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Revista Da Associacao Medica Brasileira... 2023The objective of this study was to compare the clinical outcomes of percutaneous dilatational tracheostomy in COVID-19 and non-COVID-19 patients.
First management of percutaneous dilatational tracheostomy in severe acute respiratory syndrome coronavirus 2 akin to the vital head and neck region and thyroid gland bed: trust, but be careful whom (you trust)?
OBJECTIVE
The objective of this study was to compare the clinical outcomes of percutaneous dilatational tracheostomy in COVID-19 and non-COVID-19 patients.
METHODS
A total of 48 patients who underwent percutaneous dilatational tracheostomy, with 24 COVID-19 patients (Group C) and 24 non-COVID-19 patients (Group N), were included in the study. Patients' demographic features including age and gender, time to intubation, duration of intubation, Acute Physiology and Chronic Health Evaluation scores, comorbidities, duration of opening tracheostomy, complications, duration of mechanical ventilation, length of stay in the intensive care units, and mortality were recorded and compared between the groups.
RESULTS
There was no statistically significant difference between the groups regarding age and gender (p=0.558 and p=0.110, respectively). Time to intubation was significantly more prolonged, and intubation follow-up duration was significantly shorter in Group C compared to Group N (p=0.034 and p=0.002, respectively). The Acute Physiology and Chronic Health Evaluation score was statistically significantly higher in Group N compared with Group C (p=0.012). The most common comorbidity was hypertension in 29 (60.4%) patients, followed by cerebrovascular disease in 19 (39.6%) patients. There was no statistically significant difference between the groups regarding mortality (p=0.212).
CONCLUSION
This study suggests that percutaneous dilatational tracheostomy can be performed safely in COVID-19 and non-COVID-19 patients. However, COVID-19 patients may have a longer time to intubation and shorter intubation follow-up duration than non-COVID-19 patients. The study also found a higher incidence of complications in COVID-19 patients undergoing percutaneous dilatational tracheostomy. These results emphasize the importance of careful patient selection, meticulous technique, and close postoperative monitoring in patients undergoing percutaneous dilatational tracheostomy, particularly in those with COVID-19.
Topics: Humans; Tracheostomy; SARS-CoV-2; Thyroid Gland; Trust; COVID-19
PubMed: 37792870
DOI: 10.1590/1806-9282.20230832 -
Respiratory Care Aug 2010Knowing when to change a tracheostomy tube is important for optimal management of all patients with tracheostomy tubes. The first tracheostomy tube change, performed 1-2... (Review)
Review
Knowing when to change a tracheostomy tube is important for optimal management of all patients with tracheostomy tubes. The first tracheostomy tube change, performed 1-2 weeks after placement, carries some risk and should be performed by a skilled operator in a safe environment. The risk associated with changing the tracheostomy tube then usually diminishes over time as the tracheo-cutaneous tract matures. A malpositioned tube can be a source of patient distress and patient-ventilator asynchrony, and is important to recognize and correct. Airway endoscopy can be helpful to ensure optimal positioning of a replacement tracheostomy tube. Some of the specialized tracheostomy tubes available on the market are discussed. There are few data available to guide the timing of routine tracheostomy tube changes. Some guidelines are suggested.
