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At least 19 recordsLinked to original sources
PubMed2026

Comparison of Adult Tracheostomy Outcomes Before and After Implementation of a Dedicated Tracheostomy Team.

OBJECTIVE: (A) Determine patient and institutional factors associated with increased length of stay (LOS) and complications of tracheostomy, (B) Develop data-driven quality improvement in tracheostomy care. DESIGN: Mixed methods protocol used cross-sectional survey assessing institutional trends in tracheostomy-specific care. Retrospective chart review compared tracheostomy patient outcomes prior to and during implementation of a multidisciplinary tracheostomy care team and standardized guidelines. PARTICIPANTS: Patients undergoing tracheostomy from January 2019 to December 2021 at a tertiary hospital. METHODS: Patient factors, procedure type and indication, tracheostomy tube size, management timeline, insurance, and disease severity using Acute Physiology and Chronic Health Evaluation II (APACHE II) score were analyzed for associations with LOS and adverse events. Multivariate analyses controlled for APACHE II score and payer source. LOS and complications were compared between patients before and during implementation of multidisciplinary tracheostomy care team and standardized guidelines. RESULTS: Three-hundred and eighteen patients met criteria with a 21.7% complication rate, average LOS of 24 days (SD&#x2009;=&#x2009;28.523), and median LOS post-tracheostomy of 14 days (IQR 7, 29). Departments without standardized protocols had greater LOS (F[1,316]&#x2009;=&#x2009;28.706, P&#x2009;<&#x2009;.001]) and complication odds (OR&#x2009;=&#x2009;2.92, P&#x2009;=&#x2009;.015, 95% CI[1.231, 6.930]). Larger tracheostomy tube size was linked to increased LOS (&#x3b2;&#x2009;=&#x2009;.253, t(314)&#x2009;=&#x2009;4.741, P&#x2009;<&#x2009;.001, 95% CI[4.137, 10.081]). Delays from ventilation discontinuation to cuffless tube exchange and decannulation correlated with increased LOS (&#x3b2;&#x2009;=&#x2009;.406, t(184)&#x2009;=&#x2009;6.321, P&#x2009;<&#x2009;.001, 95% CI[.928, 1.771]); (&#x3b2;&#x2009;=&#x2009;.554, t(129)&#x2009;=&#x2009;7.625, P&#x2009;<&#x2009;.001, 95% CI[1.008, 1.715]). When focusing on a single department, comparing 2019 patients to 2021 patients (pre- and post-guideline and care team), overall, LOS decreased from 33.08 to 30.83 days (P&#x2009;=&#x2009;.586). When excluding patients discharged on a ventilator, the 2019 group had average LOS of 37.938 days versus 33.41 days in 2021 (P&#x2009;=&#x2009;.344). CONCLUSIONS: Standardized tracheostomy care guidelines and multidisciplinary care teams are critical to improving institutional outcomes. Data-driven approaches to quality improvement ensure efficient and targeted methods to improving patient care. LEVEL OF EVIDENCE: 4.

Humans↗
PubMed2026

Longitudinal dynamics of respiratory microbiome composition in infants after new tracheostomy placement.

OBJECTIVES: This prospective longitudinal study characterised respiratory microbiome dynamics following new tracheostomy placement among infants. SETTING: A tertiary care paediatric hospital system in the United States. PARTICIPANTS: Fifteen infants &#x2264;12 months of age contributed 84 tracheal aspirate samples collected from day 1 through 3-4 months post-placement. PRIMARY AND SECONDARY OUTCOME MEASURES: Bacterial composition, including abundance, from 16S rRNA gene sequencing; alpha and beta diversity measures over time. RESULTS: 16S rRNA gene sequencing revealed immediate and sustained bacterial community shifts. Staphylococcus abundance increased and alpha diversity decreased in the first 30 days post-tracheostomy (p<0.05) before returning to baseline. Beta diversity demonstrated compositional changes immediately and with ongoing divergence through 3-4 months. Time and clinical factors (prematurity, ventilation and neurologic impairment) were significantly associated with microbiome structure (p=0.001). CONCLUSIONS: This study provides novel evidence that new tracheostomy placement induces rapid and prolonged airway microbiome disruption in infants, highlighting a previously uncharacterised window of vulnerability with implications for respiratory health.

