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Critical Care Clinics Apr 2017Tracheostomy remains one of the most commonly performed surgical procedures in the setting of acute respiratory failure. Tracheostomy literature focuses on 2 aspects of... (Review)
Review
Tracheostomy remains one of the most commonly performed surgical procedures in the setting of acute respiratory failure. Tracheostomy literature focuses on 2 aspects of this procedure: when (timing) and how (technique). Recent trials have failed to demonstrate an effect of tracheostomy timing on most clinically important endpoints. Nonetheless, relative to continued translaryngeal intubation, studies suggest that tracheostomy use is associated with less need for sedation and enhanced patient comfort. Evidence likewise suggests that percutaneous dilational tracheostomy is advantageous with respect to cost and complication profile and should be considered the preferred approach in appropriately selected patients.
Topics: Humans; Respiratory Distress Syndrome; Tracheostomy
PubMed: 28284297
DOI: 10.1016/j.ccc.2016.12.007 -
Respiratory Care Jun 2017Over the last decade, tracheostomy has been increasingly performed in children, aligned with the improvements in neonatal and pediatric ICU care. Nowadays, the majority... (Review)
Review
Over the last decade, tracheostomy has been increasingly performed in children, aligned with the improvements in neonatal and pediatric ICU care. Nowadays, the majority of children with tracheostomy represent a very complex cohort of patients with sustained reliance on tracheostomy and related medical technology for long-term survival. Tracheostomy is one of the most commonly performed procedures in the adult ICU. Contrary to adult practice, tracheostomy is a much less common procedure in the pediatric ICU, being performed in < 3% of patients. There is no definite consensus about the length of time a child should remain endotracheally intubated before the placement of a tracheostomy. Tracheostomy in children also continues to remain a predominantly surgical procedure, with percutaneous tracheostomy being performed infrequently and only considered feasible in older children. The indications, preoperative considerations, and procedure types for tracheostomy in children are reviewed. There is also a lack of consensus on an optimal pediatric decannulation protocol. The literature discusses a myriad of protocols that use varying combinations of in-patient/out-patient resources, specialized tests, and procedures An ideal decannulation protocol is presented, as well as review of recently published decannulation algorithms. Finally, children with tracheostomy have a higher risk of adverse events and mortality, which are largely secondary to their comorbidities rather than the tracheostomy. The majority of the tracheostomy-related events are in fact potentially preventable. There is a recognized need for improvement and coordination of care of pediatric patients with tracheostomy. A multidisciplinary coordinated approach to tracheostomy care has already shown promising results. This paper seeks to review the pertinent literature regarding quality improvement initiatives for tracheostomy care, including review of the recently established Global Tracheostomy Collaborative.
Topics: Adolescent; Airway Extubation; Catheterization; Child; Child, Preschool; Humans; Infant; Intensive Care Units, Pediatric; Quality Improvement; Tracheostomy
PubMed: 28546379
DOI: 10.4187/respcare.05366 -
Annals of Cardiac Anaesthesia Jan 2017Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in critically sick patients. It can be safely performed bedside by intensivists.This has... (Review)
Review
Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in critically sick patients. It can be safely performed bedside by intensivists.This has resulted in decline in the use of surgical tracheostomy in intensive care unit (ICU) except in few selected cases. Most common indication of tracheostomy in ICU is need for prolonged ventilation. About 10% of patients requiring at least 3 days of mechanical ventilator support get tracheostomised during ICU stay. The ideal timing of PDT remains undecided at present. Contraindications and complications become fewer with increase in experience. Various methods of performing PDT have been discovered in last two decades. Preoperative work up, patient selection and post tracheostomy care form key components of a successful PDT. Bronchoscopy and ultrasound have been found to be useful procedural adjuncts, especially in presence of unfavorable anatomy. This article gives a brief overview about the use of PDT in ICU.
Topics: Critical Care; Humans; Intensive Care Units; Minimally Invasive Surgical Procedures; Tracheostomy
PubMed: 28074819
DOI: 10.4103/0971-9784.197793 -
The Cochrane Database of Systematic... Jan 2015Long-term mechanical ventilation is the most common situation for which tracheostomy is indicated for patients in intensive care units (ICUs). 'Early' and 'late'... (Review)
Review
BACKGROUND
Long-term mechanical ventilation is the most common situation for which tracheostomy is indicated for patients in intensive care units (ICUs). 'Early' and 'late' tracheostomies are two categories of the timing of tracheostomy. Evidence on the advantages attributed to early versus late tracheostomy is somewhat conflicting but includes shorter hospital stays and lower mortality rates.