Topics: Algorithms; Equipment Design; Equipment Failure; Humans; Tracheostomy
PubMed: 20667154
DOI: No ID Found -
Respiratory Care Dec 2017One-way speaking valves have been successfully used to restore audible meaningful speech in adult patients after tracheostomy tube placement. One-way speaking valves... (Review)
Review
One-way speaking valves have been successfully used to restore audible meaningful speech in adult patients after tracheostomy tube placement. One-way speaking valves have also been used in pediatric patients after tracheostomy tube placement with promising results. We conducted a scoping review to synthesize and summarize the current evidence on the use of one-way tracheostomy tube speaking valves in the pediatric population to identify knowledge gaps that could inform future research programs and facilitate evidence-based clinical decision making. The Arksey and O'Malley 5-step methodological framework was used for this scoping review. We searched OVID MEDLINE, EMBASE, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar to locate articles published between January 1, 1946 and May 26, 2016. Our search resulted in a total of 524 articles. After removing 270 duplicates, we screened 254 abstracts, and 50 articles were identified for full text review. We excluded 38 references. A total of 12 articles met our inclusion criteria. Details of all studies were charted. Application of the Sackett levels of evidence to evaluate the qualitative strength of the evidence provided by the 12 articles selected for study found that 6 studies were level 5, 4 were level 4, and 2 studies were categorized as level 3 evidence. Eligibility criteria for trials of speaking valves were inconsistent across all studies and included a combination of clinical assessment coupled with published indications. Much of the literature has focused on tolerance/successful use of speaking valves in children with a tracheostomy with limited evidence on its impact on verbal communication. Current evidence on the use of speaking valves in children with a tracheostomy, its indication, and its impact on verbal communication is inadequate, mandating further research in this area.
Topics: Child; Female; Humans; Male; Postoperative Complications; Speech; Speech Disorders; Speech Therapy; Surgical Instruments; Tracheostomy
PubMed: 28928262
DOI: 10.4187/respcare.05599 -
Critical Care Medicine Sep 2022The use of extracorporeal membrane oxygenation (ECMO) in patients with COVID-19 has been supported by major healthcare organizations, yet the role of specific management...
Tracheostomy Practices and Outcomes in Patients With COVID-19 Supported by Extracorporeal Membrane Oxygenation: An Analysis of the Extracorporeal Life Support Organization Registry.
OBJECTIVES
The use of extracorporeal membrane oxygenation (ECMO) in patients with COVID-19 has been supported by major healthcare organizations, yet the role of specific management strategies during ECMO requires further study. We sought to characterize tracheostomy practices, complications, and outcomes in ECMO-supported patients with acute respiratory failure related to COVID-19.
DESIGN
Retrospective cohort study.
SETTING
ECMO centers contributing to the Extracorporeal Life Support Organization Registry.
PATIENTS
Patients 16 years or older receiving venovenous ECMO for respiratory support for: 1) COVID-19 in 2020 and 2021 (through October 2021) and 2) pre-COVID-19 viral pneumonia in 2019.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We identified 7,047 patients who received ECMO support for acute respiratory failure related to COVID-19. A total of 32% of patients were recorded as having a tracheostomy procedure during ECMO, and 51% had a tracheostomy at some point during hospitalization. The frequency of tracheostomy was similar in pre-COVID-19 viral pneumonia, but tracheostomies were performed 3 days earlier compared with patients with COVID-19 (median 6.7 d [interquartile range [IQR], 3.0-12.0 d] vs 10.0 d [IQR, 5.0-16.5 d]; p < 0.001). More patients were mobilized with pre-COVID-19 viral pneumonia, but receipt of a tracheostomy during ECMO was associated with increased mobilization in both cohorts. More bleeding complications occurred in patients who received a tracheostomy, with 9% of patients with COVID-19 who received a tracheostomy reported as having surgical site bleeding.
CONCLUSIONS
Tracheostomies are performed in COVID-19 patients receiving ECMO at rates similar to practices in pre-COVID-19 viral pneumonia, although later during the course of ECMO. Receipt of a tracheostomy was associated with increased patient mobilization. Overall mortality was similar between those who did and did not receive a tracheostomy.
Topics: COVID-19; Extracorporeal Membrane Oxygenation; Humans; Registries; Respiratory Distress Syndrome; Respiratory Insufficiency; Retrospective Studies; Tracheostomy
PubMed: 35607973
DOI: 10.1097/CCM.0000000000005579 -
European Annals of Otorhinolaryngology,... Sep 2018Small children with tracheostomy are at potential risk and have very specific needs. International literature describes the need for tracheostomy in 0.5% to 2% of...
