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At least 145 records · Page 8Linked to original sources

PubMed2003

Tracheostomy for long-term ventilated patients: a postal survey of ICU practice in The Netherlands.

OBJECTIVE: To assess the frequency, timing, technique, and follow-up of tracheostomy for long-term ventilated patients in different intensive care units (ICUs) in The Netherlands. DESIGN AND SETTING: Postal questionnaire, survey on retrospective data. A questionnaire was sent to all ( n=63) ICUs with six or more beds suitable for mechanical ventilation and officially recognized by The Netherlands Intensive Care Society. Pediatric ICUs were excluded. MEASUREMENTS AND RESULTS: There was an 87% ( n=55) response rate of contacted ICUs. The number of tracheostomies per year per unit varied widely (range 1-75), most ICUs (42%) performing between 11 and 25 tracheostomies per year. In 44% of ICUs ( n=24) tracheostomy was not performed on a routine basis. In 25% of ICUs ( n=14) tracheostomies were performed during the second week of ventilation. Surgical tracheostomy and percutaneous procedures were technique of first choice in 38% and 62% of ICUs, respectively. In only 7% of units were late follow-up protocols in use. Thirty-two units (58%) reported a total of 56 major complications. CONCLUSIONS: Timing and technique of tracheostomy varies widely in Dutch ICUs. The percutaneous technique is the procedure of choice for tracheostomy in most of these units. Late follow-up protocols are rarely in use.

Humans↗

PubMed2004

Use of percutaneous tracheostomy in intensive care units in Spain. Results of a national survey.

OBJECTIVES: To assess the use of percutaneous tracheostomy in Intensive Care Units (ICU) in Spain, its practice, and current opinions on the technique. DESIGN AND SETTING: An e-mail or post survey was sent to 239 Spanish ICU directors. Pediatric ICUs and coronary units were excluded. MEASUREMENTS AND MAIN RESULTS: One hundred ICUs (41.8%) replied. The 44% ( n=44) of the ICUs that answered belonged to university hospitals and 53% ( n=53) had postgraduate teaching. Eighty-two percent ( n=82) used percutaneous tracheostomy. Griggs' Guide Wire Dilating Forceps and Ciaglia Blue Rhino were the most frequent techniques employed. In 30.5% of ICUs ( n=25) endoscopic guidance was used, in 15.7% ( n= 13) it was routine. In 24.4% ( n=20) some kind of long-term follow-up was carried out, but only in 12.2% ( n=10) was follow-up done routinely. In 58.5% of ICUs ( n=48) in which percutaneous tracheostomy is performed is this technique considered safer than surgical tracheostomy and in 86.4% ( n=70) percutaneous tracheostomy is the first choice for tracheostomy in the critically ill patient. CONCLUSIONS: Percutaneous tracheostomy is a well-established technique in ICUs in Spain, and is considered the technique of choice for tracheostomy in critically ill patients. It is mainly performed without endoscopic guidance and follow-up is not usually carried out.

Dilatation↗

PubMed2005

Percutaneous tracheostomy: one center's experience with a new modality.

BACKGROUND: A retrospective review of our experience with percutaneous tracheostomy was performed to determine our complication rate and pattern of use since this modality was introduced at our institution. METHODS: A retrospective chart review captured all patients in whom tracheostomy was performed or supervised by a trauma/critical care faculty member. Dates of hospital admission, ICU admission, intubation, discontinuation of mechanical ventilation, type and location of procedure, procedural complications, Injury Severity Score, charges, and patient demographics were collected. Percutaneous tracheostomy (PT) and open tracheostomy (OT) experiences were compared. RESULTS: Three hundred sixty-eight tracheostomies were performed (190 OT and 178 PT). The average time to tracheostomy (TTT) for PT patients decreased from 12.7 to 7.4 days. The average TTT for OT patients remained stable at 14.0 days. The complication rate was 3.5%, with 4 complications (1.5%) associated with OT and 9 complications (5.1%) associated with PT. All complications in the PT group occurred before using a single dilator system. The 9 complications in the PT group occurred among 5 surgeons, all before their 11th attempt. PT saves 444 dollars in charges per procedure. CONCLUSION: OT continues to be a safe method of performing tracheostomies. PT has a steep learning curve but can be mastered quickly. Benefits include a shorter time to tracheostomy, elimination of patient transport, and saving in charges. Initial PT attempts should be supervised by an experienced surgeon.

