A Tracheostomy Support Device to Reduce Tracheostomy-Related Pressure Injury.

BACKGROUND: Tracheostomies provide many advantages for the care of patients who are critically ill but may also result in complications, including tracheostomy-related pressure injuries. Research efforts into the prevention of these pressure injuries has resulted in specialized clinical care teams and pathways. These solutions are expensive and labor intensive, and fail to target the root cause of these injuries; namely, pressure at the device-skin interface. Here we measure that pressure directly and introduce a novel medical device, the tracheostomy support system, to reduce it. METHODS: This was a cross-sectional study of 21 subjects in the ICU, each with a tracheostomy tube connected to a ventilator. A force-sensing resistor was used to measure baseline pressures at the device-skin interface along the inferior flange. This pressure was then measured again with the use of the tracheostomy support system in the inactive and active states. Resultant pressures and demographics were compared. RESULTS: Fifteen male and 6 female subjects, with an average age of 47 ± 14 (mean ± SD) years, were included in this study. Average pressures at the tracheostomy-skin interface at baseline in these 21 ICU subjects were 273 ± 115 (mean ± SD) mm Hg. Average pressures were reduced by 59% (median 62%, maximum 98%) with the active tracheostomy support system to 115 ± 83 mm Hg (P < .001). All the subjects tolerated the tracheostomy support system without issue. CONCLUSIONS: Despite best clinical practice, pressure at the tracheostomy-skin interface can remain quite high. Here we provide measures of this pressure directly and show that a tracheostomy support system can be highly effective at minimizing that pressure. There is room for improvement in tracheostomy care, and such improvement does not have to come at a great expense.

[Review of surgical treatment of suprastomal collapse in tracheostomised children]. / Übersichtsarbeit zur chirurgischen Behandlung des suprastomalen Kollapses bei tracheotomierten Kindern.

BACKGROUND: Suprastomal collapse (SSC) is considered a major late complication of paediatric tracheostomy and can be responsible for decannulation failure in up to 20% of tracheostomised children. Depending on the severity of SSC, surgery may be required. Various strategies and techniques are available, of which the treating with airway team should be aware. OBJECTIVE: This article intends to summarise the aetiology of SSC, its classification, clinical presentation, and the gold standard diagnostic and therapeutic algorithms according to the current literature. MATERIALS AND METHODS: A panel of experts reviewed the available literature on SSC. Published evidence on the different surgical techniques and their advantages and disadvantages was reviewed in detail, and a treatment algorithm created. RESULTS: The gold standard diagnostic procedure for SSC is flexible transnasal laryngotracheoscopy in spontaneous breathing followed by microlaryngoscopy (MLS) under general anaesthesia. Two main types of SSC can be differentiated, which differ in terms of surgical treatment. Purely anterior SSC is usually treated by tracheoplasty using an anterior costal cartilage graft (ACCG). Simple closure of the tracheostomy or excision of SSC with a potassium-titanyl-phosphate (KTP) laser are also described as less invasive approaches. For anterolateral SSC, segmental tracheal resection with end-to-end anastomosis or tracheoplasty with ACCG represent promising treatment options. Tracheal reinforcement with absorbable microplates is also discussed in the literature. With both types of SSC and depending on severity and the age of the child, a watch-and-wait strategy should always be considered. CONCLUSION: Dynamic airway endoscopy in spontaneous breathing followed by MLS in general anaesthesia should always be performed before decannulation. It is particularly important to visualise all segments of the airway during spontaneous breathing. The decision regarding the best surgical option for each child is based on the type and localisation of SSC, as well as on the patient's medical and surgical history and age.

Characteristics of tracheostomized patients followed up by a Palliative Care and Complex Chronic Patient Service.

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 Department of Palliative Care and Chronic Medically Complex Illness (DPCCMCI) of a tertiary care hospital. METHODS: Single-centre retrospective observational study in patients aged less than 18 years with a tracheostomy followed up 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. RESULTS: The 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 P. aeruginosa was the most frequent (56.8%). The most frequently prescribed antibiotic was ciprofloxacin (84%). In addition, 18.1% of the patients received at least 1 course of intravenous antibiotherapy and 29.5% received more than 3 systemic antibiotic regimens in the past 20 months. 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. CONCLUSIONS: Because of the complexity of caring for tracheostomized children, integral and coordinated management is essential. Schooling is possible and safe if caregivers are trained.

