Establishment and validation of a predictive model for tracheotomy in critically ill patients and analysis of the impact of different tracheotomy timing on patient prognosis.

BACKGROUND: In critically ill patients receiving invasive mechanical ventilation (IMV), it is unable to determine early which patients require tracheotomy and whether early tracheotomy is beneficial. METHODS: Clinical data of patients who were first admitted to the ICU and underwent invasive ventilation for more than 24 h in the Medical Information Marketplace in Intensive Care (MIMIC)-IV database were retrospectively collected. Patients were categorized into successful extubation and tracheotomy groups according to whether they were subsequently successfully extubated or underwent tracheotomy. The patients were randomly divided into model training set and validation set in a ratio of 7:3. Constructing predictive models and evaluating and validating the models. The tracheotomized patients were divided into the early tracheotomy group (< = 7 days) and the late tracheotomy group (> 7 days), and the prognosis of the two groups was analyzed. RESULTS: A total of 7 key variables were screened: Glasgow coma scale (GCS) score, pneumonia, traumatic intracerebral hemorrhage, hemorrhagic stroke, left and right pupil responses to light, and parenteral nutrition. The area under the receiver operator characteristic (ROC) curve of the prediction model constructed through these seven variables was 0.897 (95% CI: 0.876-0.919), and 0.896 (95% CI: 0.866-0.926) for the training and validation sets, respectively. Patients in the early tracheotomy group had a shorter length of hospital stay, IMV duration, and sedation duration compared to the late tracheotomy group (p < 0.05), but there was no statistically significant difference in survival outcomes between the two groups. CONCLUSION: The prediction model constructed and validated based on the MIMIC-IV database can accurately predict the outcome of tracheotomy in critically ill patients. Meanwhile, early tracheotomy in critically ill patients does not improve survival outcomes but has potential advantages in shortening the duration of hospitalization, IMV, and sedation.

Endotracheal Intubation via Tracheotomy and Subsequent Thoracotomy in Rats for Non-Survival Applications.

Endotracheal intubation and subsequent ventilation are often basic requirements for translational research in rat models for various interventions that require controlled or high ventilation pressures or access to the thoracic cavity and organs. Conventional endoorotracheal intubation using the anatomically existing route through the mouth is well suited for survival experiments. However, this procedure poses some challenges, including generally higher levels of the required experience and technical skill, more advanced equipment, and greater time effort with relevant intubation failure rates and complications such as tracheal perforation, temporary systemic hypooxygenation, and relevant aerial leakage. This manuscript, therefore, presents a detailed step-by-step protocol for endotracheal intubation through tracheotomy in non-survival rat models when guaranteed intubation success, constant oxygenation levels, high ventilation pressures, or open thoracotomy are required. The protocol emphasizes the importance of meticulous surgical technique to ensure consistent and reliable outcomes, especially for researchers who are inexperienced or lack routine in the technique of endoorotracheal intubation via direct laryngoscopy. This procedure is, therefore, expected to minimize animal suffering and unnecessary animal losses.

[Suctioning in intubated and tracheotomized patients : A narrative review]. / Absaugung bei intubierten und tracheotomierten Patient*innen : Eine narrative Übersichtsarbeit.

BACKGROUND: Endotracheal suctioning in intubated or tracheotomized critically ill patients is a daily task of various professional groups in intensive and emergency medicine; however, a German language summary of current evidence is lacking. OBJECTIVE: The aim is to develop a narrative overview of current evidence on endotracheal suctioning of intubated or tracheotomized patients in the clinical setting. MATERIAL AND METHODS: A literature search was conducted in the databases Cinahl, Cochrane Library, Livivo, and Medline via PubMed by nurses with an academic degree. In addition, a hand search and applying the snowball principle were performed. Following a successful critical appraisal, all English and German language publications addressing endotracheal suctioning in the context of hospital care were included. RESULTS: A total of 23 full texts were included. After developing 6 main topics on endotracheal suction 19 articles were considered in the reporting. The results showed, among others, that routine deep suctioning once per shift is contraindicated and that the catheter should be advanced no more than 0.5-1 cm beyond the distal end of the tube or tracheal cannula. Closed suction catheters offer advantages, especially for staff protection, although studies are heterogeneous. Further training of staff is obligatory. CONCLUSION: Few conclusive studies on endotracheal suction could be found; however, with the available evidence initial conclusions can be drawn which should be considered in, for example, internal standard operating procedures. Further research is needed.

