Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Tracheotomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources
PubMed2005

Impact of neck length on the safety of percutaneous and surgical tracheotomy: a prospective, randomized study.

OBJECTIVE: To investigate a correlation between neck length and the incidence of complications after both percutaneous and surgical tracheotomy (ST) and to compare the relative safety of the two procedures at our institution. STUDY DESIGN: Prospective, randomized study of patients undergoing tracheotomy at a tertiary care center. METHODS: Forty-three patients evaluated for tracheotomy at our institution between the years 2003 and 2004 were enrolled in the study and were randomly assigned to receive either an ST or a percutaneous dilatational tracheotomy (PDT). All patients underwent standardized measurement of the cricosternal distance (CSD) in the neutral and extended positions before the procedure. Demographic and procedural variables were recorded, and the occurrence of postoperative complications was followed for 1 week. RESULTS: PDT was performed in 29 patients and ST in 14 patients. The mean CSD of 2.7 cm increased to 3.7 cm after extension with a shoulder roll. PDT required less time (mean 8 vs. 23 minutes) and resulted in less blood loss compared with ST. A trend toward a higher incidence of complications with PDT (40%) compared with ST (7%) and in the first half of our series (learning curve) was noted. This, however, did not reach statistical significance. There was no correlation between the incidence of complications and neck length as determined by the CSD in either group of patients. CONCLUSIONS: We failed to demonstrate a correlation between CSD and tracheotomy related complications. Patients with short necks may be at no higher risk during either a PDT or ST. Experience, awareness of complications, and a dedicated team approach are necessary for the safe performance of PDT.

Adolescent↗
PubMedDate not supplied

Epiglottitis. Twenty-year study with tracheotomy.

One hundred and seventy patients with acute epiglottitis were admitted to the Childrens Hospital of Los Angeles between the years 1957 to 1977. No deaths occurred in any of these patients, all of whom were treated with tracheotomy to support and ensure the airway. The records of 147 of these patients were available for review. No serious complications occurred from tracheotomy in any of the patients in this study. Tracheotomy is a safe method for caring for the airway problem in epiglottitis in a setting such as is available at the Childrens Hospital of Los Angeles. The median range of total days with tracheotomy was five to six days, and the median range for total days of hospitalization was six to seven days. Complications were never severe and in the extreme, merely prolonged hospitalization by a few days. This highly lethal disease is curable with antibiotics and an artificial airway, and it is questionable whether conservative medical measures with observation should be acceptable. The establishment of an airway, whether by tracheotomy or endotracheal intubation, is mandatory in the treatment of this disease.

Acute Disease↗
PubMed1990

Predictive value of the Glasgow Coma Scale for tracheotomy in head-injured patients.

Patients with severe head trauma often require prolonged intubation and subsequent tracheotomy. The Glasgow Coma Scale (GCS), an indicator of the severity of head injury, may help identify that subpopulation of trauma victims who will ultimately undergo tracheotomy. This retrospective study demonstrates through discriminant analysis that the likelihood of tracheotomy is significantly greater in patients with a GCS rating less than or equal to 7 than it is in patients with a GCS rating greater than 7 (p = .0001). Conversely, the presence of thoracoabdominal or maxillofacial injury is associated with but not predictive of eventual tracheotomy. In the hope of minimizing complications and enhancing the utilization of hospital resources, this study argues for early tracheotomy in patients with a GCS score less than or equal to 7 who do not undergo craniotomy and are otherwise stable.

Adolescent↗
PubMed1993

The safety and efficacy of bedside tracheotomy.