Female↗

PubMed2002

A review of the current management of infantile subglottic haemangioma, including a comparison of CO(2) laser therapy versus tracheostomy.

OBJECTIVES: We reassessed the current practice and treatment options used in the management of subglottic haemangiomas (SGHs), including the place for open submucosal surgical excision, and have compared the results of different therapeutic modalities used for SGHs. METHODS: The two studies were conducted as separate exercises; (1) a retrospective review of 36 patients collected over a recent 8-year period to assess the current practice and treatment options in use; (2) a retrospective comparative study of a previous cohort of 51 patients with SGHs treated in one of four groups: (a) tracheostomy alone, (b) tracheostomy and CO(2) laser, (c) systemic steroids and CO(2) laser (no tracheostomy) and (d) intralesional steroid injection, CO(2) laser therapy, or both, followed by intubation. RESULTS: Systemic steroids were the most commonly used modality of treatment. Resolution of the SGH was achieved in 89% of cases at a mean follow up duration of 34 months. However, tracheostomy was required in 58% of cases, with a mean time from diagnosis to decannulation of 30 months. The time to resolution of SGHs does not appear to be reduced by laser therapy compared with treatment by tracheostomy alone. Intralesional steroid injection or laser therapy together with intubation was associated with avoidance of a tracheostomy in 66% of cases. Single-stage open surgical excision in two cases resulted in successful resolution of the SGH and discharge after a mean follow up period of 3 months. CONCLUSIONS: Despite the more widespread use of steroids and other treatment modalities, the requirement for tracheostomy has remained unchanged over the last 20 years. The use of laser therapy does not appear to confer any additional therapeutic benefit over and above tracheostomy alone in bringing about resolution of SGHs. Systemic steroids may reduce the size of the haemangioma but are associated with multiple adverse effects. The decision to use the above techniques must, therefore, be made in the light of these observations. Our early experience of single-stage excision suggests that this technique represents an exciting and promising surgical alternative, and its more widespread adoption may be the only way of further improving the outcome of patients with SGHs.

Carbon Dioxide↗

PubMed1998

Tracheostomy for long-term laryngeal experimentation.

To perform laryngeal research involving long-term survival surgery, a permanent tracheostomy is often necessary. For experiments using a long-term induced canine phonation model, we required a tracheostomy that was placed as low as possible, to maximize the subglottic space superior to the stoma. The ideal experimental tracheostomy would also be safe and easy to perform, require no tracheostomy tube, and be low maintenance, requiring minimal cleaning or suctioning. Tracheostomies were performed in 37 dogs based on previously published methods. If the stoma was placed below the twelfth tracheal ring, the perioperative mortality rate was 57% because of kinking of the trachea and subsequent airway obstruction. When the tracheostomy was performed above this level, the mortality rate was reduced to 3%. A number of significant modifications in technique were made to achieve this improvement and resulted in the last 12 dogs having no complications. Several of the tracheostomies were maintained for more than 18 months. The method derived meets the above criteria for the ideal experimental tracheostomy and also meets our needs for a long-term induced phonation model.

Animals↗

PubMed2003

Children with a tracheostomy: experience of their carers in school.