Traqueotomía versus traqueostomía, la necesidad de una aclaración lexicográfica / Tracheotomy versus tracheostomy, the need for lexicographical clarification

Con frecuencia se usan en el ámbito sanitario los términos traqueotomía y traqueostomía, pudiendo generar dudas entre los propios profesionales sobre qué definición corresponde a cada término o cuál de ellos debe considerarse más correcto en casos concretos. Se ha realizado una búsqueda de los términos «traqueotomía» y «traqueostomía» en los diccionarios generalistas en idioma español del Diccionario de la Real Academia Española (DRAE) y del Diccionario Histórico de la Lengua Española de la Real Academia Española (DHLE), y de los términos en inglés «tracheotomy» y «tracheostomy» en los diccionarios generalistas en idioma inglés del Oxford Dictionary, del Cambridge Dictionary y del Collins English Dictionary. Asimismo, se ha hecho una búsqueda en los diccionarios de términos médicos en español del Diccionario de Términos Médicos de la Real Academia Nacional de Medicina (DTM) y en inglés del Farlex Dictionary. Los términos se buscaron también en el buscador generalista de Internet Google®. Se analizaron las definiciones desde el punto de vista lexicográfico y etimológico. Las definiciones que aparecen en los diccionarios generalistas, tanto en español como en inglés, son imprecisas, limitadas y adolecen de ambigüedad por mezclar indicaciones desactualizadas con criterios alejados de la etimología. Sin embargo, las definiciones en los diccionarios de términos médicos en ambos idiomas están más ajustadas a la etimología. La traqueotomía identifica estrictamente el procedimiento quirúrgico de realización de una apertura en la cara anterior de la tráquea. La traqueostomía identifica la realización de un orificio que comunica la tráquea con el exterior e implica una modificación del tracto aéreo superior al proporcionar una entrada adicional de la vía respiratoria. Solo en las laringectomías totales la traqueostomía es la única vía de entrada al tracto aéreo. Ambos términos pueden utilizarse sinónimamente cuando una traqueotomía culmina con una traqueostomía. No convendrá utilizar el término traqueostomía cuando se produce el cierre de los planos al final del procedimiento y este no resulta en la creación de un estoma. Los traqueostomas pueden ser cualificados con adjetivos de tiempo de permanencia (temporal/permanente), tamaño (grande/pequeño), forma (redondo/elíptico), o profundidad por sí mismos, sin vincularse a ningún tipo de enfermedad o de indicación quirúrgica. No todos los traqueostomas permanentes tienen lugar en laringectomías totales ni tienen sistemáticamente un carácter irreversible.(AU)

In the healthcare field, the terms “traqueotomía” and “traqueostomía” are frequently used, often leading to confusion among professionals regarding the appropriate definition for each term or which one should be considered more correct in specific cases. A search was conducted for the terms “traqueotomía” and “traqueostomía” in general Spanish-language dictionaries such as the Dictionary of the Royal Spanish Academy (DRAE) and the Historical Dictionary of the Spanish Language of the Royal Spanish Academy (DHLE), as well as for the English terms “tracheotomy” and “tracheostomy” in English general dictionaries like the Oxford Dictionary, the Cambridge Dictionary, and the Collins English Dictionary. Additionally, searches were performed in medical dictionaries in both Spanish, specifically the Dictionary of Medical Terms of the National Academy of Medicine (DTM), and English, including the Farlex Dictionary. The terms were also explored using the Google search engine. Definitions were analyzed from both lexicographical and etymological perspectives. Definitions found in general dictionaries, in both Spanish and English, were found to be imprecise, limited, and ambiguous, as they mixed outdated indications with criteria that deviated from etymology. In contrast, definitions in medical dictionaries in both languages were more aligned with etymology. “Traqueotomía” strictly identifies the surgical procedure of creating an opening in the anterior face of the trachea. “Traqueostomía” identifies the creation of an opening that connects the trachea to the exterior, involving a modification of the upper airway by providing an additional entry for the respiratory pathway. “Traqueostomía” becomes the sole means of entry to the airway in total laryngectomies. Both terms can be used synonymously when a traqueotomía culminates in a traqueostomía. However, it is not appropriate to use the term “traqueostomía” when the procedure concludes with the closure of the planes and does not result in the creation of a stoma. Traqueostomas can be qualified with adjectives indicating permanence (temporary/permanent), size (large/small), shape (round/elliptical), or depth, without being linked to any specific disease or surgical indication. Not all permanent traqueostomas are the result of total laryngectomies, and they do not necessarily have an irreversible character systematically.(AU)

