Idiopathic Subglottic and Tracheal Stenosis: A Survey of the Patient Experience.

OBJECTIVES: To report and compare patients' experiences with acquired subglottic stenosis (AS) versus idiopathic subglottic and tracheal stenosis (ISTS). METHODS: A survey was made available to patients with AS and ISTS. Results were analyzed for inter- and intragroup differences using a 2-tailed t test. RESULTS: The study included 160 survey participants (AS n = 28; ISTS n = 132), with a predominance of female participants (82% AS, 98% ISTS). Acid reflux was the most prevalent comorbidity across groups (42%-43%). A significant difference in time to diagnosis was found between groups, with 32% of AS patients diagnosed within 3 months of symptom onset, compared to 2% with ISTS. A diagnosis delay greater than 18 months occurred for 58% of ISTS patients. There was no difference in treatment approach, with the most common treatment being balloon dilation, followed by laser dilation. Tracheal resection was performed in 36% of patients in both groups. Patient satisfaction with surgical outcomes was significantly higher after tracheal resection (76%) compared to other treatment modalities (39%). CONCLUSIONS: ISTS remains a diagnostic challenge as highlighted by the delay in diagnosis compared to AS. There appears to be no historical or symptomatic factors specific to ISTS. Additionally, patients report increased satisfaction and symptom resolution after tracheal resection.

[Invasive and non-invasive ventilation in conflict with best palliative care in severe COPD]. / Invasive Beatmung und nicht-invasive Beatmung im Konflikt mit bester palliativer Versorgung bei schwerer COPD.

This example of an 80-year-old patient with severe lung disease and respiratory failure demonstrates the difficult relationship between the patient's needs, physical symptoms, and social problems. This man decides after a prolonged and difficult in-patient treatment actively for home ventilation rather than die of respiratory failure. He opts for tracheostomy and invasive ventilation because he cannot handle non-invasive mask-ventilation sufficiently by himself. It requires professional communication and support to gain the acceptance of family and caregivers for home ventilation. A survey of existing data on end of life decision-making in end-stage lung disease is given.

Obstructive sleep apnea syndrome and tracheostomy. Long-term follow-up experience.

Obstructive sleep apnea syndrome (OSAS), a disabling disorder that leads to life-threatening cardiorespiratory events during sleep, has been treated by tracheostomy. This article reports long-term follow-up data of 50 patients who have undergone this procedure, and the indications for surgery are summarized. Surgery may result in secondary local and general acute and subacute complications, but, on a long-term basis, patients were completely relieved of clinical symptoms, returned to full activity, and adapted normally to social and familial life. Temporary closure of the tracheostomy during sleep led to recurrence of obstructive sleep apnea.

Psychiatric aspects of head and neck surgery. Part I: New surgical techniques and psychiatric consequences.

Individuals who undergo head and neck surgery experience extreme stressors that go beyond those which occur with the usual surgical patient. This paper will review the literature and discuss the psychiatric consequences of otolaryngeal surgery. In addition, new head and neck surgical techniques, which offer special challenges to the patient as well as to the psychiatric consultant, will be examined. Tracheostomy, which occurs as a result of head and neck surgery, is of particular importance with regard to postoperative adaptation and is a significant complication that must be reckoned with.

Clinical predictors of quality of life in patients with head and neck cancer.

OBJECTIVE: To identify clinical predictors of quality of life (QoL) in a head and neck cancer patient population. DESIGN, PATIENTS, AND SETTING: A convenience sample of 570 patients with upper aerodigestive tract cancers were surveyed at a tertiary care oncology clinic and Veterans Affairs otolaryngology clinic. INTERVENTIONS: A self-administered health survey was constructed to collect demographic, health, smoking, alcohol, depression symptom, and QoL information. Tumor site and tumor stage, clinical, and treatment data were abstracted from the patient medical records. MAIN OUTCOME MEASURES: Quality of life was assessed using the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) and the Head and Neck QoL (HNQoL) instrument. RESULTS: Of the 570 eligible respondents, the presence of a feeding tube had the most negative impact on QoL, with significant decrements in 6 of the 8 SF-36 scales and all 4 HNQoL scales (P<.01). In descending order of severity, medical comorbid conditions, presence of a tracheotomy tube, chemotherapy, and neck dissection were also associated with significant (P<.05) decrements in QoL domains. Patients who took the survey more than 1 year after diagnosis had improved QoL in 7 of 12 domains. Hospital site, age, education level, sex, race, and marital status were also significant predictors of QoL. CONCLUSION: There are at least 13 demographic and clinical characteristics that are significant predictors of QoL in patients with head and neck cancer, which should be considered when treating patients and conducting QoL studies in the future.

