Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.848
Filtrar
1.
Khirurgiia (Mosk) ; (1): 5-14, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395506

RESUMO

OBJECTIVE: To analyze the long-term postoperative outcomes in patients with cicatricial tracheal stenosis and to determine the indications for various surgical strategies. MATERIAL AND METHODS: There were 976 patients with benign cicatricial tracheal stenosis for the period 2001-2017. Tracheal stenosis occurred after mechanical ventilation and tracheostomy in 910 (93.2%) patients. Other causes were neck trauma, burns, previous surgery or tuberculosis. Idiopathic stenosis was observed in 41 (4.2%) patients. Multiple-stage reconstructive treatment was possible due to benign nature of disease. There were 2.4 operations per a patient, and 976 patients underwent 2327 procedures. Circular tracheal resection was preferred (n=396). RESULTS: Surgical complications occurred in 107 (4.6%) cases, mortality rate - 0.3%. In long-term period, 42 patients died for various causes. In most cases (n=34, 80.9%), mortality was associated with concomitant diseases or consequences of trauma rather cicatricial tracheal stenosis or its treatment. Eight patients died from cicatricial tracheal stenosis or its treatment (7 patients after staged repair, 1 after circular tracheal resection). Four patients died due to asphyxia following T-tube obturation with a tracheobronchial secret or unjustified decannulation. For various reasons, 41 (6.2%) patients continued their treatment in other hospitals (4 patients died). Mortality rate in this group was 9.8%. Favorable long-term outcome was observed in 90.1% of patients, good and unsatisfactory results - in 7.2% and 1.8% of patients, respectively. Circular tracheal resection ensured better functional outcome. CONCLUSION: Surgical treatment of cicatricial tracheal stenosis is associated with low incidence of postoperative complications and mortality. However, further improvement in long-term results is associated with advanced rehabilitation programs for concomitant diseases. Treatment of cicatricial tracheal stenosis should be carried out at specialized hospitals.


Assuntos
Cicatriz/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal , Cicatriz/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/cirurgia , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Traqueostomia/efeitos adversos , Resultado do Tratamento
6.
Laryngoscope ; 131(2): 417-422, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32652622

RESUMO

OBJECTIVES: To study a case series of preterm and extremely preterm infants, comparing their decannulation and survival rates after tracheostomy. METHODS: We performed a single-institution longitudinal study of preterm infants with a tracheostomy. Infants were categorized as premature (born > 28 weeks and < 37 weeks) and extremely premature (born ≤ 28 weeks). Decannulation and survival rates were determined using the Kaplan-Meier method. Neurocognitive quality of life (QOL) was reported as normal, mild/moderately, and severely impaired. Statistical significance was set at P < .05. RESULTS: This study included 240 patients. Of those, 111 were premature and 129 were extremely preterm. The median age (interquartile range) at tracheostomy was 4.8 months (0.4). Premature infants were more likely than extremely preterm to have airway obstruction (54% vs. 32%, P < .001); whereas extremely preterm infants were more likely to have bronchopulmonary dysplasia (68% vs. 15%, P < .001) and to be ventilation-dependent (68% vs. 54%, P < .001). The 5-year decannulation rate for premature infants was 46% and for extremely preterm was 64%. The 5-year survival rate post-tracheostomy for preterm was 79% and for extremely preterm was 73%. The log-rank test of equality showed that decannulation and survival were similar (P > .05) for both groups, even after controlling for potentially confounding factors like race, age, gender, birth weight, and age at tracheostomy. For neurocognitive QOL, 47% of patients survived with severely impaired QOL after tracheostomy. Preterm had 56% with severely impaired QOL and extremely preterm had 40% with severely impaired QOL (P = .03). CONCLUSION: This study demonstrated that the time to decannulation and the likelihood of survival did not vary among premature and extremely premature infants even when controlling for other confounding variables. LEVEL OF EVIDENCE: 3b Laryngoscope, 131:417-422, 2021.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Displasia Broncopulmonar/cirurgia , Doenças do Prematuro/cirurgia , Recém-Nascido Prematuro , Traqueostomia/mortalidade , Obstrução das Vias Respiratórias/mortalidade , Displasia Broncopulmonar/mortalidade , Feminino , Idade Gestacional , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/mortalidade , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Qualidade de Vida , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
7.
Med Intensiva ; 45(1): 27-34, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32919796