Características de los pacientes traqueostomizados en seguimiento por un Servicio de Atención Paliativa y de Paciente Crónico Complejo (SAPPCC) / Characteristics of tracheostomized patients followed up by a Palliative Care and Complex Chronic Patient Service

Introducción y objetivos: En los últimos años se ha objetivado un incremento de niños portadores de traqueostomía. El objetivo del estudio es describir las características de los pacientes pediátricos traqueostomizados en seguimiento por el SAPPCC de un hospital de tercer nivel.MétodosEstudio unicéntrico, observacional y retrospectivo que incluyó pacientes ≤18años portadores de traqueostomía atendidos por el SAPPCC de un hospital de tercer nivel (noviembre de 2020-junio de 2022). Se analizaron datos epidemiológicos, clínicos, microbiológicos y sociales mediante la revisión de la historia clínica.ResultadosSe incluyeron 44 pacientes traqueostomizados. La patología de base más frecuente fue la patología de vía aérea superior adquirida (20,5%), siendo la obstrucción de vía aérea superior (66%) la indicación más frecuente de traqueostomía. El 84% presentaron aislamientos bacterianos en aspirado traqueal, y Pseudomonas aeruginosa (56,8%) fue el microorganismo más frecuentemente aislado. El antibiótico sistémico más prescrito fue ciprofloxacino (84%). El 18,1% de los pacientes recibieron como mínimo una tanda de antibioterapia intravenosa y el 29,5% recibieron más de tres pautas de antibiótico sistémico en los últimos 20meses. El 59% de los niños estaban escolarizados: el 38,6% en escuela ordinaria, el 15,9% en escuela de educación especial y el 4,5% en domicilio. Se identificó familia en crisis en el 53,7% de los pacientes, y el 22,7% de las familias disponían de la prestación por cuidado de menores con enfermedad grave.ConclusionesDada la complejidad de los niños traqueostomizados, es fundamental un manejo integral y coordinado. La escolarización es posible y segura si se capacita a sus cuidadores/enfermeras escolares. (AU)

Introduction and objectives: In recent years, there has been an increase in the number of children with tracheostomies. The objective was to describe the characteristics of paediatric patients with a tracheostomy followed up by the palliative care and complex chronic patient service (PCCCPS) of a tertiary care hospital.MethodsSingle-centre retrospective observational study in patients aged less than 18years with a tracheostomy manage by the PCCCPS of a tertiary care hospital (November 2020-June 2022). We analysed epidemiological, clinical, microbiological and social data by reviewing the health records.ResultsThe sample included 44 tracheostomized patients. The most frequent underlying disease was acquired upper airway disease (20.5%). The most common indication for tracheostomy was upper airway obstruction (66%). Bacterial isolates were detected in 84% of the tracheal aspirates, among which Pseudomonas aeruginosa was most frequent (56.8%). The most frequently prescribed antibiotic was ciprofloxacin (84%). In addition, 18.1% of the patients received at least one course of intravenous antibiotherapy and 29.5% received more than three systemic antibiotic regimens in the past 20months. Fifty-nine percent of the children were schooled: 38.6% attended a regular school, 15.9% a special needs school and 4.5% were home-schooled. We identified social difficulties in 53.7%. Also, 22.7% of the families received financial support to care for a child with severe illness.ConclusionsBecause of the complexity of caring for tracheostomized children, integral and coordinated management is essential. Schooling is possible and safe if caregivers are trained. (AU)

Successful Recovery of a Catatonic Patient with Severe Pneumonia and Respiratory Failure: Modified Electroconvulsive Therapy Following Tracheotomy.