OBJECTIVES
To evaluate the effectiveness and safety of early (≤ 10 days after tracheal intubation) versus late tracheostomy (> 10 days after tracheal intubation) in critically ill adults predicted to be on prolonged mechanical ventilation with different clinical conditions.
SEARCH METHODS
This is an update of a review last published in 2012 (Issue 3, The Cochrane Library) with previous searches run in December 2010. In this version, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 8); MEDLINE (via PubMed) (1966 to August 2013); EMBASE (via Ovid) (1974 to August 2013); LILACS (1986 to August 2013); PEDro (Physiotherapy Evidence Database) at www.pedro.fhs.usyd.edu.au (1999 to August 2013) and CINAHL (1982 to August 2013). We reran the search in October 2014 and will deal with any studies of interest when we update the review.
SELECTION CRITERIA
We included all randomized and quasi-randomized controlled trials (RCTs or QRCTs) comparing early tracheostomy (two to 10 days after intubation) against late tracheostomy (> 10 days after intubation) for critically ill adult patients expected to be on prolonged mechanical ventilation.
DATA COLLECTION AND ANALYSIS
Two review authors extracted data and conducted a quality assessment. Meta-analyses with random-effects models were conducted for mortality, time spent on mechanical ventilation and time spent in the ICU.
MAIN RESULTS
We included eight RCTs (N = 1977 participants). At the longest follow-up time available in these studies, evidence of moderate quality from seven RCTs (n = 1903) showed lower mortality rates in the early as compared with the late tracheostomy group (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.70 to 0.98; P value 0.03; number needed to treat for an additional beneficial outcome (NNTB) ≅ 11). Divergent results were reported on the time spent on mechanical ventilation and no differences were noted for pneumonia, but the probability of discharge from the ICU was higher at day 28 in the early tracheostomy group (RR 1.29, 95% CI 1.08 to 1.55; P value 0.006; NNTB ≅ 8).
AUTHORS' CONCLUSIONS
The whole findings of this systematic review are no more than suggestive of the superiority of early over late tracheostomy because no information of high quality is available for specific subgroups with particular characteristics.
Topics: Critical Care; Critical Illness; Humans; Length of Stay; Pneumonia; Randomized Controlled Trials as Topic; Respiration, Artificial; Time Factors; Tracheostomy
PubMed: 25581416
DOI: 10.1002/14651858.CD007271.pub3 -
Problems in Veterinary Medicine Jun 1991Tracheostomies are performed to bypass life-threatening obstructions of the upper airway or to facilitate surgical procedures in the head and neck region. Neither tube... (Review)
Review
Tracheostomies are performed to bypass life-threatening obstructions of the upper airway or to facilitate surgical procedures in the head and neck region. Neither tube tracheostomy nor permanent tracheostomy is a cure for any particular disease; however, both can be important for patients' supportive or palliative care. Perioperative problems are anticipated with either tube tracheostomy or permanent tracheostomy. Obstruction of the tube or stoma is the most common and devastating problem. Careful and diligent management of tracheostomy patients can circumvent many problems and allow the patient to breath with less difficulty.
Topics: Airway Obstruction; Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Postoperative Care; Postoperative Complications; Tracheostomy
PubMed: 1802248
DOI: No ID Found -
Clinics in Perinatology Dec 2018Neonatal and infant tracheostomies have been valuable in the care and survival of children over the past century. With the implementation of neonatal and pediatric... (Review)
Review
Neonatal and infant tracheostomies have been valuable in the care and survival of children over the past century. With the implementation of neonatal and pediatric intensive care units, more infants are surviving conditions that were considered fatal. Neonatal tracheostomy plays a vital role in many of these conditions, with significant implications and association with overall mortality, morbidity, and developmental outcomes. Although the technique has not changed much, there have been significant evolutions in indications, survival, complications, and technological advances. Improved outcomes research to decrease the high associated morbidities is needed.