Many institutions require that tracheotomies be performed in the operating room. Movement of critically ill patients dependent on multiple life support systems is technically difficult, labor intensive, and potentially dangerous for the patients. Between 1983 and 1992, 1088 tracheotomies were performed on patients ages 1 week to 94 years at the University of Rochester affiliated hospitals on critically ill patients as isolated procedures. The procedure was performed in the Intensive Care Units (ICU) on 996 patients, (92.9%), whereas 92 patients (7.1%) had tracheotomies in the operating room (OR1). An additional 346 tracheotomies took place in the operating room in conjunction with other head and neck procedures (OR2). Incidence of perioperative bleeding (within 48 hours) was 2.3% in the ICU group, 2.1% in the ORI group, and 2.0% in the OR2 group. Incidence of stomal infection was also similar among the three groups at 1.8%, 2.1%, and 1.5%, respectively. Tube dislodgement in all groups was a complication. No statistical differences were noted among the three groups (ICU, OR1, OR2) at the p < 0.01 level. Criteria for performing the tracheotomy in the ICU are delineated and discussed.

Adolescent↗
PubMed1986

Tracheotomy in infants and young children: the changing perspective 1970-1985.

One hundred fifty-three children 3 years of age or younger who had tracheotomies performed during the past 15 years are reviewed. During this time, short-term endotracheal intubation for airway obstruction from acute infections and long-term intubation for patients on ventilators have replaced early tracheotomy for these conditions. The number of tracheotomies decreased during each of three 5-year periods, from 73 to 55 to 25, respectively. Improvements in medical management resulted in prolonged survival of children with multiple abnormalities and resulted in more prolonged tracheotomies. Early complications occurred in 12% of patients and late complications occurred in 26%. In spite of changes in the indications, basic fundamentals of pediatric tracheotomy management remain unchanged.

Airway Obstruction↗
PubMed1987

Surgical complications of bedside tracheotomy in an otolaryngology residency program.

A prospective analysis of 124 consecutive adult patients undergoing tracheotomy was performed to examine the incidence of resulting complications. All tracheotomies were performed by a junior otolaryngology resident under the supervision of a member of the attending staff or a chief resident. The vast majority were performed at the bedside in an intensive care unit. The complications were divided into two groups: early (within 2 days) and late (2 to 14 days). Seven patients had complications directly related to tracheotomy. Four of these complications occurred in three patients and were considered significant. There were no mortalities. Despite the fact that our tracheotomies were routinely performed by residents at the bedside, our complication rate was comparable to those reported from other centers. We believe that bedside tracheotomy, properly supervised and performed, is a safe procedure.

Adolescent↗
PubMed1992

The role of early tracheotomy in the management of the neurosurgical patient.

Neurosurgical patients often require prolonged laryngeal intubation. The literature regarding the management of these patients is controversial, with some series reporting increased benefits of early tracheotomy and others reporting similar benefits of prolonged transtracheal intubation. One hundred sixteen consecutive neurosurgical patients who had tracheotomies performed during a 5-year period are presented in order to clarify some of the factors involved with these issues. The complications that occurred in this series were less frequent than those reported in most of the published series. Of the 116 patients, 7 had posttracheotomy complications. These complications included stomal infections (4 patients), hemorrhage (1 patient), subglottic granulation tissue (1 patient), and tracheitis (1 patient). All complications were easily treated and caused no significant long-term morbidity. Furthermore, pulmonary care was universally facilitated by the placement of a tracheotomy. The performance of an early postinjury tracheotomy may prevent the known complications of prolonged endotracheal intubation while providing effective ventilation and pulmonary toilet through safe and comfortable access to the airway. Early postinjury tracheotomy is not associated with a high incidence of significant complications in the neurosurgical patient population.

Adolescent↗
PubMed1996

Late complications of percutaneous dilatational tracheotomy.