BACKGROUD: Catatonia encompasses a group of severe psychomotor syndromes affecting patients' motor, speech, and complex behaviors. Common features include rigidity, reduced mobility, speech, sputum production, defecation, and eating. Risks associated with catatonia, such as increased muscle tension and reduced swallowing and coughing reflexes, along with risks from therapeutic approaches like prolonged bed rest and sedative drugs, can elevate the risk of aspiration pneumonia, severe pneumonia, and acute respiratory failure. These complications significantly impede catatonia treatment, leading to poor prognosis and jeopardizing patient safety. CASE DESCRIPTION: In this report, we present a case of catatonia complicated by severe pneumonia and respiratory failure, successfully managed with modified electroconvulsive therapy alongside tracheotomy. We hope this case provides valuable insights for psychiatrists encountering similar scenarios, facilitating the development of rational therapeutic strategies for prompt improvement of patient condition.

Quality of life and functional outcomes in tongue cancer patients: a long-term, prospective, comparative study

Background: The tongue has an indispensable role in communication, swallowing and breathing. Tongue cancer treatment involves direct resection of the tumor and surrounding tissue, which can limit many essential functions of the tongue. There are few patient-reported quality of life studies involving tongue cancer exclusively. There is also a lack of data on the outcomes of quality of life regarding different reconstructive methods, adjuvant nonsurgical therapies and other predicting factors. Our objective is to assess the quality of life, functional status, and predicting factors in patients with tongue cancer up to one year after surgical resection. Material and Methods: Thirty-six patients with tongue cancer were prospectively identified between October of 2017 and January 2021. Patients were examined before and one, three, six and twelve months after surgical resection with the validated University of Washington Quality of Life questionnaire (UW-QOL). Data collection included patient age, sex, TNM staging, size of resection, neck dissection, tracheostomy, reconstructive method and adjuvant therapies. Outcome scores were compared using the Friedman test. Multiple linear regression analysis was used to identify the predictors of quality of life and functional status. Results: The use of UWQOL scores as dependent variables revealed the following predicting factors: age, tobacco use, radiotherapy, chemotherapy, reconstruction method and neck dissection. Conclusions: The most relevant findings in our study are that flap reconstruction becomes increasingly necessary when a glossectomy resection is over 45 mm, in order to maintain tongue function. We established that the reconstructive flap type does not influence quality of life in the long term. Also, we have found that cervical sentinel node biopsy provides better quality of life over neck dissection in the first 3 months after surgery. (AU)

[Balloon dilation as an alternative to tracheotomy for acquired subglottic stenosis in children of the first year of life]. / Ballonnaya dilatatsiya kak al'ternativa trakheotomii pri priobretennom podskladkovom rubtsovom stenoze u detei pervogo goda zhizni.

OBJECTIVE: To study the efficacy and safety of balloon dilation as the first choice method in the treatment of children of the first year of life with acquired subglottic stenosis. MATERIAL AND METHODS: A retrospective analysis of the treatment of 25 patients aged 27 days to 11 months of life (average age 5.3±3.76 months) with subglottic stenosis caused by prolonged intubation, in whom balloon dilation was the first method of treatment. Grade III Cotton-Myer stenosis was preoperatively detected in 22 children, the remaining 3 had grade II stenosis. RESULTS: The success rate of balloon dilation was 100%; tracheotomy was not required in any case, the absence of stenosis during a follow-up examination in the catamnesis was recorded in 14 (56%) children, the remaining 11 (44%) had grade 0-I stenosis and did not cause respiratory disorders. In 1 child (1.5 years old), a subglottic cyst was removed after balloon dilation. One dilation was required in 18 (72%) children, two - in 5 (20%), three and four - respectively for 1 patient. If additional intervention was necessary, the operation was repeated 10 days - 3 months after the previous one. There were no postoperative complications. CONCLUSION: Balloon dilation is a highly effective and safe alternative to traditional surgical interventions for acquired subglottic stenosis in children of the first year of life and can be recommended as a method of first choice.