RESUMO

OBJECTIVE: Information from critically ill coronavirus disease 2019 (COVID-19) patients is limited and in many cases coming from health systems approaches different from the national public systems existing in most countries in Europe. Besides, patient follow-up remains incomplete in many publications. Our aim is to characterize acute respiratory distress syndrome (ARDS) patients admitted to a medical critical care unit (MCCU) in a referral hospital in Spain. DESIGN: Retrospective case series of consecutive ARDS COVID-19 patients admitted and treated in our MCCU. SETTING: 36-bed MCCU in referral tertiary hospital. PATIENTS AND PARTICIPANTS: SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal/pharyngeal swabs. INTERVENTIONS: None MAIN VARIABLES OF INTEREST: Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. RESULTS: Forty-four ARDS COVID-19 patients were included in the study. Median age was 61.50 (53.25 - 67) years and most of the patients were male (72.7%). Hypertension and dyslipidemia were the most frequent co-morbidities (52.3 and 36.4% respectively). Steroids (1mg/Kg/day) and tocilizumab were administered in almost all patients (95.5%). 77.3% of the patients needed invasive mechanical ventilation for a median of 16 days [11-28]. Prone position ventilation was performed in 33 patients (97%) for a median of 3 sessions [2-5] per patient. Nosocomial infection was diagnosed in 13 patients (29.5%). Tracheostomy was performed in ten patients (29.4%). At study closing all patients had been discharged from the CCU and only two (4.5%) remained in hospital ward. MCCU length of stay was 18 days [10-27]. Mortality at study closing was 20.5% (n 9); 26.5% among ventilated patients. CONCLUSIONS: The seven-week period in which our MCCU was exclusively dedicated to COVID-19 patients has been challenging. Despite the severity of the patients and the high need for invasive mechanical ventilation, mortality was 20.5%.


Assuntos
/complicações , /etiologia , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , /mortalidade , Comorbidade , Estado Terminal , Infecção Hospitalar/epidemiologia , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Decúbito Ventral , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Espanha/epidemiologia , Esteroides/uso terapêutico , Traqueostomia/estatística & dados numéricos
8.
HNO ; 69(1): 22-25, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-32691089

RESUMO

Tracheostoma valves have proven to be very effective for voice restoration in patients with a tracheotomy or laryngectomy. Nevertheless, in recent years there have been a number of reports about life-threatening incidents with tracheostoma valves. An analysis of these incidents and the commercially available tracheostoma valves, their functions and limitations enables typical risk situations to be derived. The most reported incidents were caused by inadvertently filling the cuff of the tracheostomy tube while the tracheostoma valve was in place and by confusing a heat and moisture exchanger (HME) filter with a tracheostoma valve. These mistakes caused a complete obstruction of the expiratory airway leading to a barotrauma of the lungs with pneumothorax and asphyxia. Another typical risk in mechanically ventilated patients is insufficient monitoring during the use of the tracheostoma valve. Clear marking of tracheostoma valves and a specific training of hospital personnel with respect to the typical risks of tracheostoma valves could effectively reduce the associated dangers.


Assuntos
Laringectomia , Voz , Expiração , Humanos , Traqueostomia/efeitos adversos
10.
11.
Ann Otol Rhinol Laryngol ; 130(1): 104-107, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32583671

RESUMO

OBJECTIVE: To date, no cases have been reported on the effects of COVID-19 in laryngectomees. CASE PRESENTATION: We herein presented two clinical cases of laryngectomized patients affected by COVID-19, detailing their clinical course and complications. DISCUSSION: In our experience, permanent tracheostomy did not significantly affect the choice of treatment. However, dedicated devices and repeated tracheal toilettes may be needed to deal with oxygen-therapy-related tracheal crusting. CONCLUSION: In conclusion, laryngectomees should be considered a vulnerable population that may be at risk for worse outcomes of COVID-19 due to anatomical changes in their airways. The role of the ENT specialist is to guide airway management and inform the support-staff regarding specific needs of these patients.