INTRODUCTION
Small children with tracheostomy are at potential risk and have very specific needs. International literature describes the need for tracheostomy in 0.5% to 2% of children following intubation. Reports of children submitted to tracheostomy, their characteristics and needs are limited in developing countries and therefore there is a lack of health programs and government investment directed to medical and non-medical care of these patients. The aim of this study was to describe the characteristics of these children and identify problems related to or caused by the tracheostomy.
METHODS
A retrospective cohort study was performed based on a common database applied in four high complexity healthcare facilities to children submitted to tracheostomy from January 2013 to December 2015. Data concerning children's demographics, indication for tracheostomy, early and late complications related to tracheostomy, airway diagnosis, comorbidities and decannulation rates are reported. Patients who did not present a complete database or had a follow-up of less than six months were excluded.
RESULTS
A total of 160 children submitted to tracheostomy during the three-year period met the criteria and were enrolled in this study. Median age at tracheostomy was 6.9 months (ranging from 1 month to 16 years, interquartile range of 26 months). Post-intubation laryngitis was the most frequent indication (48.8%). Comorbidities were frequent: neurologic disorders were reported in 40%, pulmonary pathologies in 26.9% and 20% were premature infants. Syndromic children were 23.1% and the most frequent was Down's syndrome. The most common early complication was infection that occurred in 8.1%. Stomal granulomas were the most frequent late complication and occurred in 16.9%. Airway anomalies were frequently diagnosed in follow-up endoscopic evaluations. Subglottic stenosis was the most frequent airway diagnosis and occurred in 29.4% of the cases followed by laryngomalacia, suprastomal collapse and vocal cord paralysis. Decannulation was achieved in 22.5% of the cases in the three-year period. The main cause for persistent tracheostomy was the need for further treatment of airway pathology. Mortality rate was 18.1% during this period but only 1.3% were directly related to the tracheostomy, the other deaths were a consequence of other comorbidities.
CONCLUSION
Tracheostomies were performed mostly in very small children and comorbidities were very common. Once a tracheostomy was performed in a child in most cases it was not removed before a year. The most common early complication was stoma infection followed by accidental decannulation. The most frequent late complication was granuloma and suprastomal collapse. Airway abnormalities were very frequent in this population and therefore need to be assessed before attempting decannulation.
Topics: Adolescent; Airway Obstruction; Brazil; Child; Child, Preschool; Cohort Studies; Comorbidity; Congenital Abnormalities; Deglutition Disorders; Female; Follow-Up Studies; Granuloma; Humans; Infant; Infant, Newborn; Infections; Male; Respiration, Artificial; Retrospective Studies; Tracheostomy
PubMed: 30193946
DOI: 10.1016/j.anorl.2018.07.007 -
International Wound Journal Feb 2023Tracheostomy is one of the more commonly performed procedures in critically ill patients under mechanical ventilation. Postoperative scarring is one of the bothersome...
Tracheostomy is one of the more commonly performed procedures in critically ill patients under mechanical ventilation. Postoperative scarring is one of the bothersome sequelae of tracheostomies. Scars distort physical appearance, especially when found on the head and neck, which could have a negative impact on quality of life. The aim of this study was to evaluate and assess the impact of post-tracheostomy scars on quality of life according to the tracheostomy method. A prospective, single-center, observational, case-control study was conducted. One hundred fifty-six persons with a post-tracheostomy surgical scar for more than four months were observed using the Patient and Observer Scar Assessment Scale and Dermatology Life Quality Index questionnaire. Persons were divided into two groups depending on the method of tracheostomy, and the duration of the cannulated period was considered in both groups. Statistical analyses were performed using SPSS ver. 16.0 (SPSS Inc., Chicago, IL, USA), and P values of <0.05 were considered significant. The patients who had a tracheostomic tube cannulation period of fewer than 15 days had better cosmetic results than those who had tracheostomic tubes for more than 15 days, regardless of the tracheostomy method: 6.64 ± 0.082 versus 16.15 ± 0.096 (P < 0.001) in the surgical tracheostomy group and 7.26 ± 0.211 versus 14.17 ± 0.379 (P < 0.05) in the percutaneous dilatational group. The Dermatology Life Quality Index scores had a mean value of 0.6 ± 0.01, which means that post-tracheostomy scarring in the present study had no effect on the person's quality of life. The aesthetic outcomes of post-tracheostomy scars after the open surgical tracheostomy technique did not significantly differ from those of the percutaneous dilatational technique in the present study. Persons with a long duration of tracheostomic tube ventilation showed worse aesthetic outcomes than those with short-term tracheostomic cannulation, which was not dependent on the tracheostomy technique. The Dermatology Life Quality Index showed that post-ttracheostomy scarring in the present study had no effect on the person's quality of life.
