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At least 19 recordsLinked to original sources
PubMed2006

[Tracheotomy-endoscop for dilatational percutaneous tracheotomy (TED)].

While surgical tracheotomies are currently performed using state-of-the-art operative techniques, percutaneous dilatational tracheostomy (PDT) is in a rapidly evolving state with regard to its technology and the number of techniques available. This has resulted in a range of new complications that are difficult to quantify on a scientific basis, given the fact that more than half of the patients who are tracheotomized in intensive care units die from their underlying disease. The new Tracheotomy Endoscope (TED) is designed to help prevent serious complications in dilatational tracheotomies and facilitate their management. The endoscope has been specifically adapted to meet the require-ments of percutaneous dilatational tracheotomies. It is fully compatible with all current techniques of PDT. The method is easy to learn. The percutaneous dilatational tracheotomy with the Tracheotomy Endoscope is a seven-step procedure: Advantages of the Tracheotomy Endoscope: Injuries to the posterior tracheal wall ar impossible (tracheoesophageal fistulas, pneumothorax). Minor bleeding sites on the tracheal mucosa can be controlled with a specially curved suction-coagulation tube introudeced through the Tracheotomy Endoscope. In cases with heavy bleeding and a risk of aspiration, the rigid indwelling Tracheotomy Endoscope provides a secure route for reintubating the patient with a cuffed endotracheal tube. It also allows for rapid conversion to an open surgical procedure if necessary. All the parts are easy to clean and are autoclavable. This type of endoscopically guided PDT creates an optimal link between the specialties of intensive care medicine and otorhinolaryngology. The Tracheotomy Endoscope (TED) increases the standard of safety in PDT.

Blood Loss, Surgical↗
PubMed2004

A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients.

OBJECTIVE: The timing of tracheotomy in patients requiring mechanical ventilation is unknown. The effects of early percutaneous dilational tracheotomy compared with delayed tracheotomy in critically ill medical patients needing prolonged mechanical ventilation were assessed. DESIGN: Prospective, randomized study. SETTING: Medical intensive care units. PATIENTS: One hundred and twenty patients projected to need ventilation >14 days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were prospectively randomized to either early percutaneous tracheotomy within 48 hrs or delayed tracheotomy at days 14-16. Time in the intensive care unit and on mechanical ventilation and the cumulative frequency of pneumonia, mortality, and accidental extubation were documented. The airway was assessed for oral, labial, laryngeal, and tracheal damage. Early group showed significantly less mortality (31.7% vs. 61.7%), pneumonia (5% vs. 25%), and accidental extubations compared with the prolonged translaryngeal group (0 vs. 6). The early tracheotomy group spent less time in the intensive care unit (4.8 +/- 1.4 vs. 16.2 +/- 3.8 days) and on mechanical ventilation (7.6 +/- 2.0 vs. 17.4 +/- 5.3 days). There was also significantly more damage to mouth and larynx in the prolonged translaryngeal intubation group. CONCLUSIONS: This study demonstrates that the benefits of early tracheotomy outweigh the risks of prolonged translaryngeal intubation. It gives credence to the practice of subjecting this group of critically ill medical patients to early tracheotomy rather than delayed tracheotomy.

Procedural Sedation↗
PubMed1999

Effect of a one-way tracheotomy speaking valve on the incidence of aspiration in previously aspirating patients with tracheotomy.

The purpose of the present study was to investigate the incidence of aspiration in previously aspirating patients with tracheotomy after use of a one-way tracheotomy tube speaking valve. Twenty consecutive inpatients from the acute care setting of a large urban tertiary care teaching hospital were included. All subjects had objective documentation of aspiration by a fiberoptic endoscopic evaluation of swallowing prior to placement of a one-way tracheotomy speaking valve, from 2 to 7 days of valve use with intelligible speech production, and no surgery to the upper aerodigestive tract except tracheotomy. Results indicated that incidence of aspiration was not affected by use of a one-way tracheotomy speaking valve. These results are in agreement with previous observations that subjects either aspirated or swallowed successfully regardless of tracheotomy tube occlusion status. Also, no significant differences were found between aspiration status and time since tracheotomy, time off ventilator, or duration of valve use. It was concluded that use of a one-way speaking valve provided mostly nondeglutitive benefits and should not be considered to promote successful swallowing for patients with tracheotomy in the acute care setting.

