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1.
Khirurgiia (Mosk) ; (1): 80-84, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994504

RESUMO

We report one-stage radical surgical treatment of a 54-year-old patient with extensive cicatricial posttracheostomy tracheal stenosis complicated by tracheomalacia of anterior tracheal wall and previous numerous unsuccessful endoscopic attempts of tracheal recanalization. A new method of prevention of tracheal anastomosis failure was applied.


Assuntos
Anastomose Cirúrgica/métodos , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Traqueomalácia/cirurgia , Traqueostomia/efeitos adversos , Humanos , Pessoa de Meia-Idade , Traqueia/lesões , Estenose Traqueal/etiologia , Traqueomalácia/etiologia
2.
J Laryngol Otol ; 134(1): 63-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31910909

RESUMO

BACKGROUND: Determining prognostic factors for the probability of tracheostomy decannulation is key to an adequate therapeutic plan. METHODS: A retrospective cohort study of 160 paediatric patients undergoing tracheostomy was conducted. Associations between different parameters and eventual tracheostomy decannulation were assessed. RESULTS: Mean follow-up duration was 27.8 months (interquartile range = 25.5-30.2 months). Median age at tracheostomy was 6.96 months (interquartile range = 3.37-29.42 months), with median tracheostomy maintenance of 14.5 months (interquartile range = 3.7-21.5 months). The overall tracheostomy decannulation rate was 22.5 per cent. Factors associated with a higher probability of tracheostomy decannulation included age at tracheostomy (hazard ratio = 1.11, 95 per cent confidence interval = 1.03-1.18) and post-intubation laryngitis as an indication for tracheostomy (hazard ratio = 2.25, 95 per cent confidence interval = 1.09-4.62). Neurological (hazard ratio = 0.30, 95 per cent confidence interval = 0.12-0.80) and pulmonary (hazard ratio = 0.41, 95 per cent confidence interval = 0.18-0.91) co-morbidities were negatively associated with tracheostomy decannulation. The probability of tracheostomy decannulation decreased significantly with increasing numbers of co-morbidities (p < 0.001). CONCLUSION: Age, post-intubation laryngitis, and number and type of co-morbidities influence tracheostomy decannulation rate in the paediatric population.


Assuntos
Extubação/estatística & dados numéricos , Laringite/etiologia , Traqueostomia/instrumentação , Extubação/métodos , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Medição de Risco , Traqueostomia/efeitos adversos
3.
BMC Infect Dis ; 19(1): 1060, 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31847817

RESUMO

BACKGROUND: To enhance awareness of the clinical features and prevention of endotracheal myiasis. CASE PRESENTATION: A case of intratracheal myiasis is reported. A 61-year-old male patient with a history of laryngectomy was admitted to hospital due to tracheostomal hemorrhage of 3 h duration. Intratracheal myiasis was confirmed by bronchoscopy, and the patient underwent bronchoscopic intervention, which was complicated by a tracheal-esophageal fistula and resolved by endotracheal stenting. Twenty months after stent placement, the fistula had not healed. CONCLUSION: Intratracheal myiasis has serious complications and is difficult to treat. For post-tracheostomy patients, healthcare providers and caregivers should pay attention to the care and monitoring of wounds and maintenance of a tidy, clean living environment to prevent intratracheal myiasis.


Assuntos
Eletrocoagulação/efeitos adversos , Miíase/cirurgia , Fístula Traqueoesofágica/etiologia , Animais , Broncoscopia , Cânula/parasitologia , Carcinoma de Células Escamosas/cirurgia , Seguimentos , Humanos , Larva , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Miíase/etiologia , Stents , Traqueia/parasitologia , Fístula Traqueoesofágica/terapia , Traqueostomia/efeitos adversos , Resultado do Tratamento
5.
Khirurgiia (Mosk) ; (11): 5-12, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714523

