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The American Surgeon Aug 2023The obesity epidemic is an important public health problem in the United States. Previous studies have revealed the association between obesity and various surgical...
INTRODUCTION
The obesity epidemic is an important public health problem in the United States. Previous studies have revealed the association between obesity and various surgical complications. Tracheostomy which is an important lifesaving procedure may prove technically challenging in an obese patient. This study sought to evaluate the association between obesity and early complications following standard tracheostomy using a national registry.
METHODS
Adult patients who underwent tracheostomy from 2007 to 2017 were analyzed using the Nationwide Inpatient Sample (NIS). The population was stratified into obese and non-obese groups. Early complications following standard tracheostomy were identified and compared between the two groups. Multivariable logistic regression analyses were performed to assess the association between obesity and early complications following tracheostomy.
RESULTS
Data pertaining to 205 032 adult patients were evaluated. Obese patients accounted for 12.1% (n = 21 816) of the entire cohort. The most common complication in the cohort was perioperative bleeding (4316 [2.1%]). A total of 1382 (0.67%), 949 (0.46%), and 134 (0.07%) patients developed pneumothorax/pneumomediastinum, stoma/surgical site infection, and tracheal injury following standard tracheostomy, respectively. There was no difference in the odds of tracheal injury, perioperative bleeding, and pneumomediastinum/pneumothorax following standard tracheostomy in the obese and non-obese group in multivariable analysis. However, obesity was associated with 60% increased odds of developing stoma/surgical site infection following standard tracheostomy (OR 1.60 [1.33-1.92], < 0.01).
CONCLUSION
Obesity is associated with an increased risk of developing stoma/surgical site infection following standard tracheostomy. This adds to the growing need for measures to help curb the obesity epidemic in a bid to improve surgical outcomes.
Topics: Adult; Humans; United States; Tracheostomy; Surgical Wound Infection; Mediastinal Emphysema; Pneumothorax; Obesity; Hemorrhage; Postoperative Complications; Retrospective Studies
PubMed: 37129212
DOI: 10.1177/00031348231160831 -
The Journal of International Medical... Sep 2023Hamman's syndrome is a rare clinical entity that presents with spontaneous pneumomediastinum and subcutaneous emphysema. It is most commonly diagnosed in young men and...
Hamman's syndrome is a rare clinical entity that presents with spontaneous pneumomediastinum and subcutaneous emphysema. It is most commonly diagnosed in young men and pregnant women, and is rare in children. We report the case of a female toddler who presented to an emergency department with fever, cough and shortness of breath. Imaging studies revealed subcutaneous emphysema and pneumomediastinum. The patient was diagnosed with Hamman's syndrome after ruling out other possibilities. We discuss the underlying mechanisms of the disease, the diagnostic criteria and the treatment options. The purpose of this case report is to improve clinicians' awareness of the existence of this rare clinical entity in paediatric patients.
Topics: Pregnancy; Male; Humans; Child; Female; Mediastinal Emphysema; Subcutaneous Emphysema; Cough; Dyspnea; Emergency Service, Hospital; Syndrome
PubMed: 37747498
DOI: 10.1177/03000605231200269 -
Recenti Progressi in Medicina Jan 2024A unique case of severe measles complicated by multiple features of gas accumulation is described, on the ground of the available literature evidences. Complications... (Review)
Review
A unique case of severe measles complicated by multiple features of gas accumulation is described, on the ground of the available literature evidences. Complications from measles have been reported in every organ system and they may vary by age and underlying conditions. Pneumomediastinum is usually associated with subcutaneous emphysema and pneumopericardium, but rarely associated with pneumothorax. We report extremely rare simultaneous occurrence of self-limiting pneumomediastinum, pneumopericardium, subcutaneous neck and chest region emphysema, and pneumothorax, in a 19-year-old girl with measles. A review of the literature has documented only one previous report of spontaneous pneumomediastinum, subcutaneous emphysema and pneumothorax in the course of measles, and no previous cases reported the association of pneumomediastinum, subcutaneous emphysema, pneumopericardium and pneumothorax complicating measles.
Topics: Female; Humans; Young Adult; Adult; Pneumothorax; Mediastinal Emphysema; Pneumopericardium; Tomography, X-Ray Computed; Subcutaneous Emphysema
PubMed: 38169357
DOI: 10.1701/4169.41642 -
Journal of Pediatric Surgery May 2024Given the paucity of data on pediatric spontaneous pneumomediastinum (SPM), management is largely informed by extrapolation from adult studies or personal clinical...
