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At least 19 recordsLinked to original sources
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↗
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↗
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↗
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↗
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↗
PubMedDate not supplied

[Study of clean versus aseptic technique of tracheotomy care based on the level of pulmonary infection].

The purpose of this research study was to determine whether the clean technique of tracheotomy care is the same, or more, secure from the aseptic, by testing the difference in the level of postoperative pulmonary infection between tracheotomized patients receiving aseptic and those receiving clean tracheotomy care. The sample consisted of 103 patients with tracheotomy (transient or permanent) from ENT or IC units of four big hospitals of Athens. The level of the patient's pulmonary infection was defined using the Weighted Level of Pulmonary Infection Tool, which was constructed especially for this research study. The data were analysed using the x2 statistical test, and the coefficients phi, Cramer's V and Kendall's, while, with the same statistics, the relationship between certain important external variables and the dependent variable was examined. The findings indicated that no statistically significant difference exists between clean and aseptic technique as to the level of pulmonary infection when used for tracheotomy postoperative care of tracheotomized patients.

Adult↗
PubMed1992

Practical aspects of pediatric tracheotomy care.

Infants and children who manifest respiratory distress secondary to congenital or acquired abnormalities of the airway pose a unique problem that frequently requires a tracheotomy to control the patient's airway. These tracheotomies often are required for extended periods of time. Skilled care and astute observation are essential for the care of these patients while in hospital and at home. Although many of the care concerns relate to nursing and social issues, the otolaryngologist must maintain an active role in the medical management and co-ordination of discharge. This paper provides the otolaryngologist with an outline of the hospital care required for the pediatric tracheotomy patient. Additionally, it offers the otolaryngologist a model program for discharge planning and follow-up for the pediatric tracheotomy patient in the community.

Child↗
PubMed1992

Should granulomas be excised in children with long-term tracheotomy?

We reviewed 265 rigid bronchoscopies performed in 50 children with tracheotomy-dependent subglottic stenosis (25 congenital, 25 acquired). Granulomas developed in 40 children (80%) and were unrelated to age, sex, race, gastroesophageal reflux, tracheotomy duration, or type of stenosis. The incidence of small to medium, large, and obstructing granulomas at endoscopy was 28%, 6%, and 0%, respectively. Compared with a baseline finding of no granuloma at preceding bronchoscopy, the odds of granuloma recurrence were 3.0 after an unexcised granuloma (95% confidence interval [CI], 1.1 to 8.4), 4.1 after granuloma excision (95% CI, 1.4 to 11.9), and 7.3 after expansion surgery (95% CI, 1.1 to 49.2). Considering the low incidence of large or obstructing granulomas, and the failure of granuloma excision to diminish recurrence, we do not recommend interval excision of nonobstructing granulomas in children with stable tracheotomies.

Bronchoscopy↗
PubMed1976

Fatal complications of tracheotomy.

Thirty-six of 403 deaths after tracheotomy were direct complications of that procedure. Arterial hemorrhage caused three deaths, venous bleeding, seven. Airway obstruction resulted in six fatalities. Tracheoesophageal fistula caused five deaths. Eight deaths were due to infection and sepsis. Tension pneumothorax developed in one patient and the remaining six deaths were due to cardiopulmonary collapse. Many of the complications of tracheotomy can be avoided with accurate knowledge of anatomic variations, ideal operating conditions, proper technic, careful arterial and venous hemostasis, routine postoperative chest x-ray films, sterile suction technic, proper use of soft cuffed tracheotomy tubes, adequate humidification, and careful postoperative blood gas monitoring.

Airway Obstruction↗
PubMed1992

[Tracheotomy in children. Indications, major surgical principles, importance of nursing].

Tracheotomy in children has two main fields of indication: 1) obstructions of the upper respiratory tract, the main cause being today the post-intubation stenosis; 2) long term mechanical ventilation. When performed in good conditions, with adapted care, there are few complications, among them the accidental denaculation being the most worrying. When long-term tracheotomy is needed, parent-education, together with special equipment and adapted environment may allow the return of the tracheotomised child at home in secure conditions. Special attention with preventive measures during intubation is recommended in order to reduce the number of tracheotomies for post-intubation stenosis.

Child↗
PubMed1978

[Some observations regarding long-term intubation and tracheotomy (author's transl)].

The development of new non-irritating thermoplastic endotracheal tubes together with improved nursing techniques have resulted in a considerable reduction in the number of tracheotomies. The choice of method to keep the airways patient depends on various factors and must be made individually. The advantages and disadvantages of naso-tracheal and oro-tracheal intubation and of tracheotomy are reviewed. Some of the risks and complications attendant on long-term naso-tracheal intubation are discussed. Maxillary sinusitis due to obstructed drainage should have X-ray examination without delay and, if necessary, treatment. Suspicious of an open fracture of the base of the skull constitutes a contraindication to nasal intubation. Provided there are no contra-indications and the organs touched by the endotracheal tube (nose, pharynx, larynx) are regularly inspected, nasotracheal intubation can, with careful nursing, be continued for prolonged periods. Tracheotomy is still indicated in some cases.