RESUMO

OBJECTIVE: To analyze early and delayed results of various variants of circular tracheal resection (CTR) with anastomosis, to determine the safest approach, dates and conditions of correction, features of postoperative period in patients after previous tracheal surgery. MATERIAL AND METHODS: There were 831 patients with cicatricial tracheal stenosis. CTR was made in 330 (39.7%) patients. Most patients had previous prolonged ICU-stay. The patients were divided into 4 groups. Group 1 consisted of 61 (18.5%) patients after previous prolonged tracheal stenting. Group 2 included 45 (13.6%) patients who underwent circular tracheal resection with a functioning tracheostomy. Tracheostomy tube served as a stent in these patients. Group 3 enrolled 32 (9.7%) patients with previous staged reconstructive plastic surgeries on cranial segment of the respiratory tract. Tracheostomy or stent were absent in 192 (58.2%) patients who underwent circular tracheal resection at the first hospitalization. These patients were enrolled into the fourth (control) group. Favorable outcomes (without complications and mortality) were achieved in 85.5% (n=282) of patients. Postoperative complications occurred in 48 (14.5%) patients. Mortality rate was 0.6% (n=2). The greatest number of complications including anastomositis and restenosis was noted in patients after CTR and previous tracheoplasty with T-tube (n=8, 25%). The most common complication in patients after tracheal resection and previous stenting was anastomositis (14.7%). Long-term results depended on postoperative complications and methods of their correction. Recurrent stenosis occurred in 5 (1.5%) patients within the period of 3 months - 8 years. CTR after previous tracheoplasty with T-tube was carried out in 4 of these patients. CONCLUSION: Tracheal resection after preliminary stenting or tracheostomy is quite safe and technically feasible. Stenting allows postponing radical surgery for correction of concomitant diseases and closure of tracheostomy as a focus of infection within the surgical approach and further tracheal anastomosis. Tracheal resection with simultaneous closure of tracheostomy results a higher rate of postoperative complications compared with preliminary stenting.


Assuntos
Constrição Patológica/cirurgia , Stents/efeitos adversos , Estenose Traqueal/cirurgia , Traqueostomia/efeitos adversos , Constrição Patológica/etiologia , Humanos , Estudos Retrospectivos , Traqueia/patologia , Traqueia/cirurgia , Estenose Traqueal/etiologia
6.
J Cardiothorac Surg ; 14(1): 171, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533769

RESUMO

BACKGROUND: The treatment of persistent air leak is a challenge. Herein, we reported the combined intrabronchial and intrapleural injection of fibrin glue using fiber bronchoscopy to seal off an alveolar pleura fistula developed following necrotizing pneumonia in high-risk patient. CASE PRESENTATION: A 74-year-old man was intubated in emergency for acute ischemic stroke. Percutaneous dilatational tracheostomy was then performed, and 15 days later patient returned to spontaneous breathing. However, he developed alveolar pleural fistula following necrotizing pneumonia with persistent air leaks. The intrabronchial and intrapleural injection of fibrin glue using fiber bronchoscopy sealed off the alveolar pleura fistula after that other endoscopic treatments as bronchial valve and intrabronchial fibrin glue application had failed. CONCLUSIONS: Our strategy is safe and easy to reproduce. It represents an additional method in the armamentarium of the physicians for the management of PAL when all standard strategies are unfeasible or fail.


Assuntos
Fístula Brônquica/cirurgia , Adesivo Tecidual de Fibrina/uso terapêutico , Doenças Pleurais/tratamento farmacológico , Alvéolos Pulmonares/cirurgia , Idoso , Isquemia Encefálica/complicações , Brônquios , Fístula Brônquica/tratamento farmacológico , Broncoscopia , Endoscopia , Fístula/complicações , Humanos , Injeções , Masculino , Doenças Pleurais/etiologia , Acidente Vascular Cerebral/complicações , Traqueostomia/efeitos adversos
7.
Surg Clin North Am ; 99(5): 955-965, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31446920

RESUMO

Surgeons are often asked to perform tracheostomies and percutaneous endoscopic gastrostomies for a wide variety of patients. As consultants, surgeons are tasked with honoring the relationship between the referring provider and the patient while also assessing whether the consult is appropriate given the patient's prognosis and goals of care. This article discusses the most common conditions for which these procedures are requested and reviews the evidence supporting either the placement or avoidance of these tubes in each condition. It provides a framework for surgeons to use when discussing these procedures in the context of goals of care.