OBJECTIVE: Tracheostomies in children are increasingly performed for chronic medical conditions. There are no published studies reporting the experience of children with a tracheostomy in school. Such information would be valuable in planning the care and education of these children. The aims of this study were to identify those children with a tracheostomy in Nottinghamshire schools and determine the support they were receiving. DESIGN, SETTING AND PARTICIPANTS: Questionnaire survey to families and school carers of 11 children with a tracheostomy. RESULTS: All children of school age were in full-time education (five mainstream, five special schools). One preschool child attended a Family Centre. Four had problems finding suitable carers, delaying return to school in three. Four parents were dissatisfied with aspects of the child's experience at school: two felt the teaching staff were unsupportive, one was unhappy with the care of the tracheostomy, and one had problems funding a carer. Ten out of 11 school carers were satisfied with their training; 10 would have liked regular update sessions. The amount of care required varied. Those with complex medical problems in a special school setting needed frequent care, and one had required admission to hospital from school. One child had time off school because of lack of carer availability. Those who were severely disabled had less time off school for ill health after the tracheostomy than before the tracheostomy. CONCLUSION: Children with tracheostomies can successfully and safely achieve full-time education in both mainstream and special schools. A dedicated multidisciplinary team, including input from the parents, is essential to achieve this goal. Regular revision of skills and information sessions for the teaching staff would be beneficial.

Adolescent↗

PubMed2002

Tracheostomy in childhood: 20 years experience from a pediatric surgery clinic.

BACKGROUND: There is a limited indication for tracheostomy procedures in pediatric surgery. It is rarely applied to the pediatric patient because they can be kept intubated for a longer duration compared with adults. Problems and complications can occur after tracheostomy, even during the childhood period. PURPOSE: The purpose of this study is to evaluate our experience with tracheostomy procedure. METHODS: Records of 17 children treated over a 20-year period (1978-99) were reviewed retrospectively in the aspects of indication, complication and mortality. RESULTS: There were 13 boys and four girls with a mean age 30.3 months (range: 1 week-13 years). Indications for tracheostomy were prolonged intubation (n = 5), subglottic stenosis (n = 3), general body trauma (n = 2), tracheomalasia (n = 2), tracheoesophageal cleft (n = 1), cervical tumor pressing trachea and larynx (n = 1), congenital myotonic dystrophy plus respiratory failure (n = 1), burn injury of trachea and esophagus (n = 1), and foreign body aspiration (n = 1). In the last decade the number of cases with tracheotomy increased due to the development of new intensive care units, the use of mechanical ventilation and the increasing number of patients needing prolonged ventilation support. In this group, tracheostomies were mainly performed electively. The overall complication rate was 29%. Mortality was 59% and there was one death related to the tracheostomy procedure. CONCLUSION: Tracheostomy is a life saving procedure when performed with an appropriate indication and surgical technique. Therefore, the pediatric surgeons dealing with this procedure should be aware of the tracheostomy care problems, fatal complications and the need for reconstructive surgery. With strict indications and experience of the procedure, this should be enough effort to minimize its complications and related care problems.

Adolescent↗

PubMedDate not supplied

Effect of the Passy-Muir tracheostomy speaking valve on pulmonary aspiration in adults.

PURPOSE: We determined instances of aspiration in adults with tracheostomies and investigated the effect of the Passy-Muir tracheostomy speaking valve on occurrences of aspiration. METHODS: Adults with tracheostomies scheduled for videofluoroscopic swallowing examinations who met inclusion criteria were enrolled. According to study protocol, 6 presentations of thin liquids were recorded, 3 with and 3 without the Passy-Muir tracheostomy speaking valve. If a cuffed tube was present, the cuff was deflated fully for all presentations. RESULTS: Seven of 15 subjects aspirated material on 1 or more presentations of thin liquid. Five subjects aspirated material only with the Passy-Muir tracheostomy speaking valve off, whereas 2 subjects aspirated material with and without the valve. No subject aspirated material while the valve was on exclusively. Aspiration was significantly less frequent with the Passy-Muir tracheostomy speaking valve on than with it off. CONCLUSIONS: Clinically unapparent aspiration occurs commonly in patients with tracheostomies. An expiratory occlusive valve can reduce, though not eliminate, occurrences of aspiration. CLINICAL IMPLICATION: The benefit of the Passy-Muir tracheostomy speaking valve should be evaluated in selected patients who aspirate liquid.

Adult↗

PubMed2000

Early percutaneous tracheostomy after median sternotomy.