Humans↗
PubMed1978

Patients with tracheostomies: goals of management.

Care of the patient with tracheostomy is not difficult if care is taken to define clearly the needs of the particular patient. An awareness of the goals of care, daily maintenance, and possible complications is necessary to successful management.

Aftercare↗
PubMed1977

Reflex control of expiratory airflow and duration.

Unanesthetized, unrestrained cats were studied repeatedly after placement of a permanent tracheostomy, catheters for respiratory pressure measurements, and respiratory muscle EMG electrodes. The tracheostomy was opened or closed by a remote mechanism. Opening the tracheostomy reduced tracheal pressure to zero and diverted flow from the upper airway; closing the tracheostomy reestablished the normal pathway for airflow. Opening the tracheostomy during expiration evoked reflex responses in the diaphragm, in the laryngeal abductor and in abdominal expiratory muscles. These were sustained compensatory ("tracking") responses which, in each case, acted to offset loss of expiratory braking by the upper airway. Occlusion of the tracheostomy during expiration produced the opposite responses. Responses to tracheostomy opening usually overcompensated for the loss of upper airway resistance, suggesting that extrathoracic tracheal receptors may participate in tracking. Changes in the expiratory time course of lung volume were accompanied by changes in the duration of expiration. These "triggering" responses were shown to operate independently of the tracking responses though both were eliminated by vagotomy.

Abdominal Muscles↗
PubMed1979

Endoscopic findings in sleep apnea syndrome.

Sleep apnea syndrome is a constellation of symptoms resulting from recurrent episodes of apnea during sleep. Often the upper airway becomes obstructed during slumber in this disorder. Symptoms relate to sleep deprivation and include morning headaches, daytime somnolence, personality changes with deteriorating intellectual capacity, nocturnal enuresis, and sexual dysfunction. Diagnosis is assisted by polysomnographic recordings. Therapy is directed at the cause of obstruction when one can be found, weight loss in massively obese patients, tracheostomy in the symptomatic patient. Four patients with documented sleep apnea syndrome are discussed. One patient, a thin adolescent female underwent adenoidectomy without improvement. Two massively obese adult males required tracheostomy with marked amelioration of symptoms. One additional adult male was found to have sleep apnea due to severe, acquired micrognathia; he was significantly improved by tracheostomy. All three adult patients were found by endoscopic visualization to have marked pharyngeal soft tissue collapse with inspiration during apneic episodes. Possible causes of pharyngeal collapse are discussed.

Adolescent↗
PubMed1975

Management of flail chest without mechanical ventilation.

The pathophysiology of flail chest is usually described only on the basis of paradoxical respiration, ignoring underlying pulmonary contusion. Two groups of comparable patients were treated either with early tracheal intubation and mechanical ventilation (Group 1), or with fluid restriction, diuretics, methylpredinisolone, albumin, vigorous pulmonary toilet, and intercostal nerve blocks, ignoring the paradox and treating only the underlying lung (Group 2). When tracheostomy and mechanical ventilation were not used the mortality rate went from 21% to O(p = 0.01), the complication rate from 100% to 20% (p = 0.005), and the average hospitalization from 31.3 to 9.3 days (p = 0.005). We conclude that most patients with flail chest do not need internal pneumatic stabilization if the underlying lung is treated appropriately and that tracheostomy and prolonged mechanical ventilation with a volume respirator, as practiced in most respiratory care centers, is usually a triumph of technique over judgment.

Adolescent↗
PubMed1978

Waking and ventilatory responses to laryngeal stimulation in sleeping dogs.

We studied waking and ventilatory responses to laryngeal stimulation during sleep in three dogs. The dogs breathed through an endotracheal tube inserted caudally into the trachea through a tracheostomy. Laryngeal stimulation was produced either by inflating a small balloon that was positioned in the rostral tracheal segment, or by squirting water onto the larynx through a catheter inserted through the tracheostomy. Airflow was measured with a pneumotachograph, and sleep state was determined by behavioral, electroencephalographic, and electromyographic criteria. We found that the degree of laryngeal stimulation required to produce arousal and coughing was higher in rapid-eye-movement (REM) sleep than in slow-wave sleep (SWS). Stimuli that failed to cause arousal from SWS often produced a single expiratory effort, or brief apnea (1--2 s) and bradycardia. In contrast, during REM sleep subarousal stimuli often resulted in prolonged apnea (greater than 10 s) and marked bradycardia. We conclude that during REM sleep arousal responses to laryngeal stimulation are depressed, but ventilatory and cardiac responses are intact.

