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At least 145 records · Page 8Linked to original sources
PubMed2000

Appropriateness of routine postoperative chest radiography after tracheotomy.

OBJECTIVE: To determine the appropriateness of postoperative chest radiography after adult tracheotomy. DESIGN: Retrospective case series. SETTING: Tertiary care academic medical center. PATIENTS: The records of 379 consecutive adult patients who underwent tracheotomy by the Otolaryngology-Head and Neck Surgery Service from January 1992 to December 1996 were available for review and met inclusion criteria. All patients underwent postoperative chest radiography. MAIN OUTCOME MEASURES: Frequency of postoperative tracheotomy-associated complications, most significantly pneumothorax. RESULTS: The patients had no pneumothorax on postoperative chest films. Minor complications, which were found in 7.1% of the patients, included small bleeds, wound infection, and subcutaneous emphysema. Tracheostomy-associated death occurred in 2 patients (0.5%). CONCLUSIONS: Routine postoperative chest radiography is unnecessary after adult tracheotomy. Chest radiography may be indicated by clinically suspicious signs or symptoms.

Adolescent↗
PubMed1978

Pediatric tracheotomy. A five-year comparison study.

A five-year retrospective study (1972-1976) of pediatric tracheotomies that were performed on patients (age limit, 14 years) was undertaken with the following objectives in mind. We chose to compare the indications, complications, and both the short- and long-term follow-up results of patients who were arbitrarily classified into two groups. Group 1 consisted of those patients who weighed more than 2,500 g at the time of tracheotomy, and group 2 were those who weighed less than 2,500 g. A total of 61 patients were included in our study. Forty-eight patients (57 tracheotomies) were placed into group 1, and 13 patients (15 tracheotomies) were in group 2. The results of our study demonstrate that there is a higher morbidity, complication rate, and death rate in the patients in group 2.

Adolescent↗
PubMed1993

Endoscopic assessment in children with tracheotomies.

Pediatric tracheotomy is a safe procedure, and the tube can be maintained for a prolonged period. There are, however, few guidelines regarding the endoscopic assessment of the airway following tracheotomy. From January 1988 through December 1989, the Division of Otolaryngology of The Children's Hospital of Philadelphia (Pa) performed tracheotomies on 81 patients. Thirty-two children had direct laryngoscopy and bronchoscopy at the time of the procedure, 1 week later, and at 6-month intervals for a minimum of 18 months. Four children had normal airways while 21 had intraluminal stomal granulomas, 16 had development of subglottic stenosis, nine had collapse of the anterior tracheal wall, and three had development of distal tracheal granulations. Sixteen children had multiple lesions. Anatomic changes occur in the airways of the majority of children with long-term tracheotomies, and endoscopic evaluation is an essential part of their care.

Airway Obstruction↗
PubMed1994

Tracheotomy in patients with acquired immunodeficiency syndrome. Is it necessary?

OBJECTIVE: Patients with acquired immunodeficiency syndrome (AIDS) who develop respiratory failure and require mechanical ventilation have mortality rates of 85%. Tracheotomies are performed in this patient population for prolonged intubation. However, to date, objective data on tracheotomy in patients with AIDS are lacking. Tracheotomy in ventilator-dependent patients with AIDS presents risks to patients and exposes surgeons, nurses, and operating room personnel to human immunodeficiency virus-infected blood. DESIGN: Given these considerations, we retrospectively reviewed our experience with tracheotomy in 10 intubated and ventilator-dependent patients with AIDS. CONCLUSIONS: Our study shows a mortality rate of 100%. We identify predictive factors and a prognosis that may aid in the treatment of these patients.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Near-fatal complications of tracheotomy infections and their prevention.

Infectious complications of tracheotomy range from minor to potentially fatal. Three cases are presented: clavicular osteomyelitis; innominate artery blowout with mediastinitis; and the first reported case of necrotizing fasciitis involving the chest wall related to tracheotomy infection. All patients were debilitated, with one diabetic and another steroid-dependent. Infectious sequelae occurred as late as 8 weeks following tracheotomy. The mechanism, treatment, and prevention of tracheotomy infections are reviewed. Indications for the creation of a permanent but reversible tracheostome should be expanded to prevent infections in debilitated or immunosuppressed patients in whom decannulation is unlikely.