Aged↗
PubMed2003

Percutaneous dilation tracheotomy versus surgical tracheotomy: our experience.

BACKGROUND: Percutaneous dilation tracheotomy (PDT) is becoming a popular alternative to surgical tracheotomy. In our department, we recently adopted the use of the PDT in intensive care unit patients. Here, we compare the results of the use of these 2 techniques on 150 patients, all performed by the same surgeon. We discuss the pros and cons of PDT and present our experience with the technique compared with surgical tracheotomy (ST). MATERIALS AND METHODS: A prospective study of 75 PDTs and a retrospective study of 75 surgical tracheotomies (ST) were performed at the Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, Haifa, Israel. Age, sex, duration of intubation before surgery, time interval between the decision to perform and the performance of tracheotomy, and cost were compared. RESULTS: One hundred fifty tracheotomies were reviewed. The indication for tracheotomy in both groups was prolonged mechanical ventilation. Seven patients were found unsuitable for PDT and underwent ST. Complications included 3 cases of mild postoperative hemorrhage in the ST group, and 1 case of subcutaneous emphysema, 1 case of stomal cellulitis and 2 cases of mild postoperative hemorrhage in the PDT group. The average waiting interval was between 2 to 5 days for ST and 1 to 24 hours for PDT. The intraoperative time for ST was 20 minutes; for PDT, 5 minutes. The cost was 565 dollars for ST and 274 dollars for PDT. CONCLUSIONS: PTD provides an easy, less expensive, and convenient alternative to ST and should be added to the otolaryngologists' armamentarium of surgical airway procedures. The procedure is advantageous for the patient. Complication rates of both techniques are similar and low; however, PDT is a blind technique of obtaining a surgical airway and therefore holds more potential for serious complications. It is our conclusion that this technique is suitable for many, but not all, critical care patients and that the procedure should be performed only by surgeons who are capable of urgently obtaining a surgical airway or exploring the neck should the PDT fail.

Adult↗
PubMed2001

Cost/benefit analysis of open tracheotomy, in the or and at the bedside, with percutaneous tracheotomy.

OBJECTIVES/HYPOTHESIS: (1) To determine whether percutaneous dilational tracheotomy (PDT), open tracheotomy in the operating room (OT/OR), and open tracheotomy at the bedside (OT/BS) are equally safe; and (2) to determine which procedure was most cost effective. STUDY DESIGN: Retrospective review of patient medical records and billing data. METHODS: Any adult patient (>20 y of age) on the medical or surgical services at Penn State Milton S. Hershey Medical Center who required a tracheotomy, elective or emergent, from September 1996 to July 1997 was included. The decision to perform OT in the OR, PDT, or OT at BS was made by the attending surgeon independent of this study. Each patient's course after tracheotomy was reviewed. All complications, perioperatively or postoperatively, for up to 10 days were documented. The complications were divided into two groups: major and minor. Determination of patient cost used surgical billing and OR materials staff records. The necessary equipment and staff for each procedure was determined, and an itemized cost list was retrospectively developed for a typical PDT, OT in OR, or OT at BS. The P values were calculated with the Cochran-Mantel-Haenszel (CMH) chi(2) test of association. RESULTS: All procedures were equally safe, with PDT being the most cost effective. CONCLUSION: This report confirms the results of several studies demonstrating that PDT, OT in the OR, and OT at the BS are equally safe; PDT appears to be most cost effective. Our analysis, however, does reveal several options for decreasing the cost of bedside tracheotomy to allow this procedure to be even more cost effective than PDT.

Adult↗
PubMed2003

Improving children's cooperation with tracheotomy care by performing and caring for a tracheotomy in the child's doll-a case analysis.

Described is a 2-year-old child who required a tracheotomy for an obstructing laryngeal tumor. Post-operatively the child responded with extreme anxiety and refused to cooperate with tracheostomy care including suctioning, tie changing and cannula change. A novel approach was attempted. We performed a tracheotomy on the child's favorite doll and taught her to perform all the necessary tracheostomy care on the doll. Once the child became accustomed to treating the doll, it became much easier to care for her tracheostomy and compliance to treatment improved greatly to the point were restraint was no longer required. This model of mock surgery and care of a child's doll may be helpful in treating young children with tracheotomies.

