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Journal of Critical Care Dec 2022Tracheostomy is a common surgical procedure in ICU. Whilst often life-saving, it can have important impacts on patients. Much of the literature on tracheostomy focuses... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Tracheostomy is a common surgical procedure in ICU. Whilst often life-saving, it can have important impacts on patients. Much of the literature on tracheostomy focuses on timing and technique of insertion, risk factors and complications. More knowledge of patient experience of tracheostomy in ICU is needed to support person-centred care.
MATERIALS AND METHODS
Qualitative systematic review and metasynthesis of the literature on adult experience of tracheostomy in ICU. Comprehensive search of four bibliographic databases and grey literature. Title and abstract screening and full text eligibility was completed independently by two reviewers. Metasynthesis was achieved using thematic synthesis, supported by a conceptual framework of humanised care.
RESULTS
2971 search returns were screened on title and abstract and 127 full texts assessed for eligibility. Thirteen articles were included for analysis. Five descriptive and three analytical themes were revealed. The over-arching theme was 'To be seen and heard as a whole person'. Patients wanted to be treated as a human, and having a voice made this easier.
CONCLUSIONS
Voice restoration should be given high priority in the management of adults with a tracheostomy in ICU. Staff training should focus on both technical skills and compassionate care to improve person-centred outcomes.
Topics: Adult; Humans; Delivery of Health Care; Intensive Care Units; Tracheostomy
PubMed: 36174431
DOI: 10.1016/j.jcrc.2022.154145 -
Respiratory Care Apr 2005The trachea is easily accessible at the bedside. As such it provides ready access for emergency airway cannulation (eg, in the setting of acute upper airway obstruction)... (Comparative Study)
Comparative Study Review
The trachea is easily accessible at the bedside. As such it provides ready access for emergency airway cannulation (eg, in the setting of acute upper airway obstruction) and for chronic airway access after laryngeal surgery. More commonly, tracheostomy tubes are placed to allow removal of a translaryngeal endotracheal tube. Tracheostomy tubes have an important effect on respiratory physiology. The most recent and methodological robust studies indicate that these tubes reduce resistive and elastic work of breathing, when compared to endotracheal tubes. This is a result of tracheostomy tubes lessening inspiratory and expiratory airways resistance and intrinsic positive end-expiratory pressure. Whether these physiologic benefits are of clinical importance in enhancing weaning success remains to be elucidated.
Topics: Female; Humans; Intubation, Intratracheal; Male; Pulmonary Ventilation; Respiratory Mechanics; Trachea; Tracheostomy
PubMed: 15807905
DOI: No ID Found -
Association of mortality and early tracheostomy in patients with COVID-19: a retrospective analysis.Scientific Reports Sep 2022COVID-19 adds to the complexity of optimal timing for tracheostomy. Over the course of this pandemic, and expanded knowledge of the disease, many centers have changed...
COVID-19 adds to the complexity of optimal timing for tracheostomy. Over the course of this pandemic, and expanded knowledge of the disease, many centers have changed their operating procedures and performed an early tracheostomy. We studied the data on early and delayed tracheostomy regarding patient outcome such as mortality. We performed a retrospective analysis of all tracheostomies at our institution in patients diagnosed with COVID-19 from March 2020 to June 2021. Time from intubation to tracheostomy and mortality of early (≤ 10 days) vs. late (> 10 days) tracheostomy were the primary objectives of this study. We used mixed cox-regression models to calculate the effect of distinct variables on events. We studied 117 tracheostomies. Intubation to tracheostomy shortened significantly (Spearman's correlation coefficient; rho = - 0.44, p ≤ 0.001) during the course of this pandemic. Early tracheostomy was associated with a significant increase in mortality in uni- and multivariate analysis (Hazard ratio 1.83, 95% CI 1.07-3.17, p = 0.029). The timing of tracheostomy in COVID-19 patients has a potentially critical impact on mortality. The timing of tracheostomy has changed during this pandemic tending to be performed earlier. Future prospective research is necessary to substantiate these results.
Topics: COVID-19; Humans; Length of Stay; Proportional Hazards Models; Retrospective Studies; Tracheostomy
PubMed: 36104383
DOI: 10.1038/s41598-022-19567-w -
The British Journal of Surgery Jan 2021In this retrospective multicentre cohort study that included 27 COVID-19 patients who underwent tracheostomy, the mean time between intubation and tracheostomy was 15.8...