Assuntos
Endoscopia Gastrointestinal , Nutrição Enteral , Neoplasias de Cabeça e Pescoço/cirurgia , Doenças do Sistema Nervoso/cirurgia , Traqueostomia , Ferimentos e Lesões/cirurgia , Estado Terminal/terapia , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/mortalidade , Humanos , Cuidados Paliativos/ética , Traqueostomia/efeitos adversos , Traqueostomia/mortalidade
8.
Int J Pediatr Otorhinolaryngol ; 125: 122-127, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299421

RESUMO

OBJECTIVE: To determine the frequency and risk factors that lead to the development of persistent TCF (tracheocutaneous fistula) formation in children following tracheostomy decannulation at our institution. METHODS: A retrospective chart review of all pediatric patients at Children's Hospital Colorado who underwent tracheostomy decannulation and were being followed between January 1, 2007 and December 31, 2013. TCF was defined as a persistent fistula six months following decannulation. We determined patient demographics, age at tracheotomy, primary indication for tracheotomy, tracheostomy-tube size, medical comorbidities, age at decannulation, date of TCF closure, and method of TCF closure. RESULTS: One hundred twenty-nine patients ranging from 51 days to 19 years of age underwent tracheostomy decannulation. 63 (49%) patients underwent surgical closure of TCF. Compared to those with spontaneous closure by multivariable analysis, those with surgical closure were younger at tracheostomy placement (p = 0.0002), had a tracheostomy for a longer duration (p = 0.0025), and were diagnosed with tracheobronchomalacia (p = 0.0051). The likelihood of spontaneous closure decreased over time. Tracheostomy tube internal diameter correlated with age (R = 0.64, p < 0.0001). CONCLUSIONS: Approximately 50% of pediatric tracheostomy stoma sites will close spontaneously. Development of a persistent TCF was associated with younger age at placement, longer duration of tracheostomy, and the presence of tracheobronchomalacia. These observations may help clinicians anticipate outcomes following tracheostomy decannulation in children.


Assuntos
Extubação/efeitos adversos , Fístula Cutânea/cirurgia , Complicações Pós-Operatórias/cirurgia , Fístula do Sistema Respiratório/cirurgia , Doenças da Traqueia/cirurgia , Traqueostomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Colorado , Fístula Cutânea/etiologia , Remoção de Dispositivo/efeitos adversos , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/etiologia , Fístula do Sistema Respiratório/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Doenças da Traqueia/etiologia , Traqueobroncomalácia/cirurgia , Traqueotomia/efeitos adversos , Adulto Jovem
9.
J Cardiothorac Surg ; 14(1): 128, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272475

RESUMO

BACKGROUND: Tracheal stenosis caused by tracheotomy and intubation is considered intractable. Although the segmental tracheal resection and endoscopic intervention are available, they usually result in great operation injury or are difficult to perform. CASE PRESENTATION: A patient with acquired tracheal stenosis was treated with tracheotomy-coblation. The patient was followed up by bronchoscopy every 2 months. After 6-month follow-up, the symptoms of dyspnea and hoarseness disappeared and no tracheal stenosis was observed. CONCLUSIONS: The present technique, tracheotomy-coblation, is advantageous with less injury and easy to perform.


Assuntos
Técnicas de Ablação , Estenose Traqueal/cirurgia , Traqueotomia , Adulto , Dispneia/etiologia , Rouquidão/etiologia , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