OBJECTIVE: Tracheostomy offers significant advantages over endotracheal intubation in patients requiring long-term assisted ventilation. However, in patients who have undergone median sternotomy, it is believed that the danger of microbial contamination and consecutive infection of the sternal wound with microbes from the tracheostomy is high when conventional tracheostomy is performed. In contrast, percutaneous techniques are less likely to result in tracheostomy infection and thus bacterial contamination of neighboring structures. Nonetheless, to date there has been no prospective study confirming or disproving this assumption. Our study evaluated outcome after percutaneous tracheostomy in patients with a median sternotomy. METHODS: A total of 144 cardiac surgical patients had elective percutaneous tracheostomy at the bedside until postoperative day 14, with 4 different techniques. Systematic microbiologic monitoring of the sternal and tracheal wounds was used. RESULTS: In 13 patients sternal wound infection was suspected, but was confirmed in only 4 (2.8%) patients who actually showed microbial contamination of the sternum. In 2 of these patients, the identified microbes were not identical to those cultured from the trachea. The other 2 patients had sternal and tracheal cultures positive for methicillin-resistant Staphylococcus aureus. Cross-contamination of the sternotomy with microbes from the patient's airways was therefore ruled out. No patient had clinical signs of tracheostomy infection. Likewise, there were no cases of mediastinitis. CONCLUSIONS: On the basis of our data, we conclude that cross-contamination of the sternal wound with microbes from the trachea is not a problem. Elective percutaneous tracheostomy is safe, even if performed during the first 14 days after median sternotomy.

Analysis of Variance↗

PubMed2000

Cervical spine clearance and neck extension during percutaneous tracheostomy in trauma patients.

INTRODUCTION: The lack of cervical spine clearance and inability to extend the neck are assumed to be relative contraindications for percutaneous tracheostomy. OBJECTIVE: To determine the necessity of cervical spine clearance and neck extension in trauma patients receiving percutaneous tracheostomy. DESIGN: Prospective analysis of case series from August 1, 1995 to August 31, 1998. SETTING: A university-based Level I trauma center. PATIENTS: A total of 88 consecutive trauma patients receiving percutaneous tracheostomy. Patients were divided into two groups based on the radiographic or clinical status of their cervical spine: cleared and noncleared. RESULTS: The overall success and complication rate were 99% (87/88) and 11% (10/88), respectively. There were no procedure-related deaths. The cleared group consisted of 60 patients; three patients in this group who had "bull" or "thick" necks did not have full neck extension during percutaneous tracheostomy. The noncleared group consisted of 28 patients, 13 of which had known cervical spine fractures; 27 noncleared patients were maintained in the neutral position (no extension) during percutaneous tracheostomy, whereas one patient with low suspicion of spinal injury was partially extended. Of the 13 patients with cervical spine fractures, six patients had been stabilized with a halo or operative fixation, and seven patients were stabilized with a cervical collar at the time of percutaneous tracheostomy. The success rate was 100% (60/60) for the cleared group compared with 96% (27/28) for the noncleared group (p > .05). The complication rate was 13% (8/60) for the cleared group compared with 7.1% (2/28) for the noncleared group (p > .05). We had a 100% success rate and no complications in the seven patients with cervical spine injury who were stabilized with a cervical collar. No patient had spinal cord injury caused by percutaneous tracheostomy. CONCLUSION: Percutaneous tracheostomy can be safely performed in trauma patients without cervical spine clearance and neck extension, including patients with stabilized cervical spine or spinal cord injury.

Adolescent↗

PubMed1992

Percutaneous tracheostomy after trauma and critical illness.