Humans↗
PubMedDate not supplied

Tracheotomy for infant botulism.

Botulism is a serious intoxication caused by ingestion of food containing preformed botulinus toxin and characterized by rapidly progressive bulbar paralysis, generalized weakness, and respiratory insufficiency. In 1976 a distinct clinical entity of infant botulism was recognized. The disease apparently results from intraintestinal toxin production which produces a defect in neuromuscular transmission by interfering with release of acetylcholine at cholinergic synapses. Five cases of infant botulism were identified at the Children's Hospital of Philadelphia between 1975 and 1977. Initial symptoms included constipation, slow feeding, lethargy and weak cry. Four of the patients progressed to respiratory insufficiency requiring nasotracheal intubation. Three of the infants with respiratory failure required tracheotomy. Because infants with respiratory failure may require support for months, we recommend that a tracheotomy be performed early in the management to avoid the complications associated with prolonged intubation. The effectiveness of antitoxin or antibiotics to treat infant botulism remains questionable and therefore prolonged respiratory supportive care is the mainstay of therapy. In addition, we offer guidelines for decannulation in cases of infant botulism. None of the patients in our series could be decannulated prior to initial discharge from the hospital.

Botulism↗
PubMed1992

[Differential indication of tracheotomy in oral and maxillofacial surgery].

In the hospital for Oral and Maxillofacial Surgery at the Medical University Hannover 105 tracheostomies were performed between 1980 and 1990. We see a limited indication for a general prophylactic tracheotomy in patients with ablative surgery and microvascular reconstructive procedures. The indication for tracheotomy must be considered in each individual case.

Airway Obstruction↗
PubMed1979

[Tracheotomy superior, media and inferior? (author's transl)].

The traditional classification of tracheotomy in superior, media and inferior is not important. It only is important that the tracheotomy tube is in a tensionless position and does neither irritate the larynx nor the thyreoid gland. This can be obtained by strict conservation of at least the first tracheal ring and by dissection of the isthmus of the thyreoid gland.

Humans↗
PubMedDate not supplied

[Laryngeal and tracheal stenoses after intubation and/or tracheotomy. A review of 32 cases including 39 lesions and 33 operations (author's transl)].

After reviewing their cases of scarr-stenosis of the upper airway between 1966 and 1976 the authors compare laryngeal to tracheal lesions: Laryngeal and laryngo-tracheal stenoses are long and difficult to repair and all too often yield poor results. These stenoses are usually due to technical faults (tracheotomy after prolonged intubation, forced intubation, tracheotomy through the first ring). They are most often avoidable. Pure tracheal stenoses nearly always result from ischemic destruction from the pressure in the balloons of the tubes and cannulae. They are difficult to prevent when resuscitation requires high pressure ventilation. Their treatment however is simple: resection and anastomosis yields excellent results though it should only be performed in pure scarr-tissue stenosis. Endoscopic dilatations may be a necessary preparation.

Adolescent↗
PubMed1979

[Morphological findings after tracheotomy and laryngeal intubation (author's transl)].

4 fatal cases after tracheotomy and 35 cases after endotracheal anaesthesia were examined taking pathomorphological aspects into consideration. In long-period intubation mucous membrane necroses occurred as of the 4th day. After 6 days' intubation skeletizations of the tracheal rings were established in each case. Infections of the decubial ulcers and errosion haemorrhages from the necrotically altered tracheal wall were frequent complications. Faulty intubation of the oesophagus and the right bronchus, aspirations and reflex-related circulatory failure during intubation as well as hypoxic damage as a result of the windpipe opening being impaired are discussed from the morphological point of view.

Accidents↗
PubMed1979

Serratia marcescens in tracheotomy cultures.

Twenty-three consecutive tracheotomies were cultured after an apparent outbreak of Serratia marcescens was noted. Over a period of one year, six cases with positive cultures were found. The importance of these positive cultures in relation to the patient's clinical course is discussed. The treatment of Serratia marcescens septicemia is reviewed.

Adult↗
PubMed1976

Cricothyroidotomy: elective use in respiratory problems requiring tracheotomy.

Surgical teachings insist that cricothyroidotomy should be performed only under emergency conditions as a temporary means of securing an airway. Subsequent subglottic stenosis is thought to occur in alarming numbers of patients intubated for any length of time. The incidence of complications associated with cricothyroidotomy has not been critically examined since Jackson's classic paper in 1921, condemning the operation. A total of 655 patients with cricothyroidotomy tubes in place from hours to months were studied to determine the incidence of problems associated with this procedure. The over-all complication rate was 6.1 per cent. There was one cricothyroidotomy-associated death. Chronic subglottic stenosis did not occur, although 5 patients required resection of tracheal strictures. No additional complications occurred if the procedure was carried out at the bedside instead of in the operating room. The simplicity, absence of cross-contamination of median sternotomy incisions, and safety documented by this study recommend routine use of cricothyroidotomy in patients whose management requires tracheotomy.

Adolescent↗