In this retrospective multicentre cohort study that included 27 COVID-19 patients who underwent tracheostomy, the mean time between intubation and tracheostomy was 15.8 days and the negative conversion time of COVID-19 was 43.1 days. Eleven patients (40.7%) died of COVID-19 and the use of percutaneous dilatation tracheostomy was significantly associated with in-hospital death. Timely tracheostomy could be performed in COVID-19 patients, regardless of duration of intubation or positivity of COVID-19 test, with an open surgical tracheostomy as a preferable technique.
Topics: Adult; Aged; Aged, 80 and over; COVID-19; Critical Care; Humans; Infectious Disease Transmission, Patient-to-Professional; Middle Aged; Postoperative Complications; Republic of Korea; SARS-CoV-2; Time-to-Treatment; Tracheostomy; Treatment Outcome
PubMed: 33640938
DOI: 10.1093/bjs/znaa064 -
International Journal of Pediatric... Dec 2021Indications for tracheostomy have changed over the last decades and clinical outcome varies depending on the indication for tracheostomy. By gaining more insight in the...
OBJECTIVE
Indications for tracheostomy have changed over the last decades and clinical outcome varies depending on the indication for tracheostomy. By gaining more insight in the characteristics and outcome of the tracheostomized pediatric population, clinical care can be improved and a better individual prognosis can be given. Therefore, we studied the outcome of our pediatric tracheostomy population in relation to the primary indication over the last 16 years.
METHODS
We retrospectively included children younger than 18 years of age with a tracheostomy tube in the Erasmus Medical Center, Sophia children's hospital. The primary indication for tracheostomy, gender, age at tracheostomy, age at decannulation, comorbidity, mortality, closure of a persisting tracheocutaneous fistula after decannulation, surgery prior to decannulation and the use of polysomnography were recorded and analyzed.
RESULTS
Our research group consisted of 225 children. Reasons for a tracheostomy were first divided in two major diagnostic groups: 1) airway obstruction group (subgroups: laryngotracheal obstruction and craniofacial anomalies) and 2) pulmonary support group (subgroups: cardio-pulmonary diseases and neurological diseases). Children in the airway obstruction group were younger when receiving a tracheostomy (3.0 months vs. 31.0 months, p < 0.05), they were tracheostomy dependent for a longer time (median 21.5 months vs. 2.0 months, p < 0.05) and they required surgery more often (74.5% vs. 8.3%, p < 0.05) than the children in the pulmonary support group. The decannulation rate of children with a laryngotracheal obstruction is high (74.8%), but low in all other subgroups (craniofacial anomalies; 38.5%, cardio-pulmonary diseases; 34.6% and neurological diseases; 52.9%). Significantly more children (36.7%) died in the pulmonary support group due to underlying comorbidity, mainly in the cardio-pulmonary diseases subgroup. Surgery for a persisting tracheocutaneous fistula was performed in 34 (37.8%) children, with a significant relationship between the duration of the tracheostomy and the persistence of a tracheocutaneous fistula. No cannula related death occurred during this study period.
CONCLUSION
Main indications for a tracheostomy were airway obstruction and pulmonary support. Children in the airway obstruction group were younger when receiving a tracheostomy and they were tracheostomy dependent for a longer period. Within the airway obstruction group, the decannulation rate for children with laryngotracheal stenosis was high, but low for children with craniofacial anomalies. In the pulmonary support group, the decannulation rate was low and the mortality rate was high. Surgery for a persisting tracheocutaneous fistula was frequently needed.
Topics: Child; Device Removal; Humans; Laryngostenosis; Retrospective Studies; Trachea; Tracheostomy
PubMed: 34592656
DOI: 10.1016/j.ijporl.2021.110927 -
Pediatric Critical Care Medicine : a... Apr 2022Children receiving prolonged extracorporeal membrane oxygenation (ECMO) support may benefit from tracheostomy during ECMO by facilitating rehabilitation; however, the...