A method of percutaneous tracheostomy (PT) using a tracheostome, which permits insertion of a full-sized cuffed tracheostomy tube, was evaluated in 61 critically ill or injured patients (89% had trauma). Of the 54 trauma patients, 65% had brain injuries, 14% had injuries to the cervical spinal cord, 33% had face or jaw injuries, and 15% had lung injuries. The indications for PT were coma (46%), acute airway obstruction (5%), face or jaw injury (20%), pneumonitis (39%), adult respiratory distress syndrome (12%), and sepsis (21%). Tracheostomy was done in 51% of all cases specifically for managing pulmonary secretions, in 37% for prolonged intubation, and in 25% for neurologic lesions. The tracheostomy was done as an emergency in 5%, as urgent in 28%, and electively in 77%. Percutaneous tracheostomy was successful in 90% of the cases, and in 8% it was converted to a surgical tracheostomy after an initial percutaneous attempt. In 46% it was performed at the bedside, in 46% in the operating room, and in 7% in the emergency suite. A full-sized tracheostomy tube (#6 to #8) was used in all cases and was considered optimal or larger than needed in 87% of cases. With three exceptions the complications of PT were minor, but 30% of the patients died of their primary disease. In one case death occurred because of bronchospasm and cardiac arrest during the PT, but appeared to be independent of the type of tracheostomy. Healing after in-hospital removal (37%) was excellent in 95% of cases and 97% of physicians indicated that they would use the device again.

Adult↗

PubMed2003

The long-term evaluation of tracheostomy in the management of severe obstructive sleep apnea.

OBJECTIVE: To determine the long-term success and morbidity of tracheostomies for patients with severe obstructive sleep apnea. STUDY DESIGN: A retrospective study of patients who have undergone tracheostomy for documented obstructive sleep apnea at Hennepin County Medical Center since 1979. METHODS: Retrospective chart review of all tracheostomy patients operated January 1, 1979, to June 30, 1999, were evaluated. Follow-up data from patient records, death certificates, and DMV. RESULTS: Seventy-nine patients (70 men and 9 women; age range, 25-70 y; mean age, 47 y) received tracheostomies at a regional sleep disorder center. Respiratory distress index ranged from 45 to 146 (mean value, 81). Tracheostomy eliminated obstructive sleep apnea in all cases. Follow-up ranged from 3 months to 20 years (mean period, 8.3 y). In all, 16 patients had decannulation (range, 2 mo to 13 y): 5 of the patients chose continuous positive airway pressure, 3 grew intolerant of their tracheostomy, 3 had obstructive sleep apnea fully resolve after uvulopalatopharyngoplasty, 3 unknown diagnosis for decannulation, 2 had significant weight loss. Morbidity seen within the first year was primarily limited to granulation tissue, infection, and stoma revision. Fourteen deaths were identified. Average age at time of death was 62 years. Five deaths were cardiopulmonary related, four were from cancer, two were from postoperative complications of unrelated surgery, and one was from aspiration. Tracheostomy-related mortality included one postoperative myocardial infarction and one tracheal-innominate fistula. CONCLUSION: Severe obstructive sleep apnea and its comorbid conditions are effectively treated in the long term with tracheostomy. Initial management of more frequent complication is well tolerated. Significant morbidity and mortality are low. Chances of obstructive sleep apnea resolution allowing decannulation remain poor.

Adult↗

PubMed2000

Neurophysiological consequences of three tracheostomy techniques: a randomized study in neurosurgical patients.

We describe the effects of different tracheostomy techniques on intracranial pressure (ICP), cerebral perfusion pressure (CPP), and cerebral extraction of oxygen. We attempted to identify the main mechanisms affecting intracranial pressure during tracheostomy. To do so we conducted a prospective, block-randomized, clinical study which took place in a neurosurgical intensive care unit in a teaching hospital. The patients studied consisted of thirty comatose patients admitted to the intensive care unit because of head injury, subarachnoid hemorrhage, or brain tumor. Ten patients per group were submitted to standard surgical tracheostomy, percutaneous dilatational tracheostomy or translaryngeal tracheostomy. In every technique a significant increase of ICP (P < .05) was observed at the time of cannula placement. Intracranial hypertension (ICP > 20 mm Hg) was more frequent in the percutaneous dilatational tracheostomy group (P < .05). Cerebral perfusion pressure dropped below 60 mm Hg in eleven cases, more frequently during surgical tracheostomy. Arterial tension of CO2 significantly increased in all three groups during cannula placement. No other major complications were recorded during the procedures. At follow-up no severe anatomic or functional damage was detected. We conclude that the three tracheostomy techniques, performed in selected patients where the risk of intracranial hypertension was reduced to the minimum, were reasonably tolerated but caused an intracranial pressure rise and cerebral perfusion pressure reduction in some cases.