Fasciitis↗
PubMed2003

Microsurgical tracheotomy: a pediatric model in growing rats.

Previous studies described controversial opinions about pediatric tracheotomy concerning type of tracheal incision and long-term results, which remain as important research subjects. Experimental studies on rat tracheas are scarce, probably because of technical difficulties related to the structures' small dimensions. As many rat organ and system operative procedures were studied successfully by using microsurgical techniques, we decided to develop a pediatric tracheotomy model in growing rats which would permit long-term studies. Forty-four Wistar EPM-1 growing rats weighing 86 g and aged 35 days were divided into three groups: submitted to longitudinal, transverse, and segment excision of the trachea. Under sterile technique and intramuscular anesthesia (ketamine/xylazine), the trachea was exposed and incised, according to group, and a hand-made endotracheal cannula was inserted into the organ. This cannula was assembled using a segment of 1.5-cm-long 3 French silicone catheter passed through hexagonal-shaped silicone screen. The tracheal cannula was removed after 7 days, when we evaluated body weight, secretions, and dehiscence. In conclusion, this microsurgical tracheotomy model in growing rats is feasible, allowing studies on long-term repercussions of pediatric tracheotomy.

Animals↗
PubMed2003

Weaning from tracheotomy in long-term mechanically ventilated patients: feasibility of a decisional flowchart and clinical outcome.

OBJECTIVE: To assess the feasibility of following a decisional flowchart to decide whether to remove tracheotomy in long-term mechanically ventilated patients. DESIGN AND SETTING: Prospective study in a respiratory intensive care unit, with beds dedicated to weaning from prolonged mechanical ventilation. PATIENTS AND PARTICIPANTS: 108 tracheotomized patients with respiratory failure of different causes (chronic obstructive pulmonary disease, postsurgical complications, recovery from hypoxemic respiratory failure, neuromuscular disorders), 36 of whom died or could not be weaned from mechanical ventilation. INTERVENTIONS: We applied a decisional flowchart based on some simple clinical and physiological parameters aimed at assessing the patient's ability to remove secretions, swallowing function, absence of psychiatric diseases, possibility of reaching spontaneous breathing, and amount of respiratory space. MEASUREMENTS AND RESULTS: Following our flowchart 56 of the remaining patients were successfully weaned from the tracheotomy cannula, with a reintubation rate at 3 months of 3%. The main reasons for not proceeding to decannulation were inability to remove secretions and severe glottic stenosis. No statistical differences were found between patients who received a surgical or percutaneous tracheotomy. CONCLUSIONS: Using a simple decisional flowchart we were able to remove tracheotomy cannula in almost 80% of the patients with spontaneous breathing autonomy without major clinical complications. Further larger prospective studies are needed to confirm this clinical approach in larger and different populations.

APACHE↗
PubMed1990

Infant tracheotomy--endoscopy and decannulation.

The records of 73 infants aged 24 months or less who underwent tracheotomy in a 10-year period were reviewed. Two common problems before decannulation were granulations and suprastomal collapse of the anterior tracheal wall above the internal stoma. There were no decannulation failures which could not be accounted for by the primary airway problem. There was no evidence of unexplained "dependence" on the tracheotomy. The results confirm that tracheotomy in the infant patient can be safe both short-term and long-term. There has been no similar long-term review of tracheotomy in small infants indicating the place of endoscopy and the technique of decannulation.

Australia↗
PubMed1992

Pediatric tracheotomy referrals to speech-language pathology in a children's hospital.