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)

Comparison of Pressure Control Ventilation and Palpation Methods to Protect the Endotracheal Tube Cuff During Tracheotomy: A Manikin Simulation Study.

Objective This study aims to evaluate and compare the suitability and safety of palpation and pressure control ventilation (PCV) methods for the accurate positioning of an endotracheal tube (ETT) cuff. Methods We conducted a pilot simulation randomized crossover study using a medical manikin. Twenty junior resident physicians who had completed anesthesiology training participated in the study. Airway management was performed using a modified manikin designed to simulate palpation and PCV methods. Participants performed both methods in a randomized order. The primary outcome was the number of successful ETT placements. The secondary outcomes were procedure duration and the perceived difficulty of each procedure. Results Five successful procedures were observed in the palpation method group (PALG), while 19 were observed in the PCV method group (PCVG). The duration of the trial was 98 s (standard deviation [SD], 41) in the PALG and 93 s (SD, 49) in the PCVG. The visual analog scale score for difficulty encountered during the trial was 30 (SD, 21) in the PALG and 69 (SD, 19) in the PCVG. Conclusions Our findings suggest that the PCV method had a higher success rate than the palpation method. Thus, the PCV method may be more suitable for inexperienced physicians to perform the procedure with greater confidence.

Application of the integrated airway humidification device enhances the humidification effect of the rabbit tracheotomy model.

Long-term mechanical ventilation after tracheotomy is a common treatment in intensive care unit patients. This study investigated the differences among the effects of different wetting states on the airway, lung, and serum inflammatory factors. New Zealand rabbits (n = 36) were selected to construct tracheotomy models and then divided into four groups: Model, Mask, YTH, and Sham groups. Lung tissue dry/wet ratio was used to evaluate the humidification effect; cytokines, including tumor necrosis factor-α, interleukin (IL)-6, IL-8, and IL-10, were used to evaluate the inflammatory response; hematoxylin and eosin staining was used to evaluate the histopathology. Post hoc analysis based on the Dunnett t-test was applied. A self-developed integrated wetting device could increase the utilization of wetting solution, enhance the effect of wetting to protect tissue integrity, and suppress airway inflammation, reducing the expression of pro-inflammatory factors while promoting the expression of anti-inflammatory factor IL-10 to inhibit the inflammatory response, compared to other methods. The integrated humidification device provided a new method for clinical nursing practice, improving clinical efficiency and reducing nursing workload. Further clinical trials are required to test its effectiveness and safety in the clinic.

Percutaneous tracheostomy in the pediatric population: A systematic review.

OBJECTIVE: Percutaneous tracheostomy is routinely performed in adult patients but is seldomly used in the pediatric population due to concerns regarding safety and limited available evidence. This study aims to consolidate the current literature on percutaneous tracheostomy in the pediatric population. METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, EMBASE, CINAHL, and Web of Science were searched for studies on pediatric percutaneous tracheostomy (age ≤18). The Joanna Briggs Institute and ROBINS-I tools were used for quality appraisal. RESULTS: Twenty-one articles were included resulting in 143 patients. Patient age ranged from 2 days to 17 years, with the largest subpopulation of patients (n = 57, 40 %) being adolescents (age between 12 and 17 years old). Main indications for percutaneous tracheostomy included prolonged ventilation (n = 6), respiratory insufficiency (n = 5), and upper airway obstruction (n = 5). One-third (n = 47) of percutaneous tracheostomies were completed at the bedside in an intensive care unit. Select studies reported on surgical time and time from intubation to tracheostomy with a mean of 13.8 (SD = 7.8) minutes (n = 27) and 8.9 (SD = 2.8) days (n = 35), respectively. Major postoperative complications included tracheoesophageal fistula (n = 4, 2.8 %) and pneumothorax (n = 3, 2.1 %). There were four conversions to open tracheostomy. CONCLUSION: Percutaneous tracheostomy had a similar risk of complications to open surgical tracheostomy in children and adolescents and can be performed at the bedside in a select group of patients if necessary. However, we feel that consideration must be given to the varying anatomical considerations in children and adolescents compared with adults, and therefore suggest that this procedure be reserved for adolescent patients with a thin body habitus and clearly demarcated and palpable anatomical landmarks who require a tracheostomy. When performed, we strongly support using endoscopic guidance and a surgeon who has the ability to convert to an open tracheostomy if required.