[Analysis of the diagnosis and treatment of 10 cases of complex respiratory foreign bodies in children].

Objective:To explore the diagnosis and treatment experience of complex respiratory foreign bodies in children. Methods:The clinical data of 1 243 cases of respiratory foreign bodies in children were retrospectively analyzed, among which 10 cases（0.8%） were complicated respiratory foreign bodies. Results:Among the 10 cases of complex respiratory foreign bodies, 2 cases were removed by open thoracotomy, 1 case was removed by tracheotomy, 1 case was removed by lobectomy, 1 case was removed by fiberoptic bronchoscopy because of difficult airway caused by the accompanying congenital pulmonary artery sling, and the pulmonary artery sling correction was synchronized with the fiberoptic bronchoscopic removal, 3 cases were removed by fiberoptic bronchoscopic holmium laser and/or freezing method to make the foreign body deformed and fragmented and then taken out by the sound gate, and 2 cases were removed because of the In 3 cases, the foreign bodies were deformed and fragmented by fiberoptic bronchoscopy, and in 2 cases, the foreign bodies were removed through the vocal folds because of their special characteristics. Two cases were intubated and sent to ICU after surgery because of obvious vocal edema and difficulty in deoxygenation, two cases were transferred to ICU after cardiac or thoracic surgery, and the rest of them returned to ordinary wards after surgery, and all 10 cases recovered well after surgery. Conclusion:Respiratory foreign body combined with airway stenosis, when the foreign body type, shape, embedded location of special foreign body, foreign body is too large, need to rationally choose the method of foreign body removal. If necessary, a combination of methods can be used to ensure that the airway obstruction is quickly relieved with the best program.

Tracheotomy versus tracheostomy, the need for lexicographical clarification.

In the healthcare field, the terms "traqueotomía" and "traqueostomía" are frequently used, often leading to confusion among professionals regarding the appropriate definition for each term or which one should be considered more correct in specific cases. A search was conducted for the terms "traqueotomía" and "traqueostomía" in general Spanish-language dictionaries such as the Dictionary of the Royal Spanish Academy (DRAE) and the Historical Dictionary of the Spanish Language of the Royal Spanish Academy (DHLE), as well as for the English terms "tracheotomy" and "tracheostomy" in English general dictionaries like the Oxford Dictionary, the Cambridge Dictionary, and the Collins English Dictionary. Additionally, searches were performed in medical dictionaries in both Spanish, specifically the Dictionary of Medical Terms of the National Academy of Medicine (DTM), and English, including the Farlex Dictionary. The terms were also explored using the Google search engine. Definitions were analyzed from both lexicographical and etymological perspectives. Definitions found in general dictionaries, in both Spanish and English, were found to be imprecise, limited, and ambiguous, as they mixed outdated indications with criteria that deviated from etymology. In contrast, definitions in medical dictionaries in both languages were more aligned with etymology. "Traqueotomía" strictly identifies the surgical procedure of creating an opening in the anterior face of the trachea. "Traqueostomía" identifies the creation of an opening that connects the trachea to the exterior, involving a modification of the upper airway by providing an additional entry for the respiratory pathway. "Traqueostomía" becomes the sole means of entry to the airway in total laryngectomies. Both terms can be used synonymously when a traqueotomía culminates in a traqueostomía. However, it is not appropriate to use the term "traqueostomía" when the procedure concludes with the closure of the planes and does not result in the creation of a stoma. Traqueostomas can be qualified with adjectives indicating permanence (temporary/permanent), size (large/small), shape (round/elliptical), or depth, without being linked to any specific disease or surgical indication. Not all permanent traqueostomas are the result of total laryngectomies, and they do not necessarily have an irreversible character systematically.