The pattern of referral of infants and children with tracheotomy to speech-language pathology (SLP) was studied through a retrospective review. Less than half (29/62) were referred to SLP with no difference by surgical service (otolaryngology vs pediatric surgery) or length of time with tracheotomy. Younger children were referred far less frequently than older children. Furthermore, more than half of all children referred to SLP showed moderate to severe communication deficits. Central nervous system abnormalities were documented in 66% of the subjects. In the majority tracheotomies were in place longer than 12 months. On the basis of the findings, a protocol was established for early routine involvement of SLP with infants and children with tracheotomy.

Adolescent↗
PubMed1993

An analysis of the inferior based tracheal flap for pediatric tracheotomy.

In the past, various tracheotomy incisions have been used at the Children's Hospital of Michigan with the occurrence of complications related to accidental decannulation and immediate recannulation. Since that time the inferior based tracheal cartilage flap has been used to minimize early complications. A retrospective study of 126 pediatric tracheotomies performed at the Children's Hospital of Michigan from June 1986 to January 1991 was reviewed. Only tracheotomies performed by a staff otolaryngologist utilizing the inferior based tracheal cartilage flaps were reviewed. This study includes patients with a 6 month to 5 year follow up. The early complication rate was 4%, while the late was 50%. Stomal granulation tissue was comparatively increased in this series of patients but did not hinder decannulation. We consider the use of the inferior based tracheal cartilage flap in the pediatric population a safe and effective technique without increasing the morbidity of long-term tracheotomy.

Airway Obstruction↗
PubMed2004

Endoscopic KTP laser excision of severe tracheotomy-associated suprastomal collapse.

OBJECTIVE: The purpose of this study was to investigate the feasibility, safety, and clinical utility of potassium-titanium-phosphate (KTP) laser bronchoscopy for excision of severe, obstructing tracheotomy-associated suprastomal collapse. METHODS: A retrospective review was performed of six children at a tertiary care children's hospital with severe tracheotomy-associated collapse of the suprastomal anterior tracheal wall cartilage, precluding decannulation. All subjects had undergone KTP laser endoscopic excision of the collapsed segment of suprastomal tracheal cartilage. Medical records were assessed for: (1) endoscopic demonstration of relief of suprastomal collapse, and (2) successful tracheotomy decannulation. RESULTS: All six patients had endoscopic evidence of relief of suprastomal airway obstruction after KTP laser therapy. Five of six (83%) subsequently underwent successful decannulation. There was one case of minimal thermal airway injury associated with a laser fire during use of the KTP laser, the effects of which were fortunately transient. CONCLUSIONS: KTP laser bronchoscopic excision of severe tracheotomy-associated suprastomal collapse: (1) is a feasible technique; (2) results in relief of suprastomal obstruction with subsequent successful decannulation in selected patients; and (3) avoids the need for more extensive open neck procedures. However, risks of KTP laser therapy are not negligible and strategies must be in place to minimize the occurrence of complications.

Bronchoscopy↗
PubMed1996

Percutaneous dilatational versus conventional open tracheotomy in a growing animal: a study in goats.

Percutaneous dilatational tracheotomy (PDT) is a new technique for the introduction of a tracheal cannula. It has been performed successfully in adults; however, in children, the open conventional technique is preferred because of the technical limitations of PDT, with fear of tracheal stenosis and adverse effects on tracheal growth. The authors studied the applicability of PDT in a growing animal. Two groups of goat kids (aged 10 days) underwent PDT or conventional open tracheotomy. They were cannulated for 7 days. Three months after decannulation, the tracheas were analyzed macroscopically and microscopically. The coronal (lateral) diameter and the cross-sectional area at the level of the stoma were 4.7 mm (SEM, 0.23 mm) and 41 mm2 (SEM, 3.0 mm2) after open tracheotomy, versus 8.1 mm (SEM, 0.13 mm) and 58 mm2 (SEM, 4.6 mm2) after PDT (P < .001 and P = .023, respectively). The quotient of the stomal cross-sectional area and the normal cross-sectional area was significantly smaller after open tracheotomy than after PDT (P < .001), with a cross-sectional area reduction of 24% to 40% in the open group. The authors conclude that PDT can be performed in growing animals without an increased risk of tracheal stenosis and adverse effects on tracheal growth. They recommended that PDT be investigated in children in a clinical setting.