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.

Effect of open surgical and percutaneous dilatational tracheostomy on postoperative wound complications in patients: A meta-analysis.

Tracheostomy is one of the most common operations. The two main methods of tracheostomy are open surgical tracheostomy (OST) and percutaneous dilatational tracheostomy (PDT). In critical cases, the combination of these two approaches is especially crucial, with the possibility of successful outcomes and low complications. Thus, the purpose of this system is to analyse the effects of both methods on the outcome of postoperative wound. In this research, we performed a systematic review of Cochrane Library, PubMed, Web of Science and Embase, to determine all randomized controlled trials (RCTs) that are comparable in terms of postoperative injury outcomes. Eleven RCTs were found after screening. This study will take the necessary data from the selected trials and evaluate the documentation for RCTs. PDT was associated with a lower incidence of infection at the wound site than OST (OR, 4.46; 95% CI: 2.84-7.02 p < 0.0001), and PDT decreased blood loss (OR, 2.88; 95% CI: 1.62-5.12 p = 0.0003). But the operation time did not differ significantly in both PDT to OST (MD, 4.65; 95% CI: -1.19-10.48 p = 0.12). The meta-analyses will assist physicians in selecting the best operative procedure for critical cases of tracheostomy. These data can serve as guidelines for clinical management and in the design of future randomized, controlled studies.

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.

Adverse Events Associated With Tracheostomy: A MAUDE Database Analysis.

OBJECTIVE: Tracheotomy is one of the most common procedures. Although tracheostomy complications have been extensively studied, literature related to device complications is scarce. The objective of this study is to describe complications associated with tracheostomies utilizing the Manufacturer and User Facility Device Experience (MAUDE) database. STUDY DESIGN: Retrospective cross-sectional study. SETTING: The US Food and Drug Administration's (FDA) MAUDE database (2015-2020). METHODS: The FDA's MAUDE database was queried for all reports on adverse events related to tracheostomy from January 1, 2015 to December 31, 2020. RESULTS: A total of 3086 adverse events related to open tracheostomy and 52 related to percutaneous tracheostomy were identified. For open tracheostomy, 2872 (93%), were related to device malfunction, and 214 (7%) consisted of patient-related factors. The most frequently reported device-related adverse event was cuff malfunction, with 1834 (59%) reported events, which includes cuff deflation, pilot balloon malfunction, and cuff inflation line malfunction. The most frequently reported patient-related adverse events were tracheostomy tube obstruction with 67 events (2%). For percutaneous tracheostomy, 38 (73%) events were related to device malfunction, and 14 (27%) were related to patient injury. The most frequently reported adverse events were cuff malfunction (29%), safety ridge malfunction (17%), and bleeding (10%). CONCLUSION: The MAUDE database is a useful tool that can be utilized to complement existing literature in identifying common and rare adverse events associated with tracheostomy device-related failures, which are mostly reliant on isolated, published case reports.

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)

Comparative impact of COVID-19 infection on tracheostomy patients.