PURPOSE
Given the paucity of data on pediatric spontaneous pneumomediastinum (SPM), management is largely informed by extrapolation from adult studies or personal clinical experience, resulting in significant heterogeneity. The purpose of this study was to describe how pediatric patients with SPM are clinically managed at our institution and propose a treatment algorithm.
METHODS
Retrospective chart review of pediatric patients with SPM from April 2002 to December 2021 at a single Canadian tertiary care center. Data on medical history, presentation characteristics, clinical management, and complications were gathered. Descriptive and inferential statistics were used to analyze data.
RESULTS
We identified 63 patients for inclusion, median age was 15 years. Twenty-nine patients were transferred from another facility. Most common presenting symptoms were chest pain (72.3%), shortness of breath (44.6%), and subcutaneous emphysema (21.5%). Initial workup included chest x-ray (93.6%), CT scan (20.6%), and upper GI series (7.9%). There was no difference in the number of initial tests between admitted and discharged patients (p = 0.10). Of admitted patients (n = 35), 31.4% had primary SPM (no underlying comorbidity/inciting event) and 68.8% were secondary SPM (underlying comorbidity/inciting event). No patients with primary SPM developed complications or recurrences. In contrast, 16.7% of those with secondary SPM developed complications and 54.2% had at least one additional intervention after admission.
DISCUSSION
There is significant variability in diagnostic investigation and treatment of pediatric SPM at our center. Amongst primary SPM, additional tests did not change complication rate or recurrence, including those transferred from another facility. An expeditious treatment algorithm is warranted.
TYPE OF STUDY
Retrospective Cohort Study.
LEVEL OF EVIDENCE
III.
Topics: Adult; Humans; Child; Adolescent; Retrospective Studies; Mediastinal Emphysema; Canada; Tomography, X-Ray Computed; Radiography
PubMed: 38519387
DOI: 10.1016/j.jpedsurg.2024.01.043 -
Journal of Thoracic Disease Nov 2023Systemic artery to pulmonary artery fistula (SA-PAF) is an uncommon disease which is often incidentally diagnosed during evaluation of hemoptysis patients. The aim of...
BACKGROUND
Systemic artery to pulmonary artery fistula (SA-PAF) is an uncommon disease which is often incidentally diagnosed during evaluation of hemoptysis patients. The aim of our study was to describe the cases of SA-PAF in our institution and to report the correlating clinical and radiological findings.
METHODS
We reviewed 231 chest computed tomography (CT) scans performed in our institution due to hemoptysis from January 2020 to February 2023. In patients diagnosed with SA-PAF had their electronic medical records and CT images analyzed.
RESULTS
In 231 patients, 19 (8.2%) of them had SA-PAF findings which was characterized by a peripheral nodular soft tissue opacity in the subpleural lung and traceable vascular structure in continuity with one or more peripheral pulmonary artery branches in CT. Etiology of each patient was categorized as either congenital (7, 36.8%), and acquired (12, 63.2%). The origins of SA-PAFs were 16 intercostal, two anterior mediastinal, and one costocervical artery. Eight of 19 patients did not show any associated intralobar imaging abnormalities, while bronchiectasis, cellular bronchiolitis, centrilobular emphysema, and pleura effusion were observed in 11 patients.
CONCLUSIONS
SA-PAF is a benign vascular anomaly which is frequently overlooked when evaluating hemoptysis by either clinician or radiologists but is an important factor in the differential diagnosis of patients with hemoptysis.
PubMed: 38090324
DOI: 10.21037/jtd-23-861 -
BMC Pulmonary Medicine Jul 2023Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is reportedly associated with air leak syndrome (ALS), including mediastinal emphysema and... (Observational Study)
Observational Study
BACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia is reportedly associated with air leak syndrome (ALS), including mediastinal emphysema and pneumothorax, and has a high mortality rate. In this study, we compared values obtained every minute from ventilators to clarify the relationship between ventilator management and risk of developing ALS.
METHODS
This single-center, retrospective, observational study was conducted at a tertiary care hospital in Tokyo, Japan, over a 21-month period. Information on patient background, ventilator data, and outcomes was collected from adult patients with SARS-CoV-2 pneumonia on ventilator management. Patients who developed ALS within 30 days of ventilator management initiation (ALS group) were compared with those who did not (non-ALS group).