Age Factors↗
PubMed2001

The role of postoperative chest radiography in pediatric tracheotomy.

A postoperative chest radiograph has traditionally been obtained after tracheotomies to evaluate for the presence of a pneumothorax and to assess tube position. Several recent studies in adults have questioned the usefulness of routine postoperative chest radiography in uncomplicated cases, but the role of post-operative chest radiography in pediatric patients has not been previously reviewed. We performed this study to examine the clinical utility of post-tracheotomy chest radiography in pediatric patients and determine if this routine practice impacts patient management enough to merit continued usage. A retrospective review was performed of 200 consecutive pediatric patients who underwent tracheotomies by the otolaryngology service in a tertiary care pediatric hospital from January 1994 to June 1999. All patients received postoperative chest radiographs. Five of 200 patients had a new postoperative radiographic finding, with three requiring interventions. Two patients required chest tube placement for pneumothorax, and one patient required tracheostomy tube change for repositioning. Fifty-one patients, including both pneumothoraces, exhibited clinical signs of pneumothorax (decreased breath sounds or oxygen saturation) in the immediate postoperative period. Chest X-ray ruled out a pneumothorax in the remaining 49 patients. The majority of these 51 patients were less than 2 years old (94%, P=0.002) or weighed less than 17 kg (89%, P=0.004). Postoperative chest X-rays yielded clinically relevant information in 168 patients that fell into one or more of four high risk categories: age less than 2, weight less than 17 kg, emergent procedures, or concomitant central line placement. Avoiding chest X-rays in the remaining 32 patients would have resulted in potential savings of $5000, which does not reflect the actuarial cost of a missed complication. Since the majority of our patients (84%) fell into a high-risk category, we feel it would be prudent to continue obtaining postoperative chest radiographs following all pediatric tracheotomies.

Chest Tubes↗
PubMed1999

The shift in the indications for the tracheotomy between 1940 and 1955: an historical review.

In the period between 1940 and 1955 the indications for tracheotomy were extended. For centuries tracheotomies were performed to treat obstructive diseases of the upper airway (hypopharynx, larynx, trachea). With the end of the second World War tracheotomy was indicated more and more for the therapy of lower airway disturbances. Medical empiricism is thought to be responsible for the gradual shift in the indications during that period from upper to lower airway disturbances. Knowledge about the underlying principles of respiratory physiology was, however, already present at the end of the 19th century, but the shift in the indications did not occur until relatively recently. For many victims of World War II the discovery of the beneficial effect of a tracheotomy in a variety of traumatic disorders may have come too late.

History, 19th Century↗
PubMed2002

Tracheotomy versus endotracheal intubation for airway management in deep neck space infections.

PURPOSE: The aim of the present study was to compare costs and outcomes for patients with deep neck infections who were treated with either tracheotomy or endotracheal intubation. MATERIALS AND METHODS: The charts of 85 patients with deep neck space infections were retrospectively studied. Requirements for inclusion in the study were incision and drainage in the operating room, involvement of more than 1 deep anatomic space, impending airway compromise, and maintenance of a postoperative artificial airway. The 85 patients were divided into 2 groups based on the type of airway used for treatment. Group 1 (n = 34) included patients who received a tracheotomy, and group 2 (n = 51) included patients whose airways were maintained with endotracheal intubation until the swelling had resolved sufficiently for extubation. RESULTS: Patients in group 1 had a shorter overall hospital stay (4.8 vs 5.9 days, NS) and spent less time in the intensive care unit (1.1 vs 3.1 days, P <.05). The overall incidence of complications was 6% for group 1 and 10% for group 2. The rate of complications secondary to loss of airway was 3% for group 1 and 6% for group 2. Average costs associated with intensive care resources were 5 times greater and overall hospital stay costs were 60% greater for group 2. CONCLUSIONS: Although both methods of airway control are useful and have a unique set of complications, the use of tracheotomy allowed earlier movement to a noncritical care unit and was associated with fewer intensive care costs and less overall cost of hospitalization. Tracheotomy may therefore provide better utilization of critical care resources in this group of patients.