PURPOSE: We study outcomes after tracheostomy in COVID-19 positive patients versus COVID-19 negative patients who underwent tracheostomy during the same time frame in an effort to better understand the influence of COVID-19 despite variances in virus strain and treatment practices. MATERIALS AND METHODS: This is a retrospective cohort study of all Veterans Affairs centers nationwide, using data provided by the Veterans Affairs Informatics and Computing Infrastructure. Our cohort consisted of veteran patients who underwent tracheostomy between March 2020 and September 2022. Patients who tested positive for COVID-19 within three months prior to tracheostomy were compared to patients who had never tested positive for COVID-19. RESULTS: 956 patients were included in the analysis, and nearly 96 % of these patients were male. The COVID-19 positive group spent one more week on the ventilator and experienced lower rates of successful ventilator weaning (hazard ratio 0.74, 95 % confidence interval [0.62, 0.88], P < 0.001). Survival curves were non-proportional, and while the COVID-19 positive group had higher 30-day mortality (relative risk 1.37, 95 % confidence interval [1.09, 1.73], P = 0.007), the COVID-19 negative group had higher long-term mortality. CONCLUSIONS: Our findings suggest that while infection with COVID-19 has a significant effect on short-term outcomes after tracheostomy, chronic comorbidities seem to have the more enduring impact. In spite of prolonged ventilation and higher short-term mortality, tracheostomy in COVID-19 can be a positive intervention that does not necessarily predestine patients to the same level of long-term morbidity and mortality of typical tracheostomies.

[Factors related with microbiological contamination of surgical site in patients undergoing tracheotomy]. / Factores relacionados con la contaminación microbiológica de sitio quirúrgico en pacientes traqueotomizados.

Background: Tracheotomy is a common technique; however, microbiological contamination of the surgical site can increase morbimortality. Up to 90% of patients present a positive culture of the airway. Among the most important related factors is the lack of tracheal cannula replacement and lower airway infections. It is convenient to identify microbiological contamination of surgical site in tracheal secretions samples and the specific microorganism associated. Objective: To determine the factors related to microbiological contamination of surgical site. Material and methods: A prospective cohort study which included patients undergoing tracheotomy was carried out. Tracheal secretion was sampled by direct swabbing for culture during surgery and from the surgical site 5 days after. Results: The initial report showed contamination of samples in 58.3%, and 5 days after in 80.6%, with an incidence of contamination of 22.3%. Initially the main agents identified were Pseudomonas aeruginosa in 13.9% of the cultures, Klebsiella pneumoniae in 11.1% and Enterobacter spp. in 11%. On day 5, the most common agents were Klebsiella pneumoniae in 25% of the cases, Acinetobacter baumannii in 11.1% and Pseudomonas aeruginosa in 11.1. Conclusions: The frequency of microbiological contamination is high. The main agents were Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa. No risk factors for the presence of post-tracheotomy contamination were identified.

Introducción: la traqueotomía es un procedimiento común; sin embargo, la contaminación microbiológica del sitio quirúrgico puede aumentar la morbimortalidad. Hasta el 90% de los pacientes presentan un cultivo positivo de la vía respiratoria. Como factores relacionados, resaltan la falta de recambio de cánulas traqueales y las infecciones de vías aéreas bajas. Es conveniente identificar la contaminación microbiológica de secreción traqueal del sitio quirúrgico y el microorganismo asociado. Objetivo: determinar los factores relacionados con la contaminación microbiológica del sitio quirúrgico. Material y métodos: se hizo un estudio de cohorte prospectiva que incluyó a pacientes sometidos a traqueotomía. Se tomó cultivo por hisopado directo de secreción traqueal durante la cirugía y del sitio quirúrgico 5 días después. Resultados: la muestra inicial mostró contaminación en 58.3% de los pacientes y a los 5 días postquirúrgicos en 80.6%, con incidencia de contaminación de 22.3%. Inicialmente se aisló Pseudomonas aeruginosa en 13.9% de los casos, Klebsiella pneumoniae en 11.1% y Enterobacter spp. en 11%. Al quinto día se aisló Klebsiella pneumoniae en 25% de los casos, Acinetobacter baumannii en 11.1% y Pseudomonas aeruginosa en 11.1%. Conclusiones: la frecuencia de contaminación microbiológica es alta y se encontraron principalmente Staphylococcus aureus, Klebsiella pneumoniae y Pseudomonas aeruginosa. No se identificaron factores de riesgo para la contaminación postquirúrgica.

Teaching Tracheostomy Tube Changes: Comparison of Operant Learning Versus Traditional Demonstration.