Child, Preschool↗
PubMed1999

[Comparative study of percutaneous tracheotomy and conventional surgical tracheotomy in patients with prolonged intubation].

BACKGROUND: Percutaneous tracheotomy (PT) has become an alternative to conventional surgical tracheotomy (CST) in recent years. Our aim was to compare the advantages and disadvantages of the two techniques in our intensive care unit (ICU). PATIENTS AND METHODS: Two patient groups were compared. Sixty underwent PT and 47 underwent CST, and all were admitted to the ICU between May 1995 and August 1997. PT was performed in 49 by way of progressive dilations, and 11 were performed by Griggs' method using a dilator. Variables studied were age, sex, reason for admission, APACHE II upon admission to the ICU, duration of technique, and immediate and late complications. Statistical analysis was provided by applying a Student t test to contrast quantitative variables and a chi-squared test to compare proportions. RESULTS: The following variables were significantly different. APACHE II upon admission was 18 +/- 5 in the PT group and 15 +/- 6 in the CST group (p < 0.002). Duration of the procedure was 15 +/- 4 minutes in the PT group and 36 +/- 11 in the CST group (p < 0.005). Complications after tracheotomy in PT group patients consisted of 1 false line during a change of cannula and 1 late tracheoesophageal fistula. Complications in the CST group included 16 episodes of slight bleeding, 9 stoma infections, 3 cases of pneumothorax, 2 of bad scarring of the stoma and 1 late fistula (p < 0.005). Time of follow-up was 41 to 76 days for PT patients and 32 to 51 days for CST patients. CONCLUSIONS: PT is a fast, simple procedure that is easy to manage and requires fewer resources (operating theater, personnel and equipment) and causes fewer medium-term complications than does CST.

Adult↗
PubMed2001

[Post-tracheotomy pneumothorax. Is thoracic radiography required after each tracheotomy?].

Pneumothorax complicating a tracheotomy is a rare event, but it should be clinically considered in order to the early treatment, mostly in urgent or pediatric cases. We report 2 cases in which pneumothorax complicated postoperatively the tracheotomy and required early clinic and radiologic diagnosis followed by a promptly and satisfactorily evacuated. We review the need to perform a chest X-Ray after every tracheotomy or only following those cases found to be at risk, as well some effective preventive measures.

Female↗
PubMed1977

[The technic of tracheotomy: experience with 250 tracheotomies].

The results of 250 tracheostomies, primarily or secondarily performed at the intensive care unit of the Surgical Department of the Basle University, are presented. The standardized technique of tracheotomy is described, details for the choice and management of large prestretched double-cuff tracheostomy tubes are given, a new method of low-pressure cuff-blocking is outlined. The follow-up studies --autopsy, clinical examination and tracheoscopy--demonstrate a very low complication rate, due to the technique of tracheostomy, the preferred tracheostomy tubes and the method of alternate low-pressure cuff-blocking.

Evaluation Studies as Topic↗
PubMed2003

[Clinical study on the comparison of prophylactic tracheotomy with emergent tracheotomy after inhalation injury].

OBJECTIVE: To compare prophylactic with emergent tracheostomy in 93 patients with inhalation injury, so as to explore the clinical significance of prophylactic tracheostomy. METHODS: Tracheostomy was applied in all patients with moderate and severe inhalation injury. The patients with obvious dyspnea, low oxygen pressure and decreased oxygen saturation before the operation were set to be emergent tracheostomy group (ET, n = 21), while those without dysfunction of ventilation and gas exchange, as prophylactic group (PT, n = 72). The average operation starting time was 4.31 +/- 3.04 PBH and 34.47 +/- 2.79 PBH in PT and ET groups, respectively. RESULTS: There were evident decrease of blood oxygen pressure and oxygen saturation and increase of respiratory and heart rates before the tracheostomy in ET group, but all these signs improved after the operation. In contrary, the vital signs in PT group exhibited stable perioperatively. Assisted respiration with respirator was applied in 20 cases (95.24%) in ET and in 65 cases (90.28%) in PT groups within 2 post-operative days (POD). CONCLUSION: Early and prophylactic tracheostomy should be advocated in patients suspected to be with moderate or severe inhalation injury. Emergent tracheostomy must be avoided and respiratory assistance should be employed as early as possible.

Adolescent↗