Adult↗

PubMed2004

Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993-2002.

OBJECTIVE: Patients who require tracheostomy for prolonged mechanical ventilation have poor outcomes and high costs of care. However, recent longitudinal trends relevant to these patients and their care have not been described. We aimed to describe trends in the annual incidence and timing of tracheostomy for prolonged mechanical ventilation, as well as prolonged mechanical ventilation patient resource utilization and overall in-hospital mortality. DESIGN AND SETTING: Retrospective review of the North Carolina Hospital Discharge Database, a comprehensive record of all state nonfederal, nonpsychiatric hospital discharges between 1993 and 2002. PATIENTS: Patients were 9,794 medical and surgical patients >/=18 yrs of age with International Classification of Diseases, Ninth Revision, Clinical Modification code 96.72 (mechanical ventilation for >96 hrs) and Diagnosis Related Group code 483 (tracheostomy except for face, neck, and mouth diagnoses). INTERVENTIONS: None. MEASUREMENTS: Incidence rates adjusted for annual population growth, mechanical ventilation days until tracheostomy placement, length of stay, and hospital charges and payments adjusted by the medical component of the Consumer Price Index. MAIN RESULTS: Between 1993 and 2002, the incidence of tracheostomy for prolonged mechanical ventilation increased across all age groups from 8.3 of 100,000 to 24.2 of 100,000 (p < .001), although most significantly among patients <55 yrs of age. During this period, a decrease was seen in mortality (from 39% to 25%), median mechanical ventilation days to tracheostomy placement (from 12 to 10 days), and median length of stay (from 47 to 33 days). By 2002, patients were almost three times less likely to be discharged to home independently although twice as likely to be sent to a skilled nursing facility. Although prolonged mechanical ventilation patients with tracheostomies represented only 7% of all who required mechanical ventilation, their total charges during the study period were 1.74 billion dollars-22% of all mechanical ventilation patient charges. CONCLUSION: The incidence of tracheostomy for prolonged mechanical ventilation increased by nearly 200% during the past decade in North Carolina, exceeding changes in the overall incidence of respiratory failure three-fold. Although in-hospital mortality, length of stay, and charges per patient fell over time, the overall resource utilization of prolonged mechanical ventilation patients increased dramatically.

Adult↗

PubMed2005

Outcome of mechanically ventilated patients who require a tracheostomy.

OBJECTIVE: To estimate the prevalence of, the risk factors associated with, and the outcome of tracheostomy in a heterogeneous population of mechanically ventilated patients. DESIGN: Prospective, observational cohort study. SETTING: A total of 361 intensive care units from 12 countries. PATIENTS: A cohort of 5,081 patients mechanically ventilated for >12 hrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 546 patients (10.7%) had a tracheostomy during their stay in the intensive care unit. Tracheostomy was performed at a median time of 12 days (interquartile range, 7-17) from the beginning of mechanical ventilation. Variables associated with the performance of tracheostomy were duration of mechanical ventilation, need for reintubation, and neurologic disease as the primary reason of mechanical ventilation. The intensive care unit stay of patients with or without tracheostomy was a median of 21 days (interquartile range, 12-32) vs. 7 days (interquartile range, 4-12; p < .001), respectively, and the hospital stay was a median 36 days (interquartile range, 23-53) vs. 15 days (interquartile range, 8-26; p < .001), respectively. Adjusting by other variables, tracheostomy was independently related with survival in the intensive care unit (odds ratio, 2.22; 95% confidence interval, 1.72-2.86). Mortality in the hospital was similar in both groups (39% vs. 40%, p = .65). CONCLUSIONS: Tracheostomy is a common surgical procedure in the intensive care unit that is associated with a lower mortality in the unit but with a longer stay and a similar mortality in the hospital than in patients without tracheostomy.