Objective: Tracheostomy tube change is a multistep skill that must be performed rapidly and precisely. Despite the critical importance of this skill, there is wide variation in teaching protocols. Methods: An innovative operant conditioning teaching methodology was employed and compared to traditional educational techniques. Medical student volunteers at a tertiary care academic institution (Albert Einstein College of Medicine) were recruited and randomly distributed into 2 groups: operant vs traditional (control). Following the educational session, each group was provided with practice time and then asked to perform 10 tracheostomy tube changes. Performance was recorded and scored by blinded raters using deidentified video recordings. Results: The operant learning group (OLG) demonstrated greater accuracy in performing a tracheostomy tube change than the traditional demonstration group. Twelve of 13 operant learners performed the skill accurately each time compared to 3 of 13 in the traditional group (P = 0.002). The median lesson time was longer for the OLG (535 seconds) than for the traditional group, (200 seconds P < 0.001). The average time per tracheostomy change was not significantly different between the 2 groups (operant learners mean 7.1 seconds, traditional learners mean 7.5 seconds, P = 0.427). Discussion: Although the operant conditioning methodology necessarily requires a greater time to teach, the results support this methodology over traditional learning modalities as it enhances accuracy in the acquired skill. Operant learning methodology is under consideration for other skills and education sessions in our program. Future steps include the application and adaptation of this education model to students and residents in other settings and fields. Implications for Practice: Operant learning is effective for teaching multistep skills such as tracheostomy tube changes with decreased error rates.

Rare Cause of Severe Dyspnea After Tracheotomy-Negative Pressure Pulmonary Edema.

Deep neck infections are serious conditions and can present with acute upper airway obstruction. Our priority in the treatment is to ensure airway safety, and tracheotomy may be needed to overcome the upper airway obstruction. Unceasing dyspnea after tracheotomy should suggest serious pulmonary pathologies in patients with upper airway obstruction due to deep neck infection. Acute/chronic obstruction resolved after tracheotomy or upper respiratory tract surgical procedures of obstructive sleep apnea patients can turn into severe dyspnea with pulmonary edema. In this report, we present a 46-year-old male patient with negative pressure pulmonary edema as a complication of tracheotomy. The tracheotomy was performed due to severe upper airway obstruction secondary to a deep neck infection. The importance of early diagnosis and prompt treatment of this rare entity after unceasing dyspnea despite tracheotomy is discussed in the light of the current literature.

Pediatric Tracheostomy: A Quality-of-Life Assessment Study in Saudi Arabia.

INTRODUCTION: The pediatric population undergoes tracheostomy for a variety of reasons. For a child and their family, having a tracheostomy means learning a new way of life and facing several social, psychological, medical, and economic challenges. Our analysis of the literature indicates that this is the first study of its kind, using the Pediatric Tracheotomy Health Status Instrument (PTHSI) tool to assess the quality of life (QoL) following tracheostomy in pediatric patients and their caregivers in the Kingdom of Saudi Arabia (KSA). METHODS: This was a descriptive cross-sectional study for tracheostomized children's QoL evaluation. The medical records of the Maternity and Children Hospital, Dammam, KSA, were used to identify the patients and their caregivers. A higher score on the validated PTHSI indicated a better result. RESULTS: From a total of 56 patients, 24 were included in this study. Based on the PTHSI tool, the overall mean score was 93.3/150 (62.28%) and this indicated a good QoL score. Analysis of the correlation between the PTHSI score and other variables indicated no association between the total PTHSI score and the age or gender of the patient or the duration of the tracheostomy (p-value > 0.05). However, we found families of children with major medical comorbidities had lower scores (p-value = 0.03) and their QoL was affected much more than families of patients who did not have major medical comorbidities. CONCLUSION: Tracheostomy care for pediatric patients can significantly affect the QoL of patients and their families. Our findings using the validated PTHSI tool showed poorer QoL compared to other studies, suggesting the need for future home care training programs to support tracheostomized children and their families, particularly those with comorbidities, who tend to have lower QoL scores and require more organized support.

[The consensus among experts on the diagnosis and treatment of pediatric vocal cord paralysis].

Pediatric vocal ford paralysis is a vocal cord movement disorder caused by damage to the pediatric laryngeal motor nerves.It is mainly characterized by voice, breathing,and swallowing difficulties,and in severe cases,it can lead to choking in affected children. Currently, the diagnosis and treatment of this condition pose a significant challenge for pediatric otolaryngologists, as the goal is to minimize damage to the vocal folds and laryngeal framework.In order to standardize the diagnosis and treatment of pediatric vocal cord paralysis, the Pediatric Otolaryngology Committee of the Chinese Medical Association,in collaboration with multiple children's medical centers nationwide, have formulated this consensus document.