OBJECTIVES
Children receiving prolonged extracorporeal membrane oxygenation (ECMO) support may benefit from tracheostomy during ECMO by facilitating rehabilitation; however, the procedure carries risks, especially hemorrhagic complications. Knowledge of tracheostomy practices and outcomes of ECMO-supported children who undergo tracheostomy on ECMO may inform decision-making.
DESIGN
Retrospective cohort study.
SETTING
ECMO centers contributing to the Extracorporeal Life Support Organization registry.
PATIENTS
Children from birth to 18 years who received ECMO support for greater than or equal to 7 days for respiratory failure from January 1, 2015, to December 31, 2019.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Three thousand six hundred eighty-five children received at least 7 days of ECMO support for respiratory failure. The median duration of ECMO support was 13.0 days (interquartile range [IQR], 9.3-19.9 d), and inhospital mortality was 38.7% (1,426/3,685). A tracheostomy was placed during ECMO support in 94/3,685 (2.6%). Of those who received a tracheostomy on ECMO, the procedure was performed at a median 13.2 days (IQR, 6.3-25.9 d) after initiation of ECMO. Surgical site bleeding was documented in 26% of children who received a tracheostomy (12% after tracheostomy placement). Among children who received a tracheostomy, the median duration of ECMO support was 24.2 days (IQR, 13.0-58.7 d); inhospital mortality was 30/94 (32%). Those that received a tracheostomy before 14 days on ECMO were older (median age, 15.8 yr [IQR, 4.7-15.5] vs 11.7 yr [IQR, 11.5-17.3 yr]; p =0.002) and more likely to have been supported on venovenous-ECMO (84% vs 52%; p = 0.001). Twenty-two percent (11/50) of those who received a tracheostomy before 14 days died in the hospital, compared with 19/44 (43%) of those who received a tracheostomy at 14 days or later (p = 0.03).
CONCLUSIONS
Tracheostomies during ECMO were uncommon in children. One in four patients who received a tracheostomy on ECMO had surgical site bleeding. Children who had tracheostomies placed after 14 days were younger and had worse outcomes, potentially representing tracheostomy as a "secondary" strategy for prolonged ECMO support.
Topics: Adolescent; Child; Extracorporeal Membrane Oxygenation; Hemorrhage; Humans; Respiration, Artificial; Respiratory Insufficiency; Retrospective Studies; Tracheostomy
PubMed: 35081085
DOI: 10.1097/PCC.0000000000002902 -
Journal of Bronchology & Interventional... Jan 2023Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause severe respiratory failure leading to prolonged mechanical ventilation. Data are just emerging... (Review)
Review
BACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause severe respiratory failure leading to prolonged mechanical ventilation. Data are just emerging about the practice and outcomes of tracheostomy in these patients. We reviewed our experience with tracheostomies for SARS-CoV-2.
METHODS
We retrospectively reviewed the demographics, comorbidities, timing of mechanical ventilation, tracheostomy, and intensive care unit and hospital lengths of stay in SARS-CoV-2 patients who received tracheostomies performed by the interventional pulmonary team. A tertiary care, teaching hospital in Chicago, Illinois. From March 2020 to April 2021, our center had 473 patients intubated for SARS-CoV-2, and 72 (15%) had percutaneous bedside tracheostomy performed by the interventional pulmonary team.
RESULTS
Median time from intubation to tracheostomy was 20 (interquartile range: 16 to 25) days. Demographics and comorbidities were similar between early and late tracheostomy, but early tracheostomy was associated with shorter intensive care unit lengths of stay and a shorter total duration of ventilation. To date, 39 (54%) patients have been decannulated, 17 (24%) before hospital discharge; median time to decannulation was 22 (IQR: 18 to 36) days. Patients that were decannulated were younger (56 vs. 69 y). The rate of decannulation for survivors was 82%. No providers developed symptoms or tested positive for SARS-CoV-2.
CONCLUSION
Tracheostomy enhances care for patients with prolonged respiratory failure from SARS-CoV-2 since early tracheostomy is associated with shorter duration of critical care, and decannulation rates are high for survivors. It furthermore appears safe for both patients and operators.