Topics: Critical Care; Critical Illness; Female; Hospital Mortality; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Intensive Care Units, Pediatric; Male; Patient Positioning; Postoperative Complications; Preoperative Care; Prognosis; Risk Assessment; Role; Survival Rate; Tracheostomy; Treatment Outcome
PubMed: 30396419
DOI: 10.1016/j.clp.2018.07.014 -
Respiratory Care Apr 2005The respiratory therapist plays an integral role in tracheostomy tube decannulation. Removal of the tracheostomy tube should be considered only if the original... (Review)
Review
The respiratory therapist plays an integral role in tracheostomy tube decannulation. Removal of the tracheostomy tube should be considered only if the original upper-airway obstruction is resolved, if airway secretions are controlled, and if mechanical ventilation is no longer needed. Predictors of success include ability to produce a vigorous cough and the absence of aspiration. Tracheostomy decannulation requires caution, particularly following a prolonged period of tracheostomy use. The tracheostomy tube decannulation process is well suited for therapist-implemented protocols.
Topics: Clinical Protocols; Device Removal; Humans; Patient Selection; Tracheostomy
PubMed: 15807918
DOI: No ID Found -
Jornal de Pediatria 2009To provide an up-to-date review of pediatric tracheostomy, primarily focusing on indications, surgical technique, complications and hospital and home care. (Review)
Review
OBJECTIVE
To provide an up-to-date review of pediatric tracheostomy, primarily focusing on indications, surgical technique, complications and hospital and home care.
SOURCES
MEDLINE and PubMed databases were searched using the following keywords: tracheostomy, tracheotomy, children, newborn.
SUMMARY OF THE FINDINGS
Indications for tracheostomy in children are changing. Today the most common indication is prolonged ventilation. The age at the time of the procedure has also changed, with a peak incidence of tracheostomy in patients less than 1 year old. Except under emergency conditions, pediatric tracheostomy should be performed in the operating room with the child intubated. A horizontal skin incision with vertical tracheal incision and no tracheal resection is recommended. Although post-tracheostomy complications are not uncommon, they usually do not need special treatment or surgical procedures. Tracheostomy mortality can occur in up to 40% of pediatric cases, however the tracheostomy-related mortality rate is only 0 to 6%.
CONCLUSIONS
The decision to perform a tracheostomy remains complex, and depends on several factors. The procedure is safe and with a low number of complications if carried out at a tertiary hospital by a trained and experienced team.
Topics: Airway Obstruction; Child; Humans; Tracheostomy
PubMed: 19283325
DOI: 10.2223/JPED.1850 -
Clinics in Chest Medicine Sep 2013Tracheostomy is a commonly performed intervention with several benefits in the treatment of patients with chronic respiratory failure. Percutaneous dilational... (Review)
Review
Tracheostomy is a commonly performed intervention with several benefits in the treatment of patients with chronic respiratory failure. Percutaneous dilational tracheostomy techniques have allowed bedside tracheostomy placement in the modern intensive care unit. Percutaneous dilational tracheostomy can be safely performed by interventional pulmonologists, medical intensive care physicians, and surgical specialists. When performed with the assistance of adjuncts, such as flexible bronchoscopy, the percutaneous dilational method has a favorable complication rate, efficiency, and cost profile compared with surgical tracheostomy.
Topics: Bronchoscopy; Chronic Disease; Humans; Respiratory Insufficiency; Tracheostomy
PubMed: 23993821
DOI: 10.1016/j.ccm.2013.04.002 -
Auris, Nasus, Larynx Jun 2024Pediatric tracheostomy has been widely performed since the 1800s, and in recent years, with advances in neonatal medicine, it has been performed at younger ages,... (Review)
Review
Pediatric tracheostomy has been widely performed since the 1800s, and in recent years, with advances in neonatal medicine, it has been performed at younger ages, starting at 0. In addition, advances in surgical techniques and postoperative tube management have reduced complications. This review will discuss the entire process of pediatric tracheostomy, starting with the history of tracheostomy and ending with indications, contraindications, techniques (slit, Björk, EXIT), complications, tube management, and decannulation. Pediatric tracheostomy patients require long-term care and management as they grow after the surgery itself, so otolaryngologists and pediatric tracheostomists are particularly involved in tube management and decannulation. We believe that sharing this information with all healthcare professionals will lead to better care for children with tracheostomies.
Topics: Humans; Tracheostomy; Child; Infant; Infant, Newborn; Child, Preschool; Postoperative Complications; Device Removal; Contraindications, Procedure; History, 19th Century; History, 20th Century
PubMed: 38520972
DOI: 10.1016/j.anl.2024.01.003