Adult↗
PubMed1981

[Tracheotomy or intubation? Problems with long-term intensive care patients].

Three groups of probands were established among 77 long-term intensive care patients. Group I comprised cases intubated for more than 7 days, group II underwent tracheotomy after a variable time of intubation, and group III were tracheotomised immediately. All complications were severalfold more frequent in patients with hypercatabolic underlying disease than in those with less severe underlying disease. Long-term intubation led generally to laryngeal damage after one week and increased frequency of pneumonia after two weeks. Patients with tracheotomy after an interval showed frequent pneumonias only after one month. Inflammatory changes of trachea, bronchi, and tracheostoma with the appropriate consequences were frequent. Lower tracheal stenoses occurred in approximately 10% of cases in group II. The lowest complication rate was observed in patients tracheotomised immediately. Patients with hypercatabolic disease without prospects for improvement in the near future should be tracheotomised as early as possible. Tracheotomy can be postponed for up to three weeks if regression is to be expected in that time. In diseases without rapid physical deterioration the indication for tracheotomy can be postponed for six weeks.

Adolescent↗
PubMed2001

Incidence of pulmonary edema after tracheotomy for obstructive sleep apnea.

OBJECTIVE: The phenomenon of postobstructive pulmonary edema (POPE) has been associated with the relief of upper airway obstruction, which itself is fundamental to the pathophysiology of obstructive sleep apnea (OSA). A review of patients with OSA undergoing tracheotomy was performed to characterize this process. STUDY DESIGN: Retrospective chart review of study patients with OSA undergoing tracheotomy and of control patients without OSA undergoing tracheotomy for unrelated problems. Chest radiographs were reviewed in a double-blind fashion to score posttracheotomy changes in pulmonary status. SETTING: Academic tertiary referral center. RESULTS: Thirty (67%) of 45 OSA patients treated by tracheotomy had evidence of POPE, whereas only 5 (20%) of 25 control group patients had increased pulmonary edema. The remaining 15 (33%) of 45 OSA patients and 20 (80%) of 25 control patients had either no change or an improved pulmonary status. Those with OSA that developed POPE were mostly graded as having mild pulmonary edema (22/30, 73%). Far fewer were graded as having moderate pulmonary edema (6/30, 20%), and fewer still with severe pulmonary edema (2/30, 7%). Two (7%) of 45 patients with severe POPE died of complications related to cor pulmonale in the postoperative period. CONCLUSION: Results support maintaining a high index of suspicion for the development of postobstructive pulmonary edema in patients treated for OSA. Treatment options, such as positive pressure ventilation and diuresis, and an increased awareness of this condition may help reduce the morbidity and mortality associated with treatment of this disease.

Humans↗
PubMed1997

Suprastomal granulation tissue and pediatric tracheotomy decannulation.

Although numerous decannulation techniques have been reported, often involving costly sleep studies, repetitive laser procedures, and tracheotomy tube "downsizing," no established standard of care exists. We advocate the following simple, minimally invasive decannulation protocol. After excluding concomitant airway lesions, suprastomal granulation is removed transtomally by an endoscopically guided rongeur. A tracheotomy tube is then fashioned with a fenestration centered in the tracheal lumen. Decannulation occurs if the patient maintains adequate ventilation over a 12- to 24-hour observation period with the fenestrated tracheotomy capped. Over 18 months we prospectively followed 10 consecutive children presenting as potential decannulation candidates. Using the aforementioned technique, nine of 10 patients were successfully decannulated (average follow-up, 11.5 months). The postoperative capped fenestrated tracheotomy trial provides a realistic assessment of preparedness for decannulation. We recommend this protocol as a rapid, efficient, and cost-effective means of achieving decannulation.

Adolescent↗