Pediatric Tracheotomy Stomal Maturation and Tracheocutaneous Fistulas.

OBJECTIVE: The purpose of this study is to determine whether tracheostomy stomal maturation affects the risk of tracheocutaneous fistula (TCF) in children. METHODS: A retrospective chart review was conducted for all children who both underwent a tracheostomy and were decannulated between 2012 and 2021 at a tertiary children's hospital. Charts were analyzed for demographics, surgical technique, and development of a TCF. TCF was defined as a persistent fistula following 3 months after decannulation. RESULTS: 179 children met inclusion criteria. The median (interquartile range) age at tracheostomy was 1.5 (82.4) months, average (standard deviation [SD]) duration of tracheotomy was 20.0 (20.6) months, and length of follow-up after decannulation (range; SD) was 39.3 (4.4-110.0; 26.7) months. 107 patients (60.0%) underwent stomal maturation and 98 patients developed a TCF (54.7%). Younger age at tracheostomy placement was significantly associated with increased risk of TCF, mean (SD) age 28.4 (51.4) version 80.1 (77.5) months (p < 0.001). Increased duration of tracheostomy was significantly associated with increased risk of TCF, 27.5 (18.4) version 11.0 (18.2) months (p < 0.001). Stomal maturation was not significantly associated with the risk of TCF, including on multivariable analysis adjusting for age at tracheostomy and duration of tracheostomy (p = 0.089). CONCLUSION: Tracheostomy stomal maturation did not affect the risk of TCF in children, even after adjusting for age and duration of tracheostomy. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:2941-2944, 2024.

A Novel Dressing Method to Achieve Early Natural Tracheostoma Closure.

Tracheotomy is a routine surgical procedure in oral and maxillofacial surgery. After decannulation, spontaneous tracheostoma closure is usually expected. However, wound healing is often delayed, requiring 1 to 2 weeks for healing and resulting in the need for surgical closure. Although many reports have described the surgical closure of a tracheostoma, few reports have focused on the dressing methods for closure of tracheal openings after decannulation. Herein, the authors report a new tracheostoma closure method that does not rely on surgical closure or the adhesive strength of the tape. The authors' conventional dressing method was to place gauze over the tracheostoma after decannulation and apply pressure through elastic tape or with a film dressing to seal the tracheostoma and achieve natural closure by reducing the leakage of air and tracheal secretions. However, the conventional method cannot completely prevent the leakage of air and tracheal secretions. We developed a novel method to achieve early closure by markedly reducing the leakage by partially inserting the gauze into the tracheostoma.

Emergency front-of-neck access in infants: A pragmatic crossover randomized control trial comparing two approaches on a simulated rabbit model.

BACKGROUND: Rapid-sequence tracheotomy and scalpel-bougie tracheotomy are two published approaches for establishing emergency front-of-neck access in infants. It is unknown whether there is a difference in performance times and success rates between the two approaches. AIMS: The aim of this cross-over randomized control trial study was to investigate whether the two approaches were equivalent for establishing tracheal access in rabbit cadavers. The underlying hypothesis was that the time to achieve the tracheal access is the same with both techniques. METHODS: Between May and September 2022, thirty physicians (pediatric anesthesiologists and intensivists) were randomized to perform front-of-neck access using one and then the other technique: rapid-sequence tracheotomy and scalpel-bougie tracheotomy. After watching training videos, each technique was practiced four times followed by a final tracheotomy during which study measurements were obtained. Based on existing data, an equivalence margin was set at ∆ = ±10 s for the duration of the procedure. The primary outcome was defined as the duration until tracheal tube placement was achieved successfully. Secondary outcomes included success rate, structural injuries, and subjective participant self-evaluation. RESULTS: The median duration of the scalpel-bougie tracheotomy was 48 s (95% CI: 37-57), while the duration of the rapid-sequence tracheotomy was 59 s (95% CI: 49-66, p = .07). The difference in the median duration between the two approaches was 11 s (95% CI: -4.9 to 29). The overall success rate was 93.3% (95% CI: 83.8%-98.2%). The scalpel-bougie tracheotomy resulted in significantly fewer damaged tracheal rings and was preferred among participants. CONCLUSIONS: The scalpel-bougie tracheotomy was slightly faster than the rapid-sequence tracheotomy and favored by participants, with fewer tracheal injuries. Therefore, we propose the scalpel-bougie tracheostomy as a rescue approach favoring the similarity to the adult approach for small children. The use of a comparable equipment kit for both children and adults facilitates standardization, performance, and logistics. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05499273.

