1.11-3.52), p=0.02). CONCLUSION: Variables associated with longer time to decannulation in ICU-tracheostomized patients differ with the indications for tracheostomy.

[Achondroplasia, judgement about the upper airway approach]. / Acondroplasia, juicio crítico sobre el manejo de la vía aérea alta.

Achondroplasia is an hereditary disorder which belongs to the group of illnesses called condristrophic or anomalies in the ossification of the cartilages. Its main characteristic is a series of irregularities in the skeleton, but the most outstanding characteristic is the short height. The diagnosis of achondroplasia is achieved by means of a combination of clinical and radiological characteristics. The 99% of the cases is diagnosticated by the genetic study. Because of its multiple deformities not only in the skull and cervical but also thoracic, usually in adults, it means a challenge for the use of upper airway when it's requiered. To choose the fibreoptics or orotraqueal intubation or the tracheotomy are very complex processes in these cases. We do a revision about the ENT aspects to be considered in the patients of achondroplasia

Acondroplasia, juicio crítico sobre el manejo de la vía aérea alta / Achondroplasia, judgement about the use in the upper airway

La acondroplasia es un desorden hereditario que pertenece al grupo de enfermedades denominado condrodistrofias o anomalías en la osificación de los cartílagos. Se caracteriza por una serie de alteraciones en el esqueleto, pero lo más característico es la baja talla. El diagnóstico de la acondroplasia se consigue mediante una combinación de características clínicas y radiológicas. El estudio genético diagnostica el 99% de los casos. Por las múltiples deformidades tanto cráneo facial, cervical y torácicas usualmente presentes en el adulto, supone un reto el manejo de la vía aérea superior cuando así lo precise. Elegir la intubación fibroóptica, la intubación orotraqueal o la traqueotomía son procedimientos de gran complejidad en estos casos. Hacemos una revisión en lo referente a los aspectos ORL a considerar en el paciente acondroplásico

Acondroplasia is an hereditary disorder which belongs to the group of illnesses called condristrophic or anomalies in the ossification of the cartilages. Its main characteristic is a series of irregularities in the skelton, but the most outstanding characteristic is the short beight. The diagnosis of achondroplasia is achieved by means of a combination of clinical and radiological characteristics. The 99% of the cases is diagnosticated by the genetic study. Because of its multiple deformities not only in the skull and cervical but also thoracic, usually in adults, it means a challenge for the use of upper airway when it´s required. To choose the fibreoptics or orotraqueal intubation or the tracheotomy are very complex processes in these cases. We do a revision about the ENT aspects to be considered in the patients of achondroplasia