[History of surgical and non-surgical tracheal intubation]. / Istoriya khirurgicheskoi i nekhirurgicheskoi intubatsii trakhei. Ot trostinki do videosignala.

Anesthesiologist daily encounters the need for maintaining an airway patency. This manuscript is devoted to the development of this technique from ancient times to the present. Three areas including tracheostomy, endoscopy and tracheal intubation are comprehensively described.

Neck mass and tracheostomy in a young lady depicted by Piero di Cosimo.

Among surgical procedures currently in use, tracheostomy has a particularly long history. The first written description of the procedure is due to Brasavola, and dates from 1546. Piero di Cosimo (1462-1522) was an early Renaissance painter who painted a work traditionally known as Cephalus and Procris or The Death of Procris (1495-1500). In this painting, a vertical tracheostomy can be observed in a young woman lying on the ground. A giant mass can be seen in the lower left neck with superficial venous vessels, suggesting a thyroid malignancy. This appears to be the first detailed depiction of a malignant cervical mass and a possibly therapeutic tracheostomy. We discuss the clinical differential diagnosis and also make some comments from an art history perspective.

Anterior Mediastinal Tracheostomy: Past, Present, and Future.

Anterior mediastinal tracheostomy (AMT) is established after division of the retrosternal trachea following resection of extended upper airway malignancies, stomal recurrences, or cervicomediastinal exenteration. AMT is occasionally performed for nonmalignant diseases. Starting in the 1980s, the use of a pectoralis major myocutaneous island flap reduced the mortality attributable to innominate artery rupture previously reported in historical series. Recent advances in the vascular reconstruction of supra-aortic trunks could allow future development of AMT as salvage surgery. On the other hand, construction of the stoma using free flap procedures and advances in chemoradiotherapy could simultaneously reduce the indication for AMT.

Tracheal Injuries Complicating Prolonged Intubation and Tracheostomy.

Respiratory care advances such as the introduction of ventilatory assistance have been associated with postintubation airway stenosis resulting from tracheal injury at the site of the inflatable cuff on endotracheal or tracheostomy tubes. Low-pressure cuffs have significantly reduced this occurrence. Loss of airway stability at the site of a tracheostomy stoma may result in tracheal stenosis. Subglottic stenosis may result from a high tracheostomy site at, or just inferior to, the cricoid arch, or to malposition of an endotracheal tube cuff. Awareness of these complications and their causes is essential to prevent their occurrence.

The History of Sleep Surgery.

Snoring and the subsequent diagnosis of obstructive sleep apnea (OSA) was a life-threatening medical condition with no available treatment until the late 20th century. An early description of OSA was provided by Charles Dickens in his 1836 novel Pickwick Papers with the description of a "fat boy" who was thought to be lazy and always falling asleep but likely displayed hypersomnolence from OSA. It was not until 1976 that Ikematsu first described uvulopalatopharyngoplasty (UPPP) as an alternative surgical treatment of "snoring," with a reported cure rate of 81%. The only other surgical procedure for OSA was permanent tracheostomy, but patients suffered from social stigma from the visible stoma with skin flaps and complications such as tracheal granulomas and tracheitis. UPPP was introduced in the USA as an alternative to permanent tracheostomy by Fujita in 1981. Since then, multiple surgical approaches and combinations of approaches have surfaced, with variable success rates.

Tracheostomy in ancient Egypt.

It has often been reported that the ancient Egyptians performed tracheostomies. An analysis of this claim demonstrates it to be founded on only two depictions from the Protodynastic period (thirty-first century bc). These depictions are difficult to reconcile with tracheostomy from an anatomical point of view and can more easily be explained as human sacrifices. Considering that Egyptian surgery included only minor procedures even at its zenith during later dynastic periods, it is difficult to imagine that they would have developed such an advanced procedure at such an early date.

Contributions of Medieval Islamic physicians to the history of tracheostomy.

Tracheostomy was first described by Greco-Roman physicians, including Paulus of Aegina. Medieval Islamic clinicians extended the Greco-Roman ideas with substantial contributions to the field of surgery, including tracheostomy. Although Al-Zahrawi (936-1013 CE) stated that he had not heard or read of any Islamic physicians having performed tracheostomy, there is evidence that many prominent Islamic surgeons did practice this lifesaving procedure during medieval times. Throughout the Islamic Golden Age, Muslim physicians advanced the practice of tracheostomy with many modifications of the procedure, instrumentation, and adjuvant medicinal prescriptions.

Traqueostomia / Tracheostomy

A traqueostomia comumente é realizada eletivamente nas unidades de terapia intensiva em pacientes críticos que necessitam de assistência ventilatória prolongada. É o procedimento realizado com mais freqüência em pacientes graves intubados. Vários estudos comprovam os benefícios da traqueostomia em relação à intubação orotraqueal: facilita a aspiração de secreções, melhor conforto e mobilização dos pacientes, redução do espaço morto, diminui o esforço respiratório e a resistência na via aérea, permite a fala, alimentação por via oral e o desmame da ventilação mecânica com mais facilidade. Apesar de vários estudos indicarem os benefícios da traqueostomia em pacientes críticos, o momento mais adequado para a sua realização ainda é controverso. Pacientes com traumas graves, especialmente o crânioencefálico, provavelmente se beneficiam da realização de traqueostomia precoce. O presente estudo tem como objetivo revisar e discutir as indicações, técnica, complicações e o momento da realização da traqueostomia.

Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. Tracheostomy is themost commonly performed procedure in the critically ill of intubated patients. Several studies have identified the benefits of tracheostomy over endotracheal intubation, such as sparing further injury from translaryngeal intubation, providing a stable airway, facilitating pulmonary toilet, increasing patient comfort and mobility, reduction in dead space, work of breathing, and airway resistance, permitting speech and feedings and facilitating weaning from the ventilator. Despite several studiesadvocating tracheostomy in the surgical critically ill patient, the timing of tracheostomy continues to be a topic of controversy. Patients with severe traumatic injuries, especially those with head injury or altered mental status, are likely to benefit from earlier tracheostomy. The present study aims to review and discuss indications, techniques, complications and timingof tracheostomy.

Tracheostomy Decannulation: Suprastomal Granulation Tissue in Perspective

Background: Suprastomal granulation tissue is a complication of tracheostomy which maymake decannulation difficult and presents a therapeutic challenge to the Otorhinolaryngologists. The aims of this study therefore were to evaluate tracheostomy in black African population; determine the prevalence of suprastomal granulation tissue and provide updated information on it that will enable the otorhinolaryngologists to better understand and manage the lesion. Methods: We reviewed case files of patients who had tracheostomy between 1993 and 2007 at University College Hospital; Ibadan; Nigeria for essential clinical data.Results: Of the 256 patients who had tracheostomy; 133(51.95) had prior orotracheal intubation for 10 21days. Suprastomal granulation tissue complicated 16 (6.25) cases; this accounted for 88.89of cases of failed decannulation. Indications for tracheostomy in these patients included severe head injury in 12 (75); tetanus in 3 (18.75)] and intubation granuloma in 1(6.25) of these cases. Sixteen (4.3) cases had stomal infection. Conclusion: This study showed that the prevalence of suprastomal granulation is high among our patients. There is a need for good surgical tracheostomy technique to prevent this complication and stomal infection should be promptly treated while cuffed orotracheal intubation for more than two weeks in unconscious and tetanus patients should be avoided

Timing of tracheostomy.

Currently, tracheostomy represents an established procedure for airway management in critically ill patients who require long-term respiratory support, and it is one of the most frequently performed surgical procedures in critically ill patients. It offers a number of practical and theoretical advantages when compared to conventional translaryngeal oro- or nasotracheal intubation, but is also associated with a number of serious complications. In the last 20 years, several retrospective studies, randomized prospective trials, and meta-analyses have been published to determine the best timing for tracheostomy. However, these studies presented conflicting results. All studies performed so far in a prospective randomized fashion were relatively small and underpowered. Currently, several large controlled randomized studies are underway that will hopefully help physicians make better evidence-based decisions on the timing of tracheostomy. Based on our current knowledge, the following recommendations might be made on a low level of evidence: on day 2 or 3 after onset of mechanical ventilation (>48 h of mechanical ventilation or need for an artificial airway) tracheostomy should be seriously considered. Before decisions are made, several questions should be answered: Is the situation suitable for tracheostomy? Are there relevant contraindications for the performance of a tracheostomy? What is the most likely course of the underlying respiratory insufficiency? What is the likelihood the patient will stay in need of invasive mechanical ventilation for more than a week, either because of an ongoing impairment of oxygenation, weaning failure, upper airway obstruction, coma or a swallowing disorder? If no relevant contraindication is present and if the need for invasive mechanical ventilation can be expected to last for more than one week, tracheostomy should be planned and performed within the next 2 days.

A brief history of tracheostomy and tracheal intubation, from the Bronze Age to the Space Age.

OBJECTIVE: To present a concise history of tracheostomy and tracheal intubation for the approximately forty centuries from their earliest description around 2000 BC until the middle of the twentieth century, at which time a proliferation of advances marked the beginning of the modern era of anesthesiology. DATA SOURCES: Review of the literature. CONCLUSIONS: The colorful and checkered past of tracheostomy and tracheal intubation informs contemporary understanding of these procedures. Often, the decision whether to perform a life-saving tracheostomy or tracheal intubation has been as important as the technical ability to perform it. The dawn of modern airway management owes its existence to the historical development of increasingly effective airway devices and to regular contributions of research into the pathophysiology of the upper airway.

Emergency ventilation of the tracheostomy patient, part II: a story of tracheotomy history and emergency airway management--advocating education for emergency resuscitation.

Over a period of 5000 years, dramatic changes have occurred in airway management, tracheotomy procedure terminology, indications, techniques, instruments, settings where procedures are performed, tube design and patient outcomes. Specialized knowledge and skills necessary to safely care for tracheostomy patients and to provide effective respiratory resuscitation are reviewed. The purpose of this paper is to document the history of the tracheotomy as a backdrop for understanding patient management. Recommendations for staff education regarding emergency ventilation of the tracheostomy patient are presented.

[Tracheostomy and endotracheal intubation: a short history].

The first descriptions of tracheostomy appear in old Hindu scripts around 2000 BC and Egyptian documents around 1500 BC. Since then, other reports in animals and humans established the tracheostomy as a life saving procedure. Vesalius in 1543 reported the first tracheal intubation in an animal. Trousseau reported 200 patients suffering from diphtheria who were saved by tracheostomy. In the early 1870's, Trendelenburg from Germany performed the first endotracheal anesthesia in man. Macewen in 1878 reported the first elective endotracheal intubation for anesthesia. He isolated the trachea by packing the hypopharynx, from leaking of blood and debris. Later, Rosenberg and Kuhn administered cocaine as local anesthetic to obtund the cough reflex during intubation. Tracheostomy and intubation have been broadly used during the First World War. Magill (1888-1986) recognized the advantages of tracheal intubation. Also, by his efforts, anesthesia has become an independent specialty. In 1913 the first anesthetic laryngoscope was invented by Jackson and modified by the Magill, Miller and Macintosh. In 1942, curare was introduced as a muscle relaxant for abdominal relaxation during general anesthesia and endotracheal intubation became routine in major abdominal and other surgeries. The article also reviews the Israeli contribution to the development of tracheostomy.