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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 = 28.523), and median LOS post-tracheostomy of 14 days (IQR 7, 29). Departments without standardized protocols had greater LOS (F[1,316] = 28.706, P < .001]) and complication odds (OR = 2.92, P = .015, 95% CI[1.231, 6.930]). Larger tracheostomy tube size was linked to increased LOS (β = .253, t(314) = 4.741, P < .001, 95% CI[4.137, 10.081]). Delays from ventilation discontinuation to cuffless tube exchange and decannulation correlated with increased LOS (β = .406, t(184) = 6.321, P < .001, 95% CI[.928, 1.771]); (β = .554, t(129) = 7.625, P < .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 = .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 = .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↗

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↗

PubMedDate not supplied

Complications of long tracheostomy tubes.

Complications of long tracheostomy tubes are not generally appreciated. We report three cases which illustrate that long tracheostomy tubes may impinge on the carina or, less commonly, intubate the right main-stem bronchus, with resultant atelectasis of the left lung. Since larger diameter tracheostomy tubes are also longer, they are much more likely than narrow tracheostomy tubes to produce this complication. The tracheostomy tube position should be checked frequently, especially in patients who develop atelectasis and pneumonia of the left lung.

Adolescent↗

PubMed1978

Tracheostomy and hemodynamic changes in sleep-inducing apnea.

Because pulmonary hypertension and systemic hypertension occur during sleep-induced obstructive apnea, six patients underwent overnight hemodynamic monitoring before and after tracheostomy. Variables studied included heart rate, pulmonary artery pressure, femoral artery pressure, and arterial oxygen tension (Po2). After tracheostomy, significant reductions were noted during sleep in mean pulmonary artery pressure from 45 +/- 6 mm Hg (mean +/- SEM) to 22 +/- 2 mm Hg (P less than 0.05) and in mean femoral artery pressure from 137 +/- 6 mm Hg to 97 +/- 3 mm Hg (P less than 0.005). There was also a significant increase for the group in arterial Po2 recorded during the apneic episodes from 38 +/- 3 mm Hg before tracheostomy to 71 +/- 2 mm Hg (P less than 0.001) after tracheostomy. We conclude that tracheostomy improves the hemodynamic abnormalities and hypoxemia that occur during sleep in patients with sleep-induced obstructive apnea.

Adult↗

PubMed1976

[Prolonged endotracheal intubation or tracheostomy in children (author's transl)].

Five patients with subglottic tracheal stenosis following prolonged endotracheal intubation are reported. To minimize tracheal stenosis the indications for prolonged intubation should be well defined and tracheostomy considered as an alternative. The incidence of tracheal stenosis following prolonged intubation is stimilar to that following tracheostomy. The risk of stenosis increases with the duration of intubation, the degree of physical trauma to the laryngotracheal mucosa (suction, tube changing, restlessness), infection of the trachea or larynx, and with the age of the child. Prolonged intubation necessitates sedation and intensive care. Tracheostomy has a higher mortality but this and the risk of stenosis depend greatly on the operative technique. Particularly in cases where prolonged intubation increase the risk of tracheal stenosis, the advantages of tracheotomy become evident. Tracheostomised children rarely need sedation, the tracheobronchial tree can be easily and carefully toileted and the changing of the tube is without risk. Neither method is absolutely preferable, but the correct application of both will minimise the complication rate. The indications for each may be summarised as follows: for primary treatment of acute respiratory distress in children prolonged intubation is the treatment of choice. If after 3 days there is no chance of extubation, tracheostomy should be considered but this depends also on the child's age and behaviour, and on the laryngotracheal mucosal reaction. The younger the child the more cautiously should tracheostomy be considered. Children under 2 years of age should only be tracheostomised if there is no alternative.

Age Factors↗

PubMed1977

Massive hemorrhage from perforated thyroid complicating tracheostomy. Report of two cases.

Two cases of unusual hemorrhagic complication of tracheostomy involved perforation of the thyroid gland as the cause of hemorrhagic episodes. In one case, massive hemorrhage complicated the postoperative course of a 62-year-old man with dissecting aortic aneurysm. In the other, fatal hemorrhage occurred after tracheostomy through the thyroid gland in a 6-month-old boy. A major branch of the thyroid artery was ruptured adjacent to the tracheostomy wound. This is the sixth reported case of fatal hemorrhage from perforation of thyroid artery after tracheostomy, to our knowledge.

Arteries↗

PubMed1979

Management of the flap tracheostomy. An experimental study.

The flap tracheostomy was studied in 25 adult canines to further investigate its best management. Tracheostomies were performed by employing the inverted U flap incision in the trachea. After decannulation, the flap was either formally resewn to the trachea, bluntly dissected from the surrounding soft tissues, or left in place. The time required for epidermal closure over the tracheostomy site was measured, along with fixation of skin to soft tissues in the area. Histologic examinations were made, and tracheal dimensions were calculated on sections through the stomal area. More rapid skin closure and less soft tissue fixation occurred in animals that underwent resuturing or release of the tracheal flap. In all groups, cartilage viability and regrowth were noted. Tracheal diameters were maintained in all groups, but smoother contouring was seen with resuturing. Additional support for the flap tracheostomy is provided from this animal experimentation.

