SEARCH · PubMed Health

Results for “Tracheostomy”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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

At least 163 records · Page 9Linked to original sources

PubMed2000

Experience with percutaneous dilational tracheostomy.

Percutaneous dilational tracheostomy (PDT) has gained popularity among critical care specialists in the past 10 years. The initial studies in our specialty resulted in essentially banning the procedure as a dangerous substitute for standard operative tracheostomy. Despite this action, more than 1,100 cases of percutaneous tracheostomy have been reported with details on complications. We reviewed all published data and studied 311 patients of our own. A prospective study was performed in 3 groups of patients: 1) 50 patients scheduled for PDT performed in the operating room by a head and neck surgeon (group 1); 2) 50 patients who underwent standard operative tracheostomy performed by the same surgeon (group 2); and 3) 211 patients who underwent bedside PDT by critical care physicians (group 3). The intraoperative complication rates were 0% in group 1, 2% in group 2, and 4% in group 3; the postoperative complication rates were 13%, 4%, and 12%, respectively. There were 2 deaths in group 3, and none in groups 1 or 2. The statistically significant differences among the groups were the superiority of group I over group 3 in intraoperative complications, as well as the lower postoperative complication rate of the standard tracheostomy group. These results show that PDT can be performed with acceptable morbidity rates in relation to published complication rates of standard tracheostomy, but it has no advantage over standard tracheostomy with respect to postoperative morbidity. When they are performed by a head and neck surgeon, the morbidity associated with both standard and percutaneous tracheostomies can be reduced.

Adult↗

PubMed2005

Decannulation and outcome following pediatric tracheostomy.

OBJECTIVES: We investigated the long-term outcome of pediatric tracheostomy to identify predictive factors of early decannulation. METHODS: We performed a retrospective chart review of a consecutive series of 75 patients less than 20 years of age who underwent tracheostomy between 1998 and 2003 during their admission in a tertiary pediatric institution. Complete information was available on 65 patients. RESULTS: There were 41 male patients and 24 female patients (median age, 7 months). The indications for tracheostomy were an obstructed airway in 36 patients, prolonged mechanical ventilation in 15, and tracheobronchial toilet or aspiration risk in 14. Twelve patients died, and 30 of the 53 survivors were decannulated (median cannulation time, 123.5 days). Additional airway procedures were required for decannulation in those with obstructed airways. Patients who had tracheostomy performed for tracheobronchial toilet had a significantly shorter cannulation time than those with the other two indications (log-rank test, chi2(2) = 47.11; p < .00001). Patient diagnosis was also a significant predictor of cannulation time (log-rank test, chi2(2) = 66.05; p < .00001). Tracheobronchial toilet as a tracheostomy indication and both trauma and neurologic conditions as admission diagnoses were statistically significant independent variables that predicted earlier decannulation on multivariate analysis. Analysis of other group variables--age, sex, and tracheostomy insertion technique--did not reveal any significant difference in cannulation times. CONCLUSIONS: Tracheostomy indication and patient diagnosis are significant variables that predict early decannulation in pediatric patients in whom tracheostomy is required. Other variables were not shown to be significant independent predictors.

Adolescent↗

PubMed1999

Pulmonary mechanics in patients with prolonged mechanical ventilation requiring tracheostomy.

This study was performed to assess the changes in pulmonary mechanics before and after tracheostomy in patients with prolonged mechanical ventilation and to detect pre-tracheostomy physiologic factors that predict the outcome of weaning from mechanical ventilation. Pulmonary mechanics were recorded before and after tracheostomy in 20 patients. Work of breathing, mean airway resistance and pressure/time product showed no significant differences after tracheostomy. Peak inspiratory pressure was significantly reduced (pre 33.4 +/- 11.8 vs post 28.6 +/- 9.2 mmHg). There was no difference in age or duration of mechanical ventilation between two different groups according to the outcome (weaned and not-weaned). Pre-tracheostomy intrinsic positive end expiratory pressure (PEEPi) was significantly lower in the weaned group (1.1 +/- 1.6 vs 2.7 +/- 1.4 mmHg). A significant difference was also found in pre-tracheostomy compliance (Cstatic) (47.3 +/- 36.9 vs 28.8 +/- 16.5 ml/cmH2O). We concluded that tracheostomy changed pulmonary mechanics very little except for a fall in peak inspiratory pressure. Patients who had better underlying lung mechanics (higher Cstatic and lower PEEPi) had better chances of weaning from mechanical ventilation after tracheostomy.