STUDY OBJECTIVE: To assess the late complications of percutaneous dilatational tracheotomy, particularly the incidence of tracheal stenosis and voice changes. DESIGN: Prospective descriptive clinical study. SETTING: Teaching hospital, the Netherlands. PATIENTS: Eighty consecutive patients who were successfully decannulated after percutaneous tracheotomy. MEASUREMENTS AND RESULTS: Fourteen patients died after decannulation, of tracheotomy-unrelated causes. Sixty-six patients were followed up 3 to 39 months after decannulation (mean, 16 months). Fifty-four patients underwent tomography of the trachea. In 14 patients (26%), there was tracheal narrowing of more than 10%. Data analysis showed that these stenoses were operator dependent (p = 0.03). Voice changes, found in 13 (21%) of 61 patients, were major in 1 and minor in 12. Scars were generally cosmetically acceptable. Retraction of the scar, seen in 13 (19%) of 66 patients, was related to the duration of cannulation (p = 0.002). A persistent tracheocutaneous fistula was present in two patients. CONCLUSIONS: The incidence of tracheal stenosis after percutaneous dilatational tracheotomy is low compared with conventional tracheotomy. Experience with the technique is important to avoid late complications.

Adolescent↗
PubMed1999

Swallowing and speech in infants following tracheotomy.

Tracheotomy in children has been associated with significant operative and post-operative complications and disabilities. In this study, special attention was given to the post-operative effects on the ability to swallow and the development of speech in infants following tracheotomy. In 36 infants (19 boys, 17 girls) a tracheotomy was performed before the age of one year. Indications were: 1 severe upper airway obstruction (n = 25), 2. the requirement of prolonged mechanical ventilation (n = 10) and 3. intensive tracheal-broncheal suction (n = 1). In contrast of the absence of peri-operative complications, in the post-operative follow-up period we observed many complications and disabilities, partially attributable to several underlying disorders and to the tracheotomy itself. The swallowing ability was deteriorated in nearly all infants and the speech-development was seriously delayed in 38% of all infants. Infants following tracheotomy require intensive care to minimize complications and to stimulate the ability to swallow and the development of speech. Some proposals for treatment of swallowing disorders and rehabilitation are proposed.

Airway Obstruction↗
PubMed1999

[Reflections on percutaneous tracheotomy. Regarding a retrospective study of 106 cases with major burns].

About ten years ago, a new technique for tracheotomy was invented in the United States and has tended to replace the surgical technique in intensive care units. Percutaneous tracheotomy is performed by the intensive care unit physician working in the unit at the patient's bedside. Progressive expansion seems to be the method of choice. Physicians at the Center for burn victims at the Percy Army Hospital have used this technique since 1994. We performed a retrospective study of 106 cases, between 1994 and 1998, and reviewed the international literature. Percutaneous tracheotomies were performed via a vertical cutaneous discharge incision and appeared to be particularly interesting for patients with major burns who are difficult to transport and risk secondary infections. Three early and serious complications were observed, emphasizing the need of a peroperative endotracheal fiberoptic endoscopic control. Three tracheal stenoses were observed: however respiratory tract burns had occurred all three of these patients. In the literature, most of which has been written by intensive care physicians, it is rather surprising to note the enthusiasm for percutaneous tracheotomy based on the high risk of complications of the surgical technique. Moreover, possible late after effects of percutaneous tracheotomy remain unknown as few survivors have been seen again late after use of this recent technique.

Adolescent↗
PubMedDate not supplied

[Hereditary angioedema in organs of the head and neck as an indication for emergency tracheotomy].