Comparison of Mechanical Forces used in Open Tracheotomy versus Percutaneous Tracheotomy Techniques.

OBJECTIVE: To understand the etiology of tracheotomy-induced tracheal stenosis by comparing the differences in techniques and mechanical force applied with open tracheotomy (OT) versus percutaneous tracheotomy (PCT) placement. METHODS: This study is an unblinded, experimental, randomized controlled study in an ex-vivo animal model. Simulated tracheostomies were performed on 10 porcine tracheas, 5 via a tracheal window technique (OT) and 5 using the Ciaglia technique (PCT). The applied weight during the simulated tracheostomy and the compression of the trachea were recorded at set times during the procedure. The applied weight during tracheostomy was used to calculate the tissue force in Newtons. Tracheal compression was measured by anterior-posterior distance compression and as percent change. RESULTS: Average forces for scalpel (OT) versus trocar (PCT) were 2.6 N and 12.5 N (p < 0.01), with the dilator (PCT) it was 22.02 N (p < 0.01). The tracheostomy placement with OT required an average force of 10.7 N versus 23.2 N (p < 0.01) with PCT. The average change in AP distance when using the scalpel versus trocar was 21%, and 44% (p < 0.01), with the dilator it was 75% (p < 0.01). The trach placement with OT versus PCT had an average AP distance change of 51% and 83% respectively (p < 0.01). CONCLUSION: This study demonstrated that PCT required more force and caused more tracheal lumen compression when compared to the OT technique. Based on the increased force required for PCT, we suspect there could also be an increased risk for tracheal cartilage trauma. LEVEL OF EVIDENCE: NA Laryngoscope, 134:103-107, 2024.

Effect of empathy nursing combined with SBAR communication system on the negative emotions and nursing quality of children with tracheotomy.

BACKGROUND: Situation, Background, Assessment, and Recommendation (SBAR) is a structured method for communicating critical information that requires immediate attention and action. OBJECTIVE: To study the effects of empathy nursing combined with the SBAR communication system on the negative emotions and nursing quality of children undergoing tracheotomy. METHODS: This is a clinical observational study. A total of 100 tracheotomy patients who were cared for in the pediatric intensive care unit (subsequent treatment in the tracheotomy clinic or otolaryngology ward) of our hospital from September 2021 to June 2022 were recruited and assigned at a ratio of 1:1 either into a control group (empathic care) or an observation group (empathic care combined with SBAR) using a randomized method. Further, the postoperative anxiety self-rating scale scores, negative emotions, hope index, and nursing quality were compared between the two groups. RESULTS: After nursing, the psychological resilience scale score of the observation group was higher than that of the control group, whereas the anxiety self-rating scale score was significantly lower than that of the control group (all P< 0.05). Basic and special nursing, knowledge awareness, and safety management of the two groups of patients improved significantly, with higher results in the observation group than in the control group (P< 0.05). CONCLUSION: Empathy nursing combined with the SBAR communication system considerably improves postoperative negative emotions and enhances the quality of nursing care for patients undergoing tracheotomy.

Tracheotomy in children older than two years: Analysis of discharge trends from 2015 to 2020.