Adult↗

PubMed2004

Tracheostomy must be individualized!

Tracheostomy is one of the most frequent procedures carried out in critically ill patients with major advantages compared to translaryngeal endotracheal intubation such as reduced laryngeal anatomical alterations, reduced inspiratory load, better patient's tolerance and nursing. Thus, tracheostomy can enhance patient's care in patients who need prolonged mechanical ventilation and/or control of airways. The right timing of tracheostomy remains controversial, however it appears that early tracheostomy in selected severe trauma, burn and neurological patients could be effective to reduce the duration of mechanical ventilation intensive care stay and costs. Percutaneous tracheostomy techniques are becoming the procedure of choice in the majority of the cases, since they are safe, easy and quick, and complications are minor. However, percutaneous tracheostomies should be always performed by experienced physicians to avoid unnecessary additional complications. It is not clear the superiority of one percutaneous technique compared to another, but experience of the operator and clinical individual anatomical, physiopathological characteristics of the patient should be always considered. We believe that the operator should have experience of at least one intrusive and one extrusive percutaneous technique. The general "optimal" tracheostomy technique and timing do not exist, but tracheostomy should be targeted on the patient's individual clinical characteristics.

Humans↗

PubMed2006

Bench-to-bedside review: early tracheostomy in critically ill trauma patients.

A significant proportion of trauma patients require tracheostomy during intensive care unit stay. The timing of this procedure remains a subject of debate. The decision for tracheostomy should take into consideration the risks and benefits of prolonged endotracheal intubation versus tracheostomy. Timing of tracheostomy is also influenced by the indications for the procedure, which include relief of upper airway obstruction, airway access in patients with cervical spine injury, management of retained airway secretions, maintenance of patent airway and airway access for prolonged mechanical ventilation. This review summarizes the potential advantages of tracheostomy versus endotracheal intubation, the different indications for tracheostomy in trauma patients and studies examining early versus late tracheostomy. It also reviews the predictors of prolonged mechanical ventilation, which may guide the decision regarding the timing of tracheostomy.

Critical Illness↗

PubMed2007

A comparative study of the complications of surgical tracheostomy in morbidly obese critically ill patients.

INTRODUCTION: There is little objective comparative information about the postoperative complications of tracheostomy in morbidly obese patients. The aim of this study was to determine the incidence and severity of complications associated with open tracheostomy in critically ill morbidly obese patients during hospitalization. METHODS: During a six year period, all consecutive morbidly obese patients (body mass index [BMI] of greater than or equal to 40 kg/m2) who underwent an elective open tracheostomy were compared to a control group (BMI of less than 40 kg/m2) of the same institution. Variables examined included age, gender, BMI, Charlson index, and reasons for tracheostomy. All postoperative tracheotomy-related complications that occurred during hospitalization, including death, were recorded. RESULTS: A tracheostomy was performed in 89 morbidly obese patients out of 427 critically ill patients. A total of 27 complications were recorded in 22 morbidly obese patients (25%) compared to 65 complications in 49 patients (14%) of the control group (p = 0.03). The majority of these complications were minor in origin. Overall, nine serious events were responsible for two deaths in the morbidly obese compared to seven cases and two deaths in the control group (p = 0.001). Life-threatening complications were attributed to tube obstruction and malpositioning of the tracheostomy after being dislodged. In multivariate analysis, morbid obesity (odds ratio 4.4, 95% confidence interval 2.1 to 11.7) was independently associated with increased risk of tracheostomy-related complications. CONCLUSION: In the present series, morbid obesity is associated with increased frequency and life-threatening complications from conventional tracheostomy. Special techniques and operative policies must be applied to overcome loss of airway control.

APACHE↗

PubMed1996

Some important details in the technique of percutaneous dilatational tracheostomy via the modified Seldinger technique.