RESULTS
Of the 105 patients, 14 (13%) developed ALS. The median positive-end expiratory pressure (PEEP) difference was 0.20 cmHO (95% confidence interval [CI], 0.20-0.20) and it was higher in the ALS group than in the non-ALS group (9.6 [7.8-20.2] vs. 9.3 [7.3-10.2], respectively). For peak pressure, the median difference was -0.30 cmHO (95% CI, -0.30 - -0.20) (20.4 [17.0-24.4] in the ALS group vs. 20.9 [16.7-24.6] in the non-ALS group). The mean pressure difference of 0.0 cmHO (95% CI, 0.0-0.0) (12.7 [10.9-14.6] vs. 13.0 [10.3-15.0], respectively) was also higher in the non-ALS group than in the ALS group. The difference in single ventilation volume per ideal body weight was 0.71 mL/kg (95% CI, 0.70-0.72) (8.17 [6.79-9.54] vs. 7.43 [6.03-8.81], respectively), and the difference in dynamic lung compliance was 8.27 mL/cmHO (95% CI, 12.76-21.95) (43.8 [28.2-68.8] vs. 35.7 [26.5-41.5], respectively); both were higher in the ALS group than in the non-ALS group.
CONCLUSIONS
There was no association between higher ventilator pressures and the development of ALS. The ALS group had higher dynamic lung compliance and tidal volumes than the non-ALS group, which may indicate a pulmonary contribution to ALS. Ventilator management that limits tidal volume may prevent ALS development.
Topics: Adult; Humans; SARS-CoV-2; Retrospective Studies; COVID-19; Pneumonia; Ventilators, Mechanical; Syndrome
PubMed: 37430221
DOI: 10.1186/s12890-023-02549-7 -
Auris, Nasus, Larynx Feb 2024Surgical airway management is one of the most effective techniques for safe airway management. Within the training programs relating to knowledge and skills required by...
OBJECTIVE
Surgical airway management is one of the most effective techniques for safe airway management. Within the training programs relating to knowledge and skills required by otorhinolaryngologists, tracheostomy and postoperative management are important items that must be fully understood by airway surgeons. We performed a nationwide survey to identify problems within tracheostomy and postoperative management in Japan in order to establish practical and safe guidelines for surgical airway management.
METHODS
We conducted a questionnaire survey of the current status of tracheostomy and postoperative management at core institution of otorhinolaryngology training programs in Japan.
RESULTS
Responses were obtained from all 101 core training institutions in Japan. Tracheostomy was performed in the operating room at 61.4% of institutions and in the ICU at 26.7%. 89.1% of them performed surgical tracheostomy (ST) in all cases. Even in the remaining 10.9%, percutaneous dilatational tracheostomy (PDT) was performed in less than 10% of cases. The primary surgeon was an otorhinolaryngology resident at 89.1% of institutions. The method of securing the tube immediately after surgery was by securing it with an attached cord at 48.5% of institutions, by suturing to the skin at 25.7%, and using a Velcro band at 24.8%. The first tube change after tracheostomy was performed on the seventh postoperative day at 81.2% of institutions. 87.1% had more than one person performing the first tube change. The tracheostomy postoperative complications within the past year were as follows: tracheostomal granulation: 89.1%; subcutaneous and/or mediastinal emphysema: 62.4%; tube stenosis: 55.4%; accidental tube removal: 50.5%; incorrect tube insertion or misplacement: 15.8%; hemorrhage from tracheal foramen requiring hemostasis in the operating room: 14.9%; pneumothorax: 4.0%; tracheo-innominate arterial fistula: 2.0%; and tracheoesophageal fistula: 1.0%. The method for educating otorhinolaryngology residents about tracheostomy was on-the-job training at 98.0% of institutions.
CONCLUSIONS
For airway management in otorhinolaryngology training programs, after learning the basics of ST, PDT should also be well understood. Furthermore, in order to create safe educational programs for intraoperative and postoperative management, it is necessary to train otorhinolaryngologists with accurate knowledge and skills, and to strengthen collaboration with multiple professions in their leadership roles as airway surgeons.
Topics: Humans; Tracheostomy; Japan; Trachea; Postoperative Complications; Otolaryngology; Surveys and Questionnaires
PubMed: 37563043
DOI: 10.1016/j.anl.2023.08.003 -
Pediatrics and Neonatology Nov 2023Although uncommon, available evidence suggests that pneumorrhachis (PR) with spontaneous pneumomediastinum (SPM) in adulthood is usually benign and self-limiting. This...
BACKGROUND
Although uncommon, available evidence suggests that pneumorrhachis (PR) with spontaneous pneumomediastinum (SPM) in adulthood is usually benign and self-limiting. This study aimed to review our experience and identify the risk factors of PR in pediatric patients with SPM.