Protocol-directed weaning versus conventional weaning from mechanical ventilation for neurocritical patients in an intensive care unit: a nonrandomized quasi-experimental study.

OBJECTIVE: To investigate whether protocol-directed weaning in neurocritical patients would reduce the rate of extubation failure (as a primary outcome) and the associated complications (as a secondary outcome) compared with conventional weaning. METHODS: A quasi-experimental study was conducted in a medical-surgical intensive care unit from January 2016 to December 2018. Patients aged 18 years or older with an acute neurological disease who were on mechanical ventilation > 24 hours were included. All patients included in the study were ready to wean, with no or minimal sedation, Glasgow coma score ≥ 9, spontaneous ventilatory stimulus, noradrenaline ≤ 0.2µgr/kg/ minute, fraction of inspired oxygen ≤ 0.5, positive end-expiratory pressure ≤ 5cmH2O, maximal inspiratory pressure < -20cmH2O, and occlusion pressure < 6cmH2O. RESULTS: Ninety-four of 314 patients admitted to the intensive care unit were included (50 in the Intervention Group and 44 in the Control Group). There was no significant difference in spontaneous breathing trial failure (18% in the Intervention Group versus 34% in the Control Group, p = 0.12). More patients in the Intervention Group were extubated than in the Control Group (100% versus 79%, p = 0.01). The rate of extubation failure was not signifiantly diffrent between the groups (18% in the Intervention Group versus 17% in the Control Group; relative risk 1.02; 95%CI 0.64 - 1.61; p = 1.00). The reintubation rate was lower in the Control Group (16% in the Intervention Group versus 11% in the Control Group; relative risk 1.15; 95%CI 0.74 - 1.82; p = 0.75). The need for tracheotomy was lower in the Intervention Group [4 (8%) versus 11 (25%) in the Control Group; relative risk 0.32; 95%CI 0.11 - 0.93; p = 0.04]. At Day 28, the patients in the Intervention Group had more ventilator-free days than those in the Control Group [28 (26 - 28) days versus 26 (19 - 28) days; p = 0.01]. The total duration of mechanical ventilation was shorter in the Intervention Group than in the Control Group [5 (2 - 13) days versus 9 (3 - 22) days; p = 0.01]. There were no diffrences in the length of intensive care unit stay, 28-day free from mechanical ventilation, hospital stay or 90-day mortality. CONCLUSION: Considering the limitations of our study, the application of a weaning protocol for neurocritical patients led to a high percentage of extubation, a reduced need for tracheotomy and a shortened duration of mechanical ventilation. However, there was no reduction in extubation failure or the 28-day free of from mechanical ventilation compared with the Control Group.ClinicalTrials.gov Registry: NCT03128086.

The Impact of the COVID-19 Pandemic on Urgent Awake Tracheotomies in Adults.

Objective This study aims to investigate the impact of the COVID-19 pandemic on urgent awake tracheotomies (UATs) in adults in a reference center. Methodology During the pandemic (between March 2020 and May 2022) and before the pandemic (between January 2018 and March 2020), medical charts of patients who underwent UATs were reviewed. The analysis focused on demographic characteristics, indications, COVID-19 positivity status, surgical procedures, and complications. Results During the pandemic, 67 UATs (age 62.04 ± 11.9 years) were performed. Of the indications, 56 (83.5%) were malignancy. Before the pandemic, 22 UATs (age 63.86 ± 15.1 years) were performed, of which 14 UATs (63.6%) were due to malignancy. There was a significant increase in UATs and their indications in patients with head and neck malignancies (P < 0.05). Stay suture (65, 97%) and suture ligation of the thyroidal isthmus (61, 91%) were significantly performed during the pandemic (P < 0.05). Conclusions A significant increase in UAT was detected, especially in patients with advanced head and neck cancer. Pandemic conditions and the risk of viral transmission have led to more conservative UAT techniques.