STUDY OBJECTIVE: The percutaneous dilatational tracheostomy can be performed with a low complication rate if several important technical details are followed. This study delineates our experience and recommends changes in the operative technique. DESIGN AND SETTING: Patients requiring tracheostomy were selected for percutaneous dilatational tracheostomy based on previously reported criteria. The procedures were performed routinely in the ICU unless there was another reason to transport the patient to the operating room. The patients were monitored with an ECG and pulse oximetry. End-tidal CO2 and ventilator settings were noted by the respiratory therapist. The airway was controlled using the bronchoscope and manually by the respiratory therapist. Adjustments were made in respiratory rate or tidal volume as indicated by an increase in end-tidal CO2. PATIENTS AND MEASUREMENTS: We report our experience with 254 patients who underwent percutaneous dilatational tracheostomy. We prospectively recorded intraoperative, early, and late complications. From our personal experience of 170 cases previously reported and 84 recent cases, we find that there are several important technical details in performing the procedure that will minimize complications. RESULTS: (1) Use of a deflated endotracheal tube cuff and increased tidal volume on the ventilator to compensate for lost minute volume and maintain normal PaCO2; (2) an adequate skin incision to more easily palpate and identify the tracheal cartilages; (3) directing the cannula needle caudally to properly identify the tracheal air column; (4) a new ridge on the 8F Teflon guiding catheter to prevent injury to the posterior tracheal wall by the dilators; (5) there is a danger of partially with-drawing the double guide when removing the largest-sized dilators that are usually tightly grasped by the tissues; (6) use of a single cannula flexible tracheostomy tube and a longer tracheostomy tube when indicated; (7) a double swivel connection and flexible tubing to connect the patient to the ventilator to lessen trauma to the stoma; (8) fenestrated tracheostomy tubes allow talking in conscious patients; and (9) use of a disposable end-tidal CO2 monitor and bronchoscope to confirm intratracheal position of the endotracheal tube while performing the procedure and proper placement of the tracheostomy tube on completion of the procedure. CONCLUSION: Using these principles, minor complications occurred in 6.5% of the patients and major complications occurred in 1.5% of the patients, with a mortality rate of 0.39%.

Bronchoscopy↗

PubMedDate not supplied

Tracheostomy in surgical practice: experience in a Nigerian tertiary hospital.

BACKGROUND: Tracheostomy continues to be a standard surgical procedure for airway management. OBJECTIVE: This study was conducted to evaluate the indications, and complications associated with the utilization of open surgical tracheostomy in our center. DESIGN AND SETTING: It is a retrospective study of all patients that had open surgical tracheostomy at the Obafemi Awolowo University Teaching Hospital, Ile-Ife. Nigeria during a 15-year period between January 1986 and December 2000. PATIENTS AND METHODS: The medical records of the forty-four patients that had open surgical tracheostomy in the operating theatre within the study period were evaluated. RESULTS: There were 12 females and 32 males. The mean age was 33.6 +/- 24.8 years. The indications for tracheostomy were trauma (n =15), infections (n = 13), laryngeal (benign and malignant) tumors (n = 9), other head and neck malignancies (n = 4), neurological cases with respiratory failure (n = 2), and tracheomalacia (n = 1). All the tracheostomies were performed as an emergency as all the patients presented in respiratory obstruction. Transverse incision was employed in n = 35 cases, while the longitudinal incision was employed in n = 3 and the type of incision was not specified in the remaining six cases. Laryngeal stenosis was found in 6.9% of cases and the mortality was 25%. CONCLUSION: Upper airway obstruction was the major indication for tracheostomy in our center; and the high mortality may be due to the primary medical problems rather than the complications of tracheostomy alone.

Adolescent↗

PubMed2004

Percutaneous dilational tracheostomy--a 3 year experience in a general hospital in Malaysia.

All percutaneous tracheostomies performed in the general intensive care unit (ICU), Hospital Sultanah Aminah, Johor Bahru, Malaysia, from July 1999 to June 2002 were studied. The tracheostomies were performed as an elective bedside technique in the ICU. A total of 352 percutaneous tracheostomies were performed. Eighty-eight percent of the tracheostomies were completed within 15 minutes. The most common complication was bleeding which occurred in 52 patients (14.7%). The rest of the complications encountered were:- transient hypoxia twelve (3.4%), inability/ difficulty to insert tracheostomy tube eight (2.3%), false passage four (1.1%), transient hypotension two (0.6%), pneumothorax two (0.6%), peristomal infection two (0.6%), subcutaneous emphysema one (0.3%), cuff rupture one (0.3%), oesophageal cannulation one (0.3%), and granuloma formation one (0.3%). Conversion to conventional tracheostomies were performed on 7 patients (2%). There was one unfortunate death related to percutaneous tracheostomy. In conclusion, percutaneous dilational tracheostomy can be used safely to manage the airway of critically ill patients.