Preoperative nursing planning in pediatric tracheotomy.

Tracheotomy may be necessary in the treatment of severe, prolonged illness or airway obstruction. The preoperative nursing care plan is developed to meet the physical needs of the child as well as provide essential information and emotional support to the child and family. Comprehensive attention to all aspects of care needs in the preoperative period assists in the provision of optimum nursing care during the hospital stay and after discharge.

Developmental follow-up of long-term infant tracheostomy: a preliminary report.

In a retrospective study, medical records of a randomly selected sample of all infants less than 13 months old with tracheostomy of at least 1 month's duration were reviewed with respect to medical, demographic, and perinatal variables. Standardized outcome measures were used to document physical, cognitive, linguistic, and emotional development in a cross-sectional follow-up of all tracheostomized infants who were without primary mental retardation or neurological and physical handicap. The total sample of tracheostomized infants tended to be white, male, and premature, with moderate to severe medical illness in the perinatal period. There was a high rate of mortality and morbidity, with the majority of survivors presenting with multiple physical and mental handicaps. Follow-up of survivors without other major handicapping conditions suggested that long-term infant tracheostomy may be associated with impaired physical and emotional development, even when cognitive and language development are within normal limits. Pediatricians should be aware of the complex nature of this handicapping condition in order to coordinate appropriate interdisciplinary management.

The lived experience of survivors of prolonged mechanical ventilation: a phenomenological study.

BACKGROUND: Successful liberation from prolonged mechanical ventilation (PMV) is a challenging phenomenon. Whereas many physiological factors have been linked to successful PMV liberation, the psychosocial components are not well delineated. OBJECTIVES: This article serves to describe the experience of patients who survived PMV and to identify salient factors that contributed to successful liberation. METHODS: A phenomenological approach was used to explore the lived experience of seven PMV survivors. RESULTS: Six mutually exclusive themes emerged from the participants' descriptions to create a structural description of the lived experience. CONCLUSIONS: Survivors credited their own self-determination and the expertise and care of health care professionals with their ability to be successfully liberated from prolonged mechanical ventilation. Although surviving PMV was described as frightening and traumatic, comfort and resolve were derived from family members, religion, prayer, and angelic encounters. These findings are useful in providing direction for critical care clinical practice and future research.

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.

Tracheostomy 'decannulation panic' in children: fact or fiction?

The phenomenon of tracheostomy 'decannulation panic' is likely to occur in children but probably is not psychologically based. The relatively small airway, local reflexes and changes in airway resistance seem sufficient to explain it on a mechanical basis. Because there were delays and failures in this series despite an apparently adequate airway, it is recommended that decannulation be performed on a controlled and gradual basis. The method of blocking a fenestrated tracheostomy tube provides a margin of safety. Chest physiotherapy, humidification and mucolytic agents will assist in preventing the acquisition of chest infection. Prophylactic antibiotics and steroids, however, do not appear to be of value and may actually be harmful.

Using sign language with tracheotomized infants and children.

Children's ability to communicate with others is important for cognitive development. However, the number of infants and young children deprived of vocalization (aphonia) is increasing in the pediatric patient population due to tracheotomy. The Communication Program for Infants and Parents (CPIP) uses sign language as an alternative system to verbal communication.

Quality of life in COPD patients using transtracheal oxygen.

Transtracheal oxygen offers patients with chronic obstructive pulmonary disease many benefits. A qualitative study was conducted to examine patients' perceptions of how the technology affects quality of life. This study has several implications for nurses working in hospital and home settings.

Overcoming the top 10 tracheotomy self-care learning barriers.