Animals↗
PubMed1979

Regulation of airway smooth muscle tone in sleeping dogs.

We examined the influence of sleep state on airway smooth muscle tone in 4 unanesthetized dogs that were trained to sleep in the laboratory. The dogs had been prepared with a permanent side-hole tracheostomy and bilateral cervical vagal loops. During the studies, the dogs breathed through a cuffed endotracheal tube inserted through the tracheostomy. To monitor changes in tracheal smooth muscle tone, we measured the pressure in the water-filled cuff of the endotracheal tube. The technique was validated by examining changes in cuff pressure after administration to the dogs of a series of chemical agents and physiologic stimuli known to constrict or relax tracheobronchial smooth muscle. Sleep state of the dogs was determined by behavioral, electroencephalographic, and electromyographic criteria. During quiet wakefulness, tracheal smooth muscle tone was stable. With the onset and progression of sleep through the nonrapid-eye movement stages, airway smooth muscle tone relaxed (decrease in cuff pressure of 20 to 40 cm H2O), reaching a new steady level during slow-wave sleep. In contrast, during rapid-eye-movement sleep, tracheal smooth muscle tone fluctuated markedly and erratically, as reflected by changes in cuff pressure as large as 90 cm H2O. Partial blockade of the vagus nerves, by cooling the exteriorized cervical vagal loops, decreased or abolished the fluctuations in tracheal smooth muscle tone during rapid-eye-movement sleep at temperatures that did not abolish resting tone, demonstrating that the changes in tone during rapid-eye-movement sleep were related to variability in neural control of airway smooth muscle.

Animals↗
PubMedDate not supplied

Conservative surgical management of tracheal stenosis.

Tracheal stenosis has become an increasing complication following tracheostomy or prolonged intubation for mechanical ventilation and is directly related to trauma. Tracheal resection up to 4 to 5 cm with end-to-end anastomosis is the generally accepted treatment. However, tracheal resection carries mortality and considerable morbidity. From 1974 to 1977 all patients seen with tracheal stenosis, regardless of the etiology and age, were initially treated with a conserative surgical management. It consists of dilation, severance of the stenotic ring, intralesional injection of triamcinolone acetonide, and stenting with a silicone T tube for 90 days. Nine out of 11 patients had good results and enjoy an adequate airway without a tracheostomy tube. The longest follow-up is three years and the shortest is eight months. Intralesional injection of triamcinolone acetonide is essential for a successful treatment. No serious complications due to this treatment have occurred. This technique appears worthy of trial prior to contemplating a more extensive procedure.

Adolescent↗
PubMedDate not supplied

Airway intervention in croup and epiglottitis: the changing role of the otolaryngologist.

Recent evidence indicates that endotracheal intubation is supplanting tracheostomy for the short-term treatment of airway obstruction in epiglottitis and croup. Care should be provided by a triumvirate of physicians to include and otolaryngologist, a pediatrician, and an anesthesiologist. Intensive care facilities are also a prerequisite. Standard tracheostomy should be considered in cases requiring intubation longer than 72 hours.

Child↗
PubMed2026

Surgical management of jugular foramen meningiomas: a function-prioritized perioperative workflow.

OBJECTIVE: Jugular foramen meningiomas are challenging because of their deep, neurovascularly crowded location and multicompartment extension; hyperostosis and rigid dural attachment further narrow the corridor and increase the risk of lower cranial nerve morbidity, causing dysphagia and airway complications that may rarely require tracheostomy. This study aimed to describe a contemporary function-first workflow integrating compartment-based anatomy, venous sinus status, preoperative embolization, and continuous vagus nerve monitoring and its relation to clinically actionable recovery endpoints. METHODS: The authors retrospectively reviewed 26 consecutive patients who underwent primary surgery for jugular foramen meningiomas (2014-2025). Tumors were classified as intradural + intrajugular (IJ) or intradural + intrajugular + extracranial extension (IJE). Retrosigmoid, suprajugular, or transjugular approaches were selected by tumor extension and sigmoid-jugular venous status. Selective embolization and continuous vagus nerve monitoring were used when feasible. Outcomes included extubation timing, time to oral intake, 1-year swallowing/voice severity, extent of resection, and salvage stereotactic radiosurgery (SRS) for progression/regrowth. RESULTS: Twenty tumors were IJ and 6 were IJE. Selective embolization was performed in 16 patients (62%) without complications. Continuous vagus nerve monitoring was implemented in 16 patients (62%); lower preservation rates showed an exploratory association with worse 1-year swallowing. All patients were extubated immediately after surgery. Oral intake began by postoperative day &#x2264; 7 in 20 patients (77%); only 1 required > 14 days before resuming oral intake. At 1 year, swallowing and hoarseness remained worse in 54% and 46% of patients, respectively, but almost all cases were mild; the same patient had moderate dysphagia/hoarseness, and none required tracheostomy, gastrostomy, long-term tube feeding, or phonosurgery. Simpson grade IV comprised 69% of cases but predominantly reflected intrajugular/extracranial residual rather than persistent intradural disease. No patient without preoperative facial nerve palsy developed new palsy; serviceable hearing was preserved in 70%, and 38% with preoperative nonserviceable hearing improved to serviceable hearing. During a median 55.6-month follow-up, 3 patients (12%) underwent salvage SRS for regrowth; none required reoperation. CONCLUSIONS: A function-first workflow guided by anatomical compartment extension and intraoperative monitoring can support rapid recovery and durable functional independence in jugular foramen meningiomas. The IJE phenotype identifies a higher-risk subgroup for delayed oral intake and postoperative subjective dysphagia/hoarseness, while continuous vagus nerve monitoring may provide actionable insights to calibrate surgical aggressiveness and support function-prioritized acceptance of intrajugular/extracranial residual with close surveillance and salvage SRS when needed.

Humans↗
PubMed1979

Lingeous conjunctivitis with tracheal obstruction. A case report, with light and electron microscopy findings.

A white male infant of 1 year had unilateral membranous conjunctivitis and severe laryngotracheobronchitis which required tracheostomy. Cultures from eye and throat swabs and of fluid suctioned through the tracheostomy grew many organisms, including H. influenzae, adenovirus type 3, and Candida species, but he had no specific immunologic disturbance. Ligneous conjunctivitis was diagnosed. The infant's general condition responded slowly to intensive therapy but the membrane continued to slough off the regrow. The excised membrane contained massive subepithelial deposits of eosinophilic material and a moderately vascular chronic inflammatory-cell infiltrate with numerous mast cells in the perivascular spaces and the hyaline membrane. The conjunctivitis cleared when treated with topical sodium cromoglycate (Intal), a known inhibitor of mediator release from mast-cell granules. The success of Intal therapy in this case supports the theory that mast cells are involved in the pathogenesis of ligneous conjunctivitis.

Anti-Bacterial Agents↗
PubMedDate not supplied

[Anesthesiological problems in maxillo-facial surgical interventions and reconstructive plastic surgery].

11 years of anaesthesiological experience in maxillofacial and reconstructive plastic surgery (1-4-1966/1-4-1977) are reviewed. The problems connected with these operations are examined. On the basis of localizations, types of operation and surgical requirements, the problems of greatest importance in these branches of surgery may be indicated in the following 5 parameters: 1. Control of the respiratory ways with naso-tracheal intubation under direct view or blind (more than a thousand cases), oro-tracheal intubation: their indications and contraindications as alternatives to pre- intra- and postoperative tracheotomy. 2. Local control of bleeding. 3. Arousal and prevention of possible postnarcotic complications. 4. Prevention and treatment of postoperative oedema. 5. Nutrition of the patient undergoing surgery. In the interests of history, the superseded problem of whether to use local anaesthesia and general anaesthesia in maxillofacial surgery is mentioned and the various problems are discussed exhaustively. Personal anaesthesiological conduct is then specified in relation to the parameters examined and results reported. The importance in certain endo- and extraoral operations of prolonged intubation in the immediate postoperative period (10-15-30 hours) with respect to the indication for postoperative tracheostomy is highlighted. Apart from certain special pathological situations, tracheostomy is rather exceptional and is no longer employed on a routine basis as it was 2-3 years ago.

Anesthesia↗