Cohort Studies↗

PubMed2006

Tracheostomy in ventilator dependent trauma patients: a prospective, randomized intention-to-treat study.

BACKGROUND: Tracheostomy is a commonly performed procedure in ventilator dependent patients. Many critical care practitioners believe that performing a tracheostomy early in the postinjury period decreases the length of ventilator dependence as well as having other benefits such as better patient tolerance and lower respiratory dead space. We conducted a randomized, prospective, single institution study comparing the length ventilator dependence in critically ill multiple trauma patients who were randomized to two different strategies for performance of a tracheostomy. We hypothesized that earlier tracheostomy would reduce the number of days of mechanical ventilation, frequency of pneumonia and length of intensive care unit (ICU) stay. METHODS: Patients were eligible if they were older than 15 years and either a Glasgow Coma Score (GCS) >4 with a negative brain computed tomography (CT) (no anatomic head injury), or a GCS >9 with a positive head CT (known anatomic head injury). Patients who required tracheostomy for facial/neck injuries were excluded. Patients were randomized to an intention to treat strategy of tracheostomy placement before day 8 or after day 28. RESULTS: The study was halted after the first interim analysis. There were 60 enrolled patients, who had comparable demographics between groups. There was no significant difference between groups in any outcome variable including length of ventilator support, pneumonia rate, or death. CONCLUSION: A strategy of tracheostomy before day 8 postinjury in this group of trauma patients did not reduce the number of days of mechanical ventilation, frequency of pneumonia or ICU length of stay as compared with the group with a tracheostomy strategy involving the procedure at 28 days postinjury or more.

Adult↗

PubMed1996

Tracheostomy and peristomal recurrence.

Emergency tracheostomy prior to laryngectomy for laryngeal carcinoma has been associated with peristomal recurrence. Is the peristomal recurrence caused by the tracheostomy per se, or is it due to the association of tracheostomy with subglottic tumours and locally advanced tumours? This study examines the association between tracheostomy, as an independent variable, and peristomal recurrence. Forty-three patients with T3 glottic carcinomas and treated by a combination of total laryngectomy and radiotherapy were studied. The difference in peristomal recurrence between the tracheostomy and non-tracheostomy patients was not statistically significant. Nor was there a correlation between the time interval between tracheostomy and laryngectomy, and the incidence of peristomal recurrence. It is concluded that tracheostomy, as an independent variable, does not cause peristomal recurrence.

Carcinoma, Squamous Cell↗

PubMed2004

Outcome of survivors of acute stroke who require prolonged ventilatory assistance and tracheostomy.

BACKGROUND AND PURPOSE: Mechanical ventilation after stroke is associated with high mortality. However, little is known about survivors who require prolonged ventilatory assistance and tracheostomy. Our goal was to assess the rate of pulmonary complication, effect of early tracheostomy and prognosis of patients with stroke requiring prolonged ventilatory support. METHODS: Retrospective review of 97 patients with stroke who required ventilatory assistance and tracheostomy admitted to a single teaching hospital between 1976 and 2000. Outcome was defined using the Glasgow Outcome Scale (GOS). RESULTS: Poor outcome (GOS 1-3) occurred in 74% of patients at 1 year and it was associated with older age (p = 0.03), prior history of brain damage (p = 0.02), and neurological worsening after intubation (p < 0.01). However, long-term functional recovery (GOS 4-5) was possible and more likely after strokes involving the posterior circulation (p = 0.03). Pulmonary complications were prevalent and more frequent before tracheostomy (68 vs. 20% after tracheostomy) but did not determine functional outcome. Mean duration of mechanical ventilation was 11 +/- 19 days and did not significantly differ between outcome groups. Early tracheostomy correlated with shorter ICU and hospital stays (p < 0.01 in both cases). CONCLUSIONS: Surviving patients with stroke who require prolonged ventilatory assistance and tracheostomy can have a better outcome than previously reported. Aggressive care is justified in patients who do not continue to deteriorate neurologically. Pulmonary complications are frequent but treatable. Early tracheostomy can shorten ICU and hospital stays and reduce costs.

Adult↗