Adolescent↗

PubMed2005

[Tracheostomy for home-care patients with severe motor and intellectual disabilities].

We discuss here the indication and complications of tracheostomy performed in 57 home-care pateints with severe motor and intellectual disabilities (SMID) during the past 13 years at our hospital. Thirty-five cases underwent tracheostomy following emergency endotracheal intubation for acute respiratory failure. Recently, the number of cases without preceding endotracheal intubation have increased. Many patients underwent tracheostomy at the age of 1 to 4 years and 10 to 14 years. The quality of life (QOL) of almost all the patients without preceding intubation markedly improved, as well as that of their families, and they were able to return to home. The most decisive reason for tracheostomy was secretions and recurrent aspiration pneumonia in 8 patients, gastroesophageal reflux in 4 and upper airway obstructions in 3. Several complications of tracheostomy were observed: tracheal granulations in 9 patients, tracheal malacia in 8, and tracheoinnominate artery fistula in 5. Among 8 patients with tracheal malacia, bleeding from the tracheoinnominate artery fistula occurred in 3. In 7 patients, self-made long tracheostomy tubes were necessary for the initial management of the tracheal malacia or tracheal granulations. Subsequently, made-to-order long tracheostomy tubes were used in three of these patients. In 12 patients, improved endotracheal T-tube with the tip sealed on the vocal cord side was used to prevent aspiration. Home-care SMID patients with respiratory disturbance require tracheostomy timely performed, followed by careful observation to prevent postoperative complications.

Adolescent↗

PubMed1994

A comparative study of systemized vs. random tracheostomy weaning.

The purpose of this study was to compare a systematic tracheostomy weaning procedure to a random weaning approach by asking the question: "What is the benefit to the patient of a systematic vs. random weaning process for tracheostomy removal as defined by the number of weaning attempts and post-weaning complications?" A tracheostomy weaning procedure was developed at St. Boniface General Hospital as a joint venture between the neuroscience nurses and neurosurgeons in response to a perceived clinical need. This project evaluated the systemic procedure in two neuroscience units in Manitoba on ten adult patients who met the assessment criteria for tracheostomy removal established in the procedure. The patients were monitored for thirty days post removal for complications. In addition, a retrospective chart review was completed on twenty charts of patients who had undergone random tracheostomy weaning from 1990-1992. Content analysis of the documentation immediately before, during and after each tracheostomy weaning procedure was undertaken. The results of the study indicate that there were fewer weaning attempts required for the patients with the systemized procedure than the random procedure, and although not statistically significant, there were fewer post-removal complications per patient in the systemized procedure than with the random procedure. Content analysis of the retrospective data indicates that the random tracheostomy weaning procedure was subject to the individual nurses' judgement. The systemized procedure was more standardized and conformed to the protocols in the procedure. Most importantly, the patient's comfort and safety were greatly enhanced through the use of standard tracheostomy weaning procedure.

Adult↗

PubMed1993

[Puncture tracheostomy in intensive care patients. Technique and results of a minimally invasive method].

The so-called percutaneous dilatational tracheostomy-essentially a minimally invasive puncture method-inserting the tracheal cannula by a modified Seldinger-technique is an alternative method to the conventional operative tracheostomy. The percutaneous dilatational tracheostomy was evaluated in a prospective trial (June 92-January 93) on 50 consecutive surgical (n = 36), medical (n = 10), and neurological-neurosurgical (n = 4) critically ill patients (29 m, 21 f; age 14-87 years) with need for prolonged mechanical ventilation. After an average duration of endotracheal intubation of 6 (0-22) days, the procedure was endoscopically guided and controlled via the endotracheal tube. An 8 mm cannula was inserted in each case. Eight patients had severe thrombocytopenia (< or = 50,000 Plt./microL). The percutaneous tracheostomy was always performed with success. The average procedure duration was 8 (5-15) minutes. The perioperative complications were: one patient died of acute cardiac failure independent from the method of tracheostomy, one sustained a temporary subcutaneous emphysema and one a minor bleeding. During a mean duration of cannulation of 21 (0-113) days only one bleeding from the skin margin was observed postoperatively. Infection of stoma site, misplacement of cannula, rupture of the tube cuff, and pneumothorax were not noticed. On 13 decannulated patients stenosis of the trachea was not found in a period of 6-8 weeks following the tracheostomy. As a bedside procedure the percutaneous dilatational tracheostomy is safe and quick and should therefore be the method of choice for critically ill patients who require a tracheostomy.