Topics: Humans; Tracheostomy; Cicatrix; Case-Control Studies; Prospective Studies; Quality of Life
PubMed: 35801258
DOI: 10.1111/iwj.13885 -
The Journal of Spinal Cord Medicine Jul 2022Patients with spinal cord injury (SCI) often require tracheostomy as an immediate life-saving measure. Successful decannulation, or removal of the tracheostomy,...
Patients with spinal cord injury (SCI) often require tracheostomy as an immediate life-saving measure. Successful decannulation, or removal of the tracheostomy, improves patient quality of life, function, and physical appearance and is considered an important rehabilitative milestone for SCI patients. We sought to synthesize the existing published literature on SCI patients undergoing decannulation. Ovid MEDLINE, Embase, Web of Science, CINAHL, and Cochrane Central Register of Controlled Trials were systematically searched through July 2, 2019 using appropriate keywords and MeSH terms pertaining to tracheostomy and SCI. Searches were human-subject only without language restrictions. Published literature discussing the outcomes of SCI patients who underwent decannulation were screened using inclusion/exclusion criteria determined and reviewed. Twenty-six publications were eligible for review and synthesis out of 1,493 unique articles. Over half of the studies were retrospective case series or reports. The research was nearly all published within the fields of physical medicine and rehabilitation, neurology, and pulmonary/critical care. Three themes emerged from review: (1) interdisciplinary or multidisciplinary tracheostomy team management to optimize decannulation processes, (2) non-invasive intermittent positive-pressure ventilatory support instead of tracheostomy-based ventilator support, and (3) wide variation in the reporting of post-decannulation clinical outcomes. Published research lacks a consistent taxonomy for reporting post-decannulation outcomes in SCI patients. Non-invasive ventilation research could benefit many SCI patients but has been studied in depth primarily by a single authorship group. Further investigation into the socioeconomic and fiscal impact on tracheostomies on SCI patients is warranted.
Topics: Catheterization; Device Removal; Humans; Respiration, Artificial; Retrospective Studies; Spinal Cord Injuries; Tracheostomy
PubMed: 33166214
DOI: 10.1080/10790268.2020.1832397 -
ANZ Journal of Surgery Jul 2022Tracheostomy is a commonly performed procedure in patients with coronavirus disease 2019 (COVID-19) receiving mechanical ventilation (MV). This review aims to... (Review)
Review
BACKGROUND
Tracheostomy is a commonly performed procedure in patients with coronavirus disease 2019 (COVID-19) receiving mechanical ventilation (MV). This review aims to investigate the occurrence of SARS-CoV-2 transmission from patients to healthcare workers (HCWs) when tracheostomies are performed.
METHODS
This systematic review used the preferred reporting items for systematic reviews and meta-analysis framework. Studies reporting SARS-CoV-2 infection in HCWs involved in tracheostomy procedures were included.