Multispecialty inpatient units are the norm in today's acute care settings. Since few units have the luxury of seasoned otorhinolaryngology (ORL) nurses, care of the postoperative patient with a tracheotomy, including discharge teaching and planning are left to the generalists. Generalist nurses and new ORL nurses may find themselves experiencing fear and anxiety along with the tracheotomy patients they care for and teach. Experienced ORL nurses are continually challenged to find ways to share their expertise with patients and less experienced nurses in effective ways. This article presents a unique approach to preparing nurses to teach self-tracheotomy care to their patients. Medical-surgical staff nurses attended a 90-minute inservice program presenting actual clinical scenarios of temporarily learning-impaired patients with tracheotomies, and were asked to role play effective interventions. The program content is designed to address the reluctance of inexperienced, busy nurses to confront learning barriers and motivate patients to accomplish early postoperative involvement in tracheotomy self care. The widespread nature of the challenges faced by nurses and patients regarding tracheotomy care has been confirmed by discussions with colleagues on a national level. It has been confirmed further by the first author's clinical experiences in a wide variety of health care settings. Recommended nursing actions and responses to learning barriers presented here are based on expert opinion and clinical experience.

Medical hypnosis as a tool to acclimatize children to noninvasive positive pressure ventilation: a pilot study.

BACKGROUND: Patient cooperation is crucial for the success of noninvasive positive pressure ventilation (NPPV). This study evaluated the efficacy of medical hypnosis to reduce anticipatory anxiety and acclimatization time in children who are candidates for long-term NPPV. METHODS: Medical hypnosis was performed by a trained nurse. The acclimatization time and long-term compliance with NPPV were evaluated. RESULTS: Hypnosis was performed in nine children aged 2 to 15 years. Seven children had a high level of anticipatory anxiety because of a tracheotomy since birth (n=2), a history of maxillofacial surgery (n=2), severe dyspnea because of lung disease (n=2), and morbid obesity and depression (n=1), and two children with obstructive sleep apnea failed standard NPPV initiation. The hypnosis techniques were based on distraction in the youngest patient and indirect or direct hypnotic suggestions in the older children to obtain a progressive psychocorporal relaxation. All patients accepted the interface and the NPPV after the first hypnosis session. A median of three sessions was needed for overnight (>6 h) NPPV acceptance. The 6-month compliance with NPPV was excellent, with a median use of 7.5 h per night. CONCLUSION: Medical hypnosis is an effective, safe, noninvasive, and inexpensive tool for reducing the anticipatory distress and acclimatization time for NPPV. This therapy is particularly useful in children with traumatic experiences, such as a tracheotomy or facial surgical procedures.

[Assessment of degree of psychological health involvement in pre-laryngectomized patients]. / Valoración del grado de afectación sobre la salud psíquica en el paciente prelaringectomizado.

INTRODUCTION AND OBJECTIVE: Several authors have found increased anxiety in patients the day before an intervention and its correlation with anxiety levels the post-operative period. In this study, we determined a number of problems to which patients who underwent total laryngectomy often objected: the tracheostomy, being left without a voice and it being an aggressive, major surgery. Our objective was to assess the degree of anxiety and fears of the patient prior to total laryngectomy. MATERIAL AND METHODS: We compared 2 groups of 20 patients who underwent operation for total laryngectomy and for other ENT pathologies. On the day before the operation, we collected demographic and medical data and administered the Spanish versions of the Folstein Mini-Mental State Examination (MMSE) and the Goldberg General Health Questionnaire (GHQ-28). We also investigated whether the patients had any fear or fear of surgery and what that fear was. RESULTS: Completion of the MMSE revealed cognitive impairment in only one patient. We subsequently conducted the GHQ-28 and found psychological distress in 20-25% of our cases. When the different fears in both groups were compared by X(2), the results were not statistically significant. CONCLUSIONS: Total laryngectomy causes the loss of oral communication and impairs self-image, contributing to a strong emotional reaction. It is essential to have effective rehabilitation, which considers all aspects of health-sickness, such as the recovery of spoken language, social aspects and the psychological characteristics, vital for proper comprehensive patient management.