OBJECTIVE: In light of increasingly complex patients being discharged with tracheostomies, we aimed to evaluate discharge trends over time in pediatric tracheotomy patients. We hypothesized that there would be delays in discharge from increased focus on preparing families for at-home care of critically ill pediatric patients. MATERIALS AND METHODS: We conducted a cross-sectional analysis of pediatric patients who underwent tracheotomy (Current Procedural Terminology code 31600) between 2015 and 2020 using the American College of Surgeons National Surgical Quality Improvement Program Pediatric database (ACS NSQIP-P). Univariate and multivariate regression analyses were performed to assess patient demographics, comorbidities, perioperative factors, postoperative complications, and discharge information. Data were analyzed using Stata 15. RESULTS: A total of 1552 patients were identified. There were 868 (56 %) males and 684 (44 %) females with a mean age of 7.3 ± 5.7 years. At least one comorbidity was seen in 1282 (83 %) patients, with 907 (58 %) having impaired cognitive status or developmental delay. Thirty-six (2.3 %) patients experienced mortality within 30 days, while 710 (46 %) were still in the hospital at 30 days. The odds of remaining in the hospital after 30 days were positively correlated with the year (p=.001). Other factors associated with an increased likelihood of remaining in the hospital after 30 days included younger patient age (p <.001), any complication (p <.001), and a higher American Society of Anesthesiologists classification (p <.001). CONCLUSION: As years have progressed, fewer children were discharged from the hospital after 30 days following tracheotomy. Further research may identify socioeconomic factors contributing to the increasing length of hospital stays associated with a need for tracheotomy.

Successful Recovery of a Catatonic Patient with Severe Pneumonia and Respiratory Failure: Modified Electroconvulsive Therapy Following Tracheotomy

Backgroud: Catatonia encompasses a group of severe psychomotor syndromes affecting patients' motor, speech, and complex behaviors. Common features include rigidity, reduced mobility, speech, sputum production, defecation, and eating. Risks associated with catatonia, such as increased muscle tension and reduced swallowing and coughing reflexes, along with risks from therapeutic approaches like prolonged bed rest and sedative drugs, can elevate the risk of aspiration pneumonia, severe pneumonia, and acute respiratory failure. These complications significantly impede catatonia treatment, leading to poor prognosis and jeopardizing patient safety. Case Description: In this report, we present a case of catatonia complicated by severe pneumonia and respiratory failure, successfully managed with modified electroconvulsive therapy alongside tracheotomy. We hope this case provides valuable insights for psychiatrists encountering similar scenarios, facilitating the development of rational therapeutic strategies for prompt improvement of patient condition. (AU)

Management of Bilateral Vocal Fold Paralysis: A Systematic Review.

OBJECTIVE: To review the current literature about epidemiology, etiologies and surgical management of bilateral vocal fold paralysis (BVFP). DATA SOURCES: PubMED, Scopus, and Cochrane Library. REVIEW METHODS: A systematic review of the literature on epidemiology, etiologies, and management of adult patients with BVFP was conducted through preferred reporting items for systematic reviews and meta-analyses statements by 2 investigators. RESULTS: Of the 360 identified papers, 245 were screened, and of these 55 were considered for review. The majority (76.6%) of BVFP cases are iatrogenic. BVFP requires immediate tracheotomy in 36.2% of cases. Laterofixation of the vocal fold was described in 9 studies and is a cost-effective alternative procedure to tracheotomy while awaiting potential recovery. Unilateral and bilateral posterior transverse cordotomy outcomes were reported in 9 and 7 studies, respectively. Both approaches are associated with a 95.1% decannulation rate, adequate airway volume, but voice quality worsening. Unilateral/bilateral partial arytenoidectomy data were described in 4 studies, which reported lower decannulation rate (83%) and better voice quality outcome than cordotomy. Revision rates and complications vary across studies, with complications mainly involving edema, granuloma, fibrosis, and scarring. Selective posterior cricoarytenoid reinnervation is being performed by more surgeons and should be a promising addition to the BVFP surgical armamentarium. CONCLUSION: Depending on techniques, the management of BVFP may be associated with several degrees of airway improvements while worsened or unchanged voice quality. The heterogeneity between studies, the lack of large-cohort controlled randomized studies and the confusion with posterior glottic stenosis limit the draw of clear conclusion about the superiority of some techniques over others.