RESULTS
Sixty-nine studies (between 01/11/2019 and 16/01/2022) reporting 3117 tracheostomy events were included, 45.9% (1430/3117) were performed surgically. The mean time from MV initiation to tracheostomy was 16.7 ± 7.9 days. Location of tracheostomy, personal protective equipment used, and anaesthesia technique varied between studies. The mean procedure duration was 14.1 ± 7.5 minutes; was statistically longer for percutaneous tracheostomies compared with surgical tracheostomies (mean duration 17.5 ± 7.0 versus 15.5 ± 5.6 minutes, p = 0.02). Across 5 out of 69 studies that reported 311 tracheostomies, 34 HCWs tested positive for SARS-CoV-2 and 23/34 (67.6%) were associated with percutaneous tracheostomies.
CONCLUSIONS
In this systematic review we found that SARS-CoV-2 transmission to HCWs performing or assisting with a tracheostomy procedure appeared to be low, with all reported transmissions occurring in 2020, prior to vaccinations and more recent strains of SARS-CoV-2. Transmissions may be higher with percutaneous tracheostomies. However, an accurate estimation of infection risk was not possible in the absence of the actual number of HCWs exposed to the risk during the procedure and the inability to control for multiple confounders related to variable timing, technique, and infection control practices.
Topics: COVID-19; Health Personnel; Humans; Personal Protective Equipment; SARS-CoV-2; Tracheostomy
PubMed: 35655401
DOI: 10.1111/ans.17814 -
Revista Do Colegio Brasileiro de... 2011The percutaneous dilatational tracheostomy has become the technique of choice in the Intensive Care Unit, due safety and facilities to be performed at bedside, wich may... (Review)
Review
The percutaneous dilatational tracheostomy has become the technique of choice in the Intensive Care Unit, due safety and facilities to be performed at bedside, wich may overcome the risks associated with transport of critically ill patients to the Operating Room. Proponents of percutaneous dilatational tracheostomy suggest that the limited dissection results in less tissue damage, lowers the risk of bleeding and wound infection. The aim of this study is to review the techniques of percutaneous dilatational tracheostomy through a critical analysis of it's indications, contra-indications and complications, as well to compare percutaneous dilatational tracheostomy to surgical tracheostomy. This manuscript analysis and synthesizes randomized prospective studies, meta-analysis and systematic reviews, comparing both techniques in adult critically ill patients in the Intensive Care Unit.
Topics: Equipment Design; Humans; Tracheostomy
PubMed: 22267143
DOI: 10.1590/s0100-69912011000600012 -
Thorax Oct 2023Tracheostomies in children are associated with significant morbidity, poor quality of life, excess healthcare costs and excess mortality. The underlying mechanisms...
BACKGROUND
Tracheostomies in children are associated with significant morbidity, poor quality of life, excess healthcare costs and excess mortality. The underlying mechanisms facilitating adverse respiratory outcomes in tracheostomised children are poorly understood. We aimed to characterise airway host defence in tracheostomised children using serial molecular analyses.
METHODS
Tracheal aspirates, tracheal cytology brushings and nasal swabs were prospectively collected from children with a tracheostomy and controls. Transcriptomic, proteomic and metabolomic methods were applied to characterise the impact of tracheostomy on host immune response and the airway microbiome.
RESULTS
Children followed up serially from the time of tracheostomy up to 3 months postprocedure (n=9) were studied. A further cohort of children with a long-term tracheostomy were also enrolled (n=24). Controls (n=13) comprised children without a tracheostomy undergoing bronchoscopy. Long-term tracheostomy was associated with airway neutrophilic inflammation, superoxide production and evidence of proteolysis when compared with controls. Reduced airway microbial diversity was established pre-tracheostomy and sustained thereafter.
CONCLUSIONS
Long-term childhood tracheostomy is associated with a inflammatory tracheal phenotype characterised by neutrophilic inflammation and the ongoing presence of potential respiratory pathogens. These findings suggest neutrophil recruitment and activation as potential exploratory targets in seeking to prevent recurrent airway complications in this vulnerable group of patients.
Topics: Child; Humans; Tracheostomy; Proteomics; Quality of Life; Trachea; Inflammation
PubMed: 36808087
DOI: 10.1136/thorax-2022-219557