Adolescent↗

PubMed1978

Tracheostomy in children without heart disease.

A series of 27 patients less than 15 years of age who had tracheostomies from 1968--1975 showed that only two of these patients had cardiac disease as the primary lesion. Only three pneumothoraces could be definitely attributed to the tracheostomy, while sepsis in two patients and pneumonia in one patient might possibly have been related to the tracheostomy itself. One death was due to the performance of the tracheostomy. In patients who have tracheostomy for noncardiac conditions, performance of the tracheostomy in the operating room with an endotracheal tube in place, the use of plastic or silastic body contour conforming tubes, and proper intensive care nursing immediately after tracheostomy have reduced complications to a minimum and made the performance of tracheostomy in this age group a safe and effective procedure when oro- or nasotracheal intubation is inadequate.

Adolescent↗

PubMed1996

Bedside percutaneous tracheostomy with bronchoscopic guidance in critically ill patients.

BACKGROUND: Bedside percutaneous dilational tracheostomy, a relatively new method of tracheal cannulation, provides safe and ready access to the trachea to relieve airway obstruction and tracheopulmonary secretions. The dilational technique has undergone various modifications during the past decade. Complications of this procedure are primarily related to the lack of direct visualization during tracheostomy tube placement and to poor patient selection. OBJECTIVE: To report the utility of percutaneous dilational tracheostomy with bronchoscopic guidance in 162 critically ill patients. MAIN OUTCOME MEASURES: Mortality rates and complications associated with this technique. RESULTS: Twenty-five patients (15.4%) died while hospitalized. No deaths were related to tracheostomy. There were four (2.5%) major complications: one pneumothorax and three posterior tracheal tears, which healed spontaneously. There were five (3.1%) minor complications: one posterior mucosal disruption, one minor bleeding episode, and three minor episodes of cellulitis. One hundred thirty-seven patients (84.6%) were discharged. Twenty-nine patients (21.2%) were available for follow-up and were experiencing no significant problems or complications following the procedure. Compared with standard open tracheostomy, charges were reduced by $1628.20 per patient ($263,768.40 total savings). CONCLUSIONS: Bedside percutaneous tracheostomy with bronchoscopic guidance is safe and cost-effective. Complications compare favorably with that of open tracheostomy. Major complications should be avoided with continuous bronchoscopic observation during the procedure.

Adult↗

PubMed1992

Appraisal of percutaneous tracheostomy.

Two commercially available kits have been used to create 25 percutaneous tracheostomies, 20 using the Cook system and five using the Rapitrac system. The operation time and complication rates of these tracheostomies have been compared with those for 16 conventional tracheostomies performed for similar indications. Median operating times were 60 (range 30-105) min for conventional tracheostomy, 15 (range 8-70) min for Cook and 5 (range 3-15) min for Rapitrac systems (P less than 0.001). A significantly higher proportion of patients in the Rapitrac group had complications compared with the other two groups (P less than 0.05). The complication rate for the Cook group compared favourably with that for the conventional tracheostomy group. The Cook system of percutaneous tracheostomy is a simple, rapid and safe alternative to conventional tracheostomy.

Adult↗

PubMed1994

Bedside percutaneous dilational tracheostomy with endoscopic guidance: experience with 71 ICU patients.