INTRODUCTION: Angioedema (angioneurotic edema) is often associated with urticaria, but edema is located deeper in the skin and mucous membranes. There are limited, painless, soft and medium hard swellings. Lack of general symptoms is evident, except if mucous membranes of the gastrointestinal system are affected and pain appears. It is particularly dangerous if located in the brain or larynx when there is a risk of suffocation. In 20% cases with laryngeal involvement intubation or tracheotomy is necessary. CASE REPORT: This is a case report of a patient hospitalized at the Clinic, having a swelling at the front side of neck, lower lip and difficulties with deglutition. Occasionally the patient had similar difficulties in the main joints whereas periodical swellings are characteristic for his father, sister, and sister's daughter. Clinical check-up indicated a greyish swelling, of the oropharynx structure, with 1 cm respiratory space. Larynx was not visible due to swelling of epiglottis. The patient received intravenous steroid therapy, followed by infusion of physiologic solution with calcium. As his condition become very bad half an hour after admittance he was transported to the operation room. He received adrenaline but within the excepted time his respiration did not improve. Emergency tracheotomy was performed and afterwards his respiration and skin colour became normal. Regarding family anamnesis, clinical picture and laboratory results, hereditary angioedema was diagnosed. DISCUSSION: Hereditary angioedema is a rare form of angioedema which is an inherited autosomal dominant disorder. The disease is a result of deficit in C esterase inhibitor, which is a serum glycoprotein of SERPIN family (serum protease inhibitors), that is usually synthesized in hepatocytes. All the diseased are heterozygotes. There are two genetic variantions of the disease: I--patients with decreased quantity of inhibitor level in serum due to decreased synthesis and II--patients that have normal protein concentrations, but with abnormal protein, which is functionally inactive. Laryngeal edema can very soon cause narrowing of respiratory space, and if tracheotomy is not performed on time, suffocation occurs. Tracheotomy is one of the most urgent surgical interventions with the purpose to make patient's breathing easier to prevent suffocation and sometimes to save thr patient from certain death. CONCLUSION: In differential diagnosis of laryngeal edema, hereditary angioedema should be considered. Therapy of acute hereditary angioedema attacks should involve antihistamines, corticosteroids and adrenaline, as well as administration of fresh frozen plasma or infusion of C 1 inhibitor concentrate. Hereditary angioedema of the head and neck causing airway obstruction, is an indication for emergency tracheotomy.

Adult↗
PubMed2004

[Tracheotomy or prolonged tracheal intubation for long-term ventilation].

130 critically ill patients undergoing long term mechanical ventilation were divided into two groups, tracheotomy versus translaryngeal intubation. There were no difference in demographic characteristics between the two groups. The incidence of chronic obstructive pulmonary disease (COPD) was also higher in T. The tracheotomy was achieved at mean within 14 days after the beginning of mechanical ventilation. The incidence of pneumonia is the same in the two groups (41% for T versus 39% for I). The length of mechanical ventilation is longer in T (25 +/- 12 d versus 12 +/- 4 d). The COPD represent a risk factor for prolonged mechanical ventilation in T (18 days in COPD patients with tracheotomy versus 9 days in non COPD patients). The length of stay in intensive care unit is higher in T (29 +/- 13 d versus 15 +/- 4 d). The 28th day mortality is similar between the two groups. The tracheotomy didn't allow a shorter duration of mechanical ventilation. That's can be explain by the fact that we performed the tracheotomy in a high risk population for pulmonary complications (COPD) and often after a first failure of weaning form mechanical ventilation.

Adolescent↗
PubMed2006

[Tracheotomy in patients with liver transplantation].

OBJECTIVE: To investigate the indications, complications and their prevention of tracheotomy in patients with liver transplantation. METHOD: Data of 45 patients with liver transplantation who underwent tracheotomy were summarized. RESULT: Twenty-five patients(54.35%) succeeded in removing trachea cannula in one month after tracheotomy. Hemorrhage after tracheotomy occurred in 11 patients and haemostasis succeeded in all of them. Subcutaneous emphysema occurred in 2 patients. Infection of tracheal fistula occurred in 4 patients. Common bacterial culture of sputum was positive in 9 patients. No other operative complication occurred. CONCLUSION: Indications of tracheotomy in patient with liver transplantation include respiratory complication and lower respiratory tract infection. Postoperative hemorrhage and infection are the main complications and available measures should be adopted.

Adult↗
PubMed1988

[The history of tracheotomy].

Tracheotomy is one of the oldest operations in medicine. The development of tracheotomy from antiquity to our time is reported. After the beginnings of the operation in Greek and Roman medicine, the operation was called laryngotomy or bronchotomy. It was Heister who coined the name "tracheotomy". Tracheotomy is still an important operation even after more than 2000 years. In recent years there has been a change from simple tracheotomy to plastic tracheostomy.