Topics: Humans; SARS-CoV-2; Tracheostomy; COVID-19; Retrospective Studies; Respiration, Artificial; Respiratory Insufficiency; Intensive Care Units
PubMed: 35696591
DOI: 10.1097/LBR.0000000000000854 -
Brazilian Journal of Otorhinolaryngology 2017Tracheostomy is a procedure with unique characteristics when used on pediatric patients due to the greater technical difficulty and higher morbidity and mortality rates... (Review)
Review
INTRODUCTION
Tracheostomy is a procedure with unique characteristics when used on pediatric patients due to the greater technical difficulty and higher morbidity and mortality rates relative to the procedure in adults. In recent decades, there have been significant changes in the medical care available to children, particularly for those who need intensive care. Surgical conditions have also improved, and there has been an advent of new equipment and medications. These advances have brought changes to both tracheostomy indications and tracheostomy complications.
OBJECTIVE
To perform a review of the articles published over the last three decades on the complications and mortality associated with tracheostomies in children.
METHODS
Articles were selected from the Cochrane, Latin American and Caribbean Health Sciences Literature, SciELO, National Library of Medicine (Medline Plus), and PubMed online databases. The articles selected had been published between January 1985 and December 2014, and the data was compared using the Chi-square test.
RESULTS
A total of 3797 articles were chosen, 47 of which were used as the basis for this review. When the three decades were evaluated as a whole, an increase in tracheostomies in male children under one year of age was found. The most common complications during the period analyzed in descending order of frequency were granuloma, infection, and obstruction of the cannula, accidental decannulation, and post-decannulation tracheocutaneous fistula. In the second and third decades of the review, granulomas represented the most common complication; in the first decade of the review, pneumothoraces were the most common. Mortality associated with tracheostomy ranged from 0% to 5.9%, while overall mortality ranged from 2.2% to 59%. In addition, the review included four studies on premature and/or very underweight infants who had undergone tracheostomies; the studies reported evidence of higher mortality in this age group to be largely associated with underlying diseases.
CONCLUSION
Improved surgical techniques and intensive care, the creation of new medications, and vaccines have all redefined the main complications and the mortality rates of tracheostomy in children. It is a safe procedure that increases chances of survival in those who require the prolonged use of mechanical ventilation.
Topics: Child; Humans; Postoperative Complications; Tracheostomy
PubMed: 27256033
DOI: 10.1016/j.bjorl.2016.04.005 -
Respiratory Care Apr 2005Complications from surgical procedures are common and must be taken into account when assessing the risks and benefits of a particular treatment approach. Common acute... (Comparative Study)
Comparative Study Review
Complications from surgical procedures are common and must be taken into account when assessing the risks and benefits of a particular treatment approach. Common acute risks of tracheostomy include bleeding, airway loss, damage to adjacent structures, and failure of the chosen technique to achieve successful airway placement. The frequency and severity of these occurrences depends on several factors. These include the specific approach to tracheostomy, the skill and experience of the operator, and patient anatomic and physiologic factors. The incidence of undesired outcomes during tracheostomy cannot be exactly predicted because of the interaction of the above issues. This paper will consider some of the common and less common acute complications of several of the usual techniques for temporary tracheostomy placement in critically ill patient.
Topics: Equipment Failure; Hemorrhage; Humans; Patient Selection; Pneumothorax; Risk Assessment; Tracheal Stenosis; Tracheostomy; Wound Infection
PubMed: 15807913
DOI: No ID Found -
European Archives of... Jul 2020The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients.
PURPOSE
The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients.
METHODS
We describe our synergic experience between ENT and ICU Departments at University Hospital of Modena underlining some controversial aspects that would be worth discussing tracheostomies in these patients. During the last 2 weeks, we performed 28 tracheostomies on patients with ARDS due to COVID-19 infection who were treated with IMV.
RESULTS
No differences between percutaneous and surgical tracheostomy in terms of timing and no case of team virus infection.
CONCLUSION
In our experience, tracheostomy should be performed only in selected patients within 7- and 14-day orotracheal intubation.
Topics: Adult; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Intensive Care Units; Intubation, Intratracheal; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pandemics; Patient Care Team; Pneumonia, Viral; Respiratory Distress Syndrome; SARS-CoV-2; Tracheostomy; Treatment Outcome
PubMed: 32322959
DOI: 10.1007/s00405-020-05982-0