OBJECTIVE: To assess the value of endoscopic guidance in bedside percutaneous dilational tracheostomy. DESIGN: The medical critical care unit of a large community hospital. SETTING: 71 consecutive adult patients who required prolonged mechanical ventilation. INTERVENTIONS: 72 elective percutaneous dilational tracheostomies using the Ciaglia technique were performed under view of a flexible fiberoptic bronchoscope. MEASUREMENTS AND RESULTS: Patients were examined during tracheostomy and on days 2 and 7 after the procedure, at discharge and after half a year if they were still alive. A correct median puncture was observed by endoscopic control in 59 interventions. An initial paramedian puncture was detected in 13/72 (18%) procedures and was corrected by renewed insertion in all cases. No severe complications related to percutaneous dilational tracheostomy were noticed. Minor complications occurred in 4/71 (5.6%) patients including minor bleeding in 2, inflammatory infiltration in 1 and one superficial lesion of the posterior tracheal mucosa. Long-term follow-up revealed stomal granulation in 3 patients including one at the tracheal site. At the end of the observation period the tracheostomy still was in use in 14/71 (20%) patients and 12/71 (17%) patients were decannulated. Due to their severe underlying diseases 45/71 (63%) patients had died. To facilitate weaning from the tracheostomy a minitracheostomy tube was used in 3 patients. CONCLUSION: Percutaneous dilational tracheostomy is a simple bedside procedure associated with a low complication rate. We recommend the use of endoscopic guidance to increase the safety of tracheal puncture and dilation procedure.

Adult↗

PubMedDate not supplied

Loss of the airway during tracheostomy: rescue oxygenation and re-establishment of the airway.

PURPOSE: To describe loss of the airway during tracheostomy and suggest a method for re-establishment of the airway and providing rescue oxygenation. CLINICAL FEATURES: A 22-yr-old female diagnosed with encephalomyelopathy was admitted to the intensive care unit with a progressively deteriorating level of consciousness and respiratory failure requiring intubation and ventilation. Several weeks later, an elective tracheostomy was performed under anesthesia. The surgeon made an anterior tracheal wall incision and inserted a cuffed #6 Shiley tracheostomy tube. No end-tidal CO(2) was detected and the patient could not be ventilated. After another failed attempt at insertion of a second tracheostomy tube, the diagnosis was made of a false passage within the trachea. The Shiley tracheostomy tube was removed and a #6 regular endotracheal tube was introduced in the trachea through the tracheostomy incision. The patient now could be ventilated with difficulty and low readings of end-tidal CO(2) were noted. Despite all efforts to further ventilate the patient, the arterial oxygen saturation never recovered, resulting in cardiac arrest. CONCLUSION: To restore a lost airway during tracheostomy, we recommend that a jet ventilation airway exchange catheter (JVAE) be inserted in the endotracheal tube through a bronchoscope port attachment prior to surgical entry into the trachea. The JVAE will also ensure continued ability to oxygenate the patient.

Adult↗

PubMed2002

Single-dilator percutaneous tracheostomy: a comparison of PercuTwist and Ciaglia Blue Rhino techniques.

OBJECTIVE: To compare two single-dilator percutaneous tracheostomy techniques, Ciaglia Blue Rhino and the new PercuTwist technique. DESIGN AND SETTING: Randomized, observational clinical trial in patients undergoing elective percutaneous tracheostomy in the intensive care units of a university hospital. PATIENTS: Seventy consecutive, adult patients undergoing either Blue Rhino ( n=35) or PercuTwist tracheostomy ( n=35). INTERVENTIONS: Performance of percutaneous tracheostomy with a novel screwlike dilating device (PercuTwist) or conically shaped, flexible rubber dilator (Blue Rhino). RESULTS: Stoma dilation was successful with the respective device in all patients. While subsequent tracheostomy cannula insertion was uneventful in all but one patients undergoing the Blue Rhino technique, it was difficult or even impossible in eight patients who underwent PercuTwist tracheostomy. Regarding serious and intermediate procedural-related complications, two cases of posterior tracheal wall injury occurred with the PercuTwist technique. No serious or intermediate complications were noted during Blue Rhino tracheostomy. There was no statistical significance between the two techniques in terms of minor and overall complications. CONCLUSIONS: So far the new PercuTwist technique represents an alternative to the established Blue Rhino technique. Nonetheless, the two cases of posterior tracheal wall injury should not be underestimated, on the one hand, but, on the other, may be attributed to a learning curve with a new technique. The new PercuTwist technique should be performed by various teams and in a considerably larger numbers of patients before an ultimate rating can be made.

Aged↗