Ten-Year Review of Tracheostomy Techniques and Related Complications.

BACKGROUND: Tracheostomy is a frequently performed procedure that allows for definitive airway access in critically ill patients. Complications associated with tracheostomy have been well documented in the literature. This study aims to examine if different tracheostomy techniques were associated with specific complications. Secondary objectives were to determine the rate and commonality of post-tracheostomy complications. METHODS: This was a descriptive retrospective study of patients who underwent tracheostomy between June 2009 and June 2019. Patients included in the study were ≥18 years and were admitted to a rural tertiary care hospital system. RESULTS: Overall procedure complication rate was 34.3% with pneumonia (18.6%), obstruction (6.2%), bleeding (4.0%), and accidental tube decannulation (3.8%) being the most common. Rate of complications was not associated with the timing of the tracheostomy, the incision type, tube location, tracheostomy technique, and securing technique. However, tube size significantly differed between patients with or without complications (P = .016). Tube size 8 Shiley was most commonly used in both groups and was significantly associated with reduced complication rate (72.0% vs 78.8%, P = .002). CONCLUSION: Tracheostomy technique should be guided by proceduralist experience and patient clinical picture to determine the best approach. However, the association of post-tracheostomy complication with tube size perhaps will guide clinicians with tube size selection.

Endovascular repair of a traumatic inferior vena cava injury after exploratory laparotomy.

The incidence of traumatic inferior vena cava (IVC) injury is infrequent but is associated with high mortality. No clear and current society-based guidelines are available to dictate the role of endovascular therapy. In the present case report, we have described a unique clinical presentation of a patient in extremis after emergent exploratory laparotomy who had experienced an IVC injury that could not be controlled with open surgery. The IVC injury was treated with an endovascular approach with a Gore TAG endograft (W.L. Gore & Associates, Flagstaff, AZ). We have reported a technique for successful treatment of a complex IVC injury, with the aim of adding to the current body of literature supporting the use of endovascular approaches.

TrapEase vena cava filter: a case of filter migration and pulmonary embolism after placement.

Inferior vena cava filters provide an alternative method of protection against pulmonary embolism in situations where anticoagulation either fails or is contraindicated. These filters are easily placed, with a relatively minor risk of complications. Currently, we know of only one reported case of filter migration using the TrapEase filter. We present a case report of a migrating TrapEase filter, as well as pulmonary embolism after TrapEase filter placement. This complication developed in a 31-year-old trauma patient who developed bilateral popliteal deep vein thromboses and an initial pulmonary embolus while on low molecular weight heparin.