METHODS
Between September 2007 and September 2017, SPM in patients aged ≤18 years was retrospectively reviewed and clinical features and outcomes between SPM patients with and without PR were analyzed.
RESULTS
In total, thirty consecutive occurrences of SPM in 29 patients were finally identified and classified into SPM (n = 24) and SPM plus PR (n = 6) groups. No significant differences in received interventional exams, prophylactic antibiotic administration or restriction of oral intake between the two groups were found. Both groups were treated with hospitalization predominantly; but the SPM plus PR group tended to have longer length of hospital stay (median 5.5 vs. 3 days, p = 0.08). PR was observed more frequently in patients with abnormal serum C-reactive protein (CRP) levels (>5 mg/L), identified predisposing factors, and those with more severe grade of SPM (p = 0.005, 0.001 and < 0.001, respectively). On multivariable regression analysis, the SPM plus PR group exhibited more predisposing factors than did the SPM group (coefficient: 0.514, standard error: 0.136, p < 0.001). All patients were successfully treated without morbidity and mortality.
CONCLUSION
Although patients with pneumorrhachis retained a higher CRP level, more identified predisposing factors and prolonged inpatient care, conservative management without an extensive work-up would be an appropriate and favorable strategy in pediatrics with concurrent SPM and PR.
Topics: Humans; Child; Mediastinal Emphysema; Retrospective Studies; Pneumorrhachis; Taiwan; Tomography, X-Ray Computed
PubMed: 37301660
DOI: 10.1016/j.pedneo.2023.03.008 -
International Journal of Surgery Case... Jul 2024Tonsillectomy is known as one of the safest otorhinolaryngology surgery procedure. Rarely, it can lead to serious complications. Cervico-facial emphysema is an...
INTRODUCTION
Tonsillectomy is known as one of the safest otorhinolaryngology surgery procedure. Rarely, it can lead to serious complications. Cervico-facial emphysema is an exceptional complication of tonsillectomy. Here we reported a case of post-tonsillectomy emphysema. Our objective was to emphasize the different characteristics of this entity and draw attention to the risk of potentially fatal respiratory complications.
PRESENTATION OF CASE
A 46-year-old healthy woman had a tonsillectomy because of recurrent tonsillitis. Four hours after extubation, she presented a subcutaneous emphysema under the left mandibular angle, slightly extended to the left cheek and left laterocervical region. An immediate cervicofacial CT scan showed a dissecting cervical emphysema of the left hemiface of moderate abundance that extended to the pre-vascular space of the superior mediastinum. The decision was to keep the patient hospitalized, to avoid forced glottic closure and to put her on prophylactic antibiotics. The further course was uneventful with respiratory state stability and emphysema's disappearance.
CLINICAL DISCUSSION
Cervicofacial emphysema is a very rare but life-threatening tonsillectomy complication that may cause acute respiratory failure. Emphysema's main clinical characteristics are a non-tender cervicofacial swelling and crepitus. Post-tonsillectomy emphysema treatment is usually conservative. In cases of respiratory failure, it is necessary to secure the airway by intubation or tracheostomy. An important mediastinal expansion of the emphysema requires a thoracotomy.
CONCLUSION
Cervicofacial emphysema is an unpredictable complication of tonsillectomy. Its prevention requires per-operative vigilance from both ENT surgeons and anesthetists. Moreover, early diagnosis and management are essential to avoid its potentially fatal consequences.
PubMed: 38889514
DOI: 10.1016/j.ijscr.2024.109866 -
Case Reports in Anesthesiology 2023Tracheal diverticulum (TD) is a rare disease. Due to the worldwide pandemic of COVID-19, the increase of routine preoperative chest CT examination has led to a higher...
Tracheal diverticulum (TD) is a rare disease. Due to the worldwide pandemic of COVID-19, the increase of routine preoperative chest CT examination has led to a higher detection rate of TD. Although TD is very rare, it is one of the reasons for difficult intubation and difficult ventilation. Improper treatment can cause severe airway emergencies such as diverticulum tearing, tracheal rupture, and subcutaneous or mediastinal emphysema. Unfortunately, there are few studies on TD, especially in perioperative airway and anesthesia management. This paper reports a case of TD found by preoperative chest CT examination who required tracheal intubation under general anesthesia. For the first time, ultrasound was used to confirm the position of tracheal tube and TD, and good results were achieved. This attempt provides a new idea and method for airway management in patients with TD.
PubMed: 37767048
DOI: 10.1155/2023/5586490