Europe↗
PubMed1988

[Complications of tracheotomy].

The complications of tracheotomy are reviewed and divided into two categories: early and late complications depending on whether the cannula has been removed or remains in situ. In the acute period, severe haemorrhages (0.3 to 2%) and oesophagotracheal fistulae (0.5 to 2%) result from a conflict between cannula and trachea during prolonged intensive care. Cardiac arrhythmia is frequent during aspiration (35%) but rarely lethal. Various technical problems related to the tracheotomy material are common (4 to 6%) and often very serious. Air leakage is represented mainly by severe pneumothorax (1 to 5%) under artificial ventilation. Tracheotomy wound infections (0.5 to 3.5%) may facilitate pulmonary superinfections (15 to 30%) which have a 5 to 8.5% mortality rate. In the acute phase, the overall mortality rate due to the tracheotomy itself is 1.7% (40 deaths in the 2,692 tracheotomies reviewed). The main post-decannulation complication is tracheal stenosis. The incidence of severe stenosis (more than two-thirds of the tracheal diameter) varies from 8 to 12%. Stenosis is difficult to diagnose unless endoscopic examination is routinely performed. The classical treatment is surgical, but laser is helpful in this as in granulomas. In patients with in-dwelling cannula, granulomas may be responsible for pain, obstruction and bleeding which can be avoided by using an adequate equipment. Chronic invasion of the bronchi by Gram-negative organisms is almost constant and results in episodes of superinfection. Finally, patients with a permanent cannula often have psychological and social problems influencing their quality of life.

Catheterization↗
PubMed1987

[Aspects of infant and child tracheotomy].

A series of 57 tracheotomies in infants and children was subdivided into two categories. Group A consisted of patients who primarily suffered from severe obstruction of the upper airway. The results demonstrated that tracheotomy was an effective procedure in handling these cases. 30 patients were placed into group B. In this series the upper airway was primarily not involved. Considering the severe cardiac, central and nephrogenic underlying diseases tracheotomy did not play a significant role in the healing process except in few cases. Patients in group B had a higher complication rate and death rate than those in group A. Altogether two patients died because of tracheotomy-related complications (haemorrhage and displacement of cannula). For decreasing the complication rate proper surgical technique and regular endoscopic controls are necessary. "pro and contra" of tracheotomies in children are discussed.

Adolescent↗
PubMed1996

Effect of occlusion of a tracheotomy tube on aspiration.

The purpose of the present study was to investigate the effect of occlusion of a tracheotomy tube on aspiration utilizing fluoroscopy. Twenty consecutive tracheotomized patients referred for a modified barium swallow were included. Selection criteria were ability to tolerate tracheotomy tube occlusion during the modified barium swallow procedure, no surgery of the upper aerodigestive tract except tracheotomy, and no history of oropharyngeal cancer or stroke. There was 100% agreement among 3 independent reviewers on ratings of the presence or absence of aspiration. It was found that the occlusion status of the tracheotomy tube did not influence the prevalence of aspiration. Nine of 10 (90%) subjects who exhibited aspiration were over 65 years of age (mean = 72 years 2 months). No trends were observed for bolus consistency, type of tracheotomy tube, or presence/absence of a nasogastric tube and ratings of aspiration.

Adolescent↗
PubMed1950

Tracheotomy in bulbar poliomyelitis.

Tracheotomy was performed on 181 of 351 patients with bulbar poliomyelitis. The essential indication for tracheotomy was secretional obstruction of the respiratory tract that could not be relieved by postural drainage and aspiration. Comparison of mortality rates in this series with those of previous series in which tracheotomy was not done in the presence of similar indications, suggests that the procedure may be life-saving in a considerable percentage of cases. Outside the respirator the tracheotomy can be done with or without the aid of the bronchoscope or endotracheal anesthesia tube. When done inside the opened respirator the Bennett flow-sensitive positive pressure machine should be used to supply oxygen to the patient while the respirator is not operating.

Anesthesia↗