Assuntos
/terapia , Laringectomia , Oxigenoterapia/métodos , Faringectomia , Traqueostomia , Idoso , Manuseio das Vias Aéreas/métodos , Humanos , Umidificadores , Neoplasias Hipofaríngeas/cirurgia , Neoplasias Laríngeas/cirurgia , Masculino , Neoplasias Orofaríngeas/cirurgia , Seio Piriforme , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia
12.
Eur Rev Med Pharmacol Sci ; 24(23): 12558-12574, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33336776

RESUMO

The Coronavirus Disease 2019 (COVID-19) is a viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which emerged in East Asia and spread around the world from December 2019. The most severe stage of COVID-19 pathology is characterized by respiratory distress requiring intubation. In specific cases, tracheostomy is indicated to ensure the safety of the procedure. The aim of our study was to analyze the scientific literature identifying the indications for tracheostomy and safety precautions to reduce contamination. We analyzed the literature from February 2003 to April 2020, including papers on pandemics of other coronaviruses, such As Severe Acute Respiratory Syndrome Coronavirus 1 and Middle East Respiratory Syndrome Coronavirus, to obtain a variety of relevant information. We focused on indications for tracheostomy in patients affected by COVID-19 or related viruses and the measures adopted to perform a safe procedure. We included 35 papers, of which 24 (68.57%) discussed guidelines for tracheostomy indications. All 35 studies discussed the procedures for performing tracheostomy safely. Data obtained indicated that the authors generally agreed on safety measures but expressed different opinions about indications. Therefore, we provided guidelines addressing safety recommendations. After the pandemic has been resolved, we plan to conduct an international retrospective study to identify the criteria for tracheostomy indications.


Assuntos
/terapia , Insuficiência Respiratória/terapia , Traqueostomia/métodos , Manuseio das Vias Aéreas/métodos , /transmissão , Infecções por Coronavirus , Dispositivos de Proteção dos Olhos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Isoladores de Pacientes , Equipamento de Proteção Individual , Respiração Artificial/métodos , Dispositivos de Proteção Respiratória , Síndrome Respiratória Aguda Grave , Fatores de Tempo
13.
Anaesthesiol Intensive Ther ; 52(5): 366-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33327694

RESUMO

INTRODUCTION: COVID-19 infection has resulted in thousands of critically ill patients admitted to ICUs and treated with mechanical ventilation. Percutaneous tracheostomy is a well-known technique utilised as a strategy to wean critically ill patients from mechanical ventilation. Worldwide differences exist in terms of methods, operators, and settings, and questions remain regarding timing and indications. If tracheostomy is to be performed in COVID-19 patients, a safe environment is needed for optimal care. MATERIAL AND METHODS: We present a guidewire dilating forceps tracheostomy procedure in COVID-19 patients that was optimised including apnoea-moments, protective clothing, checklists, and clear protocols. We performed a retrospective analysis of the outcome after tracheostomy in COVID-19 patients between March 2020 and May 2020. RESULTS: The follow-up of the first 16 patients, median age 62 years, revealed a median intubation time until tracheostomy of 18 days and median cannulation time of 20 days. The overall perioperative complication rate and complication rate while cannulated was 19%, mainly superficial bleeding. None of the healthcare providers involved in performing the procedure developed any symptoms of the disease. CONCLUSIONS: This COVID-19-centred strategy based on flexibility, preparation, and cooperation between healthcare providers with different backgrounds facilitated percutaneous tracheostomy in COVID-19 patients without an increase in the overall complication rate or evidence of risk to healthcare providers. Our findings provide initial evidence that tracheostomy can be performed safely as a standard of care for COVID-19 patients requiring prolonged mechanical ventilation as was standard practice in ICU patients prior to the COVID-19 pandemic to promote ventilator weaning and patient recovery.