Animals↗

PubMed1978

Infant tracheostomy. A new look with a solution to the difficult cannulation problem.

Although most infant airway and ventilatory problems will be best solved by the use of endotracheal tubes, clear-cut indications for tracheostomy exist. Past reticence to use tracheostomy for infants has been due mainly to the fear of decannulation problems. Recognition of obstructive airway lesions, particularly the lumen-narrowing tracheal stomal granuloma, has been facilitated by the routine use of the newer infant bronchoscopes with optical telescopes. Successful decannulation begins with proper tracheostomy technique, and continues through tracheostomy management and a well-conceived decannulation program. Decannulation should include evaluation of the structure and function of the airway endoscopically and it may include translaryngeal endoscopic resection or formal surgical removal of any obstructing lesions. Experienced nursing personnel are essential to the entire program.

Airway Obstruction↗

PubMedDate not supplied

Tracing the tracheostomy.

The evolution of tracheostomy can be divided into five stages. The first and longest period (covering roughly 3,000 years from 1500 BC to 1500 AD) begins with references to incisions into the "wind pipe" in the Ebers Papyrus and the Rig Veda. However, Alexander the Great, Asclepiades, Aretaeus and Galen are all recorded as having used this operation. Between 1546 with the writings of Brassarolo until 1883, the procedure was considered futile and irresponsible and few surgeons had the courage to perform it. The third period starts with Trousseau's report of 200 cases in the therapy of diphtheria in 1833. Tracheostomy became a highly dramatized operation for asphyxia and acute respiratory obstruction. In 1932 Wilson suggested its prophylactic and therapeutic use in poliomyelitis. Tracheostomy was then recommended for a large variety of assorted maladies. This started a tremendous period of enthusiasm. Finally, the present era starting in 1965 comes as a period of rationalization. Complications, indications and interrelation with endotracheal intubation are clearly outlined. Tracheostomy has found its place.

Animals↗

PubMedDate not supplied

Tetanus and tracheostomy.

Forty-one patients with tetanus in different stages of the disease on whom tracheostomies were performed are discussed in this paper. Out of these, 21 died, giving a mortality rate of just over 50%, which is about equal with those reported from other centers. It was found that patients in Stage III of the disease referred for tracheostomy hardly ever recovered. Patients in Stage II on whom tracheostomy was performed early stood the best chance of survival and recovery. However, if the operation was delayed in Stage II patients, there was a much greater chance for complications to develop, mostly due to aspiration of secretions into the tracheobronchial tree with consequent bronchopneumonia. There were four deaths, all in Stage III patients undergoing tracheostomy, where no definite or conventional identifiable cause could be determined. There were three deaths due to "technical failure" in tracheostomized tetanus patients, which underlines the difficulties and technical problems encountered in satisfactorily maintaining a totally paralyzed patient without any means of communication.

Adolescent↗

PubMed1978

Pediatric tracheostomy and associated complications.

A retrospective analysis of 123 pediatric tracheostomies reveals an overall complication rate of 33%. Immediate complications were present in 12% or 15 patients. The most frequent immediate complications were pneumomediastinum and pneumothorax. Delayed complications occurred in 24% or 30 patients. The most frequent delayed complications were subglottic stenosis, fused vocal cords, and tracheal granuloma. Four patients died because of tracheostomy-related complications. Age, underlying disease, and prior endotracheal intubation had a high degree of correlation with complications. The use of a mechanical respirator following tracheostomy did not appear to be significantly related to complications. Fifty percent of the delayed complications in this series were regarded as being unrelated to the tracheostomy or the trachesotomy tube itself.

Age Factors↗

PubMed1978

Pediatric tracheostomy. I. Radiographic features of normal healing.

Serial radiographic studies were used in a prospective study of tracheostomy healing in 30 consecutive infants and children. The examinations were simple, required no anesthesia or sedation, and were coordinated with decannulation of the tracheostomy. In 22 of 30, the tracheostomy site healed normally; in four of these 22 patients the primary cause for obstruction persisted. In 19 of 22 the radiologic study served as an alternative to bronchoscopy before decannulation. Particularly in small infants, the features of normal healing vary in the first days; temporary narrowing of the tracheal lumen can occur at the stomal site and mimic early granulations. After 1 month the trachea is normal except for minor changes at the previous site of the tracheostomy.

Bronchoscopy↗

PubMed1978

Pediatric tracheostomy. II. Radiographic features of difficult decannulations.

A difficult decannulation was the principal complication in 12 of 30 consecutive infants and children with tracheostomies. Simple radiographic studies permitted accurate diagnoses which correlated with bronchoscopy. In eight patients an endotracheal lesion was caused directly by the tracheostomy, a risk of complication higher than expected. These obstructions were usually granulomas at the superior margin of the stoma; resectable and nonresectable granulomas could not be differentiated radiographically. Four patients had a primary tracheal or laryngeal obstruction which preceded the tracheostomy and complicated decannulation; these included adhesions of the vocal cords and subglottic trachea and posed difficulties in radiographic diagnosis. In no case was dependency on tracheostomy entirely due to emotional causes.

Bronchoscopy↗

PubMed1977

Acute epiglottitis in children - the morbidity of management by elective tracheostomy.

Acute epiglottitis is a pediatric airway emergency. No deaths occurred in 61 cases treated by elective tracheostomy at The Montreal Children's Hospital between 1966 and 1974. Seven patients (11.5%) showed evidence of aspiration pneumonia prior to tracheostomy and seven others developed pulmonary atelectasis in the first 24 hours following tracheostomy but only 9.8% of the total had a complication which continued in evidence 24 hours following surgery. A further 19.5% developed further complications unrelated to this earlier morbidity prior to discharge from hospital. The mean cannulation time was seven days and the mean hospital stay was nine days. Of these patients, 32 (52.4%) were seen between a year and seven-and-a-half years later. Twenty were completely asymptomatic with a small, neat scar. Twelve patients had experienced some upper respiratory problem or minor problems related to the tracheostomy incision.

Acute Disease↗

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 ≤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↗

PubMed1977

Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy.

Cardiac arrhythmias during wakefulness and sleep in 15 patients with sleep-induced obstructive apnea, and the effect of atropine and tracheostomy on these arrhythmias were studied by continuous overnight Holter electrocardiographic, respiratory and electroencephalographic recordings. Sleep was characterized by marked sinus arrhythmia in 14, extreme sinus bradycardia ( less than 30 beats/minute) in six, asystole of 2.5 to 6.3 seconds in five, second degree atrioventricular (A-V) block in two, and ventricular arrhythmias--complex premature ventricular beats in 10 and ventricular tachycardia in two. Arrhythmias during wakefulness were limited to premature ventricular beats in six. Atropine administration was partially and tracheostomy highly effective in preventing the majority of these arrhythmias during sleep. Marked sinus arrhythmia during sleep is characteristic of the syndrome of obstructive sleep apnea and is frequently accompanied by potentially life-threatening tachy- and bradyarrhythmias. Possible mechanism of production of these arrhythmias, the mode of action of tracheostomy and atropine, and the probable role of similar arrhythmias in the sudden infant death syndrome are discussed.

Apnea↗

PubMed1978

The influence of tracheal vascularization on the optimum location, shape and size of the tracheostomy in prolonged intubation.

Tracheal complications due to prolonged intensive therapy were studied. By means of angiography and dye injection of blood vessels in human cadavers, and by means of surgery in dogs, the arterial systems of the trachea in both species have been analysed with regard to problems arising during prolonged intubation in the Intensive Care Unit. In experiments the main arterial networks of the trachea have been exposed, their extent assessed and the anastomoses between them determined. From analysis of the results, the most advantageous location, shape and size of the tracheostomy is proposed. A transisthmic, round and oval-shaped tracheostomy respectively, taking no more than the medial two quarters of the tracheal diameter, was found to be most suitable. Three main arterial systems, segmentally arranged blood vessels, and rich vertical and horizontal anastomoses effectively prevent necrosis of the major tracheal segments. If only one of the three arterial systems functions, the trachea survives. When designing a tracheostomy, its role in the technical procedure of prolonged intubation should have priority. The blood supply of the trachea is of secondary importance.

Animals↗

PubMed1976

Stenosis following tracheostomy. A quantitative study of long term results.

Seventy out of the 320 patients treated with tracheostomy and respiratory care in an intensive care unit, were included in a follow-up study. A variety of surgical (38) and medical (32) conditions had prompted IPPV for 1-59 days; 33 had had primary and 37 secondary tracheostomies. The final study included an interview, physical examination, radiographic examination and spirometry. Using radiographic measures, the area of stenosis was calculated as well as the pressure drop across the stenosis at various flow rates. The methods of calculation were tested in one patient and compared with the actual tracheal pressure and gas flow recordings. Lateral stenosis was found in 69 and frontal stenosis in 25 patients, the length being 0-2-5-0 cm. The stenosis was situated at the level of the stoma in 59, at the cuff in 6, and at both sites in 2; in 2 the level could not be determined accurately. The mean area of normal trachea was 2-8+/-0-8 cm2 in females and 3-7+/-0-7 cm2 in males, while the stenotic area ranged from 0-86 to 4-54 cm2. A stenosis of potential functional significance was found in 8 patients (area less than 1-5 cm2). The stenotic area correlated well with the pressure drop across the stenosis and better than with the stenosis percentage (1-74%). The predicted pressure falls over the stenosis at different flow rates were in excellent agreement with those measured in one patient. Spirometry was unsuitable for detecting the stenosis. Poor correlation were found between the degree of tracheal stenosis and chronic respiratory disease, smoking, age, interval between intubation and tracheostomy, or duration of IPPV. Dysponea during moderate exercise was present in all patients who had a pronounced stenosis.

Female↗