Assuntos
/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Traqueostomia/métodos , Idoso , Anestesia , Broncoscopia , Lista de Checagem , Cuidados Críticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Equipamento de Proteção Individual , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/terapia , Respiração Artificial , Estudos Retrospectivos , Instrumentos Cirúrgicos , Traqueostomia/instrumentação , Desmame do Respirador
15.
J Extra Corpor Technol ; 52(4): 266-271, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33343028

RESUMO

Although the ideal timing of tracheostomy for critically ill patients is controversial, transitioning from an endotracheal tube can be beneficial. Concerns arise for patients under extracorporeal membrane oxygenation (ECMO) support. Studies have described percutaneous and open tracheostomy approaches for critically ill patients but, to our knowledge, have not compared the two specifically in ECMO patients. This study analyzed safety and aimed to identify if there was a difference in major bleeding or other tracheostomy-associated complications. A single-center retrospective cohort study of all patients who received tracheostomy while on ECMO from July 2013 to May 2019 was completed. The primary endpoint was a significant difference in the incidence of a major bleeding adverse event at 48 hours. Secondary endpoints included differences in the incidence of complications (e.g., procedure-related mortality, ECMO decannulation, tracheal/esophageal injury, and pneumothorax/pneumomediastinum) and survival to discharge. A secondary analysis separated the groups further by comparing those with bleeding events and those without. The study included 27 ECMO patients: 16 (59%) in the percutaneous arm and 11 in the open arm. The median number of ECMO days before tracheostomy was 10 vs. 13, respectively. There were no statistically significant differences between the two groups for major bleeding events (percutaneous 44% vs. open 27%, p = .45), procedure-related mortality, or procedure-related complications. Both percutaneous and open tracheostomies in patients on ECMO require a multidisciplinary approach to minimize adverse effects. Major bleeding does occur, but there was no statistically significant correlation between bleeding events and the type of the tracheostomy approach. Thus, both open and percutaneous tracheostomy approaches have a favorable safety profile.


Assuntos
Oxigenação por Membrana Extracorpórea , Traqueostomia , Hemorragia/etiologia , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos
16.
Khirurgiia (Mosk) ; (12): 16-21, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33301248

RESUMO

OBJECTIVE: To summarize an experience of endoscopy-assisted dilatational tracheostomies in patients with COVID-19. MATERIAL AND METHODS: There were 31 endoscopy-assisted dilatational tracheostomies in patients with COVID-19 for the period from April 17 to June 10, 2020 (11 women and 19 men). Mean age of patients was 66.7 years (range 48-87). Tracheostomy was performed using Ciaglia (22) and Griggs (9) techniques. All procedures were carried out at the intensive care unit in elective fashion. RESULTS: Tracheostomy was performed in 19.8% of ICU patients or 36.9% of all patients on mechanical ventilation within 6.5±2.5 days [min 3, max 11]. There were 22 survivors with tracheostomy (70.9%) that is comparable with survival of patients without mechanical ventilation (79.7%) and slightly higher than in patients on ventilation without tracheostomy (65.4%). No complications during the procedure were noted. CONCLUSION: Endoscopy-assisted dilatational tracheostomy is preferred for prolonged mechanical ventilation, including patients with COVID-19. The undeniable advantages of this operation are fewer intraoperative complications due to endoscopic control, and lower risk of tracheal strictures.


Assuntos
Infecções por Coronavirus/prevenção & controle , Dilatação/métodos , Surtos de Doenças/prevenção & controle , Endoscopia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Traqueostomia/instrumentação , Traqueostomia/métodos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Dilatação/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traqueostomia/efeitos adversos
19.
N Engl J Med ; 383(25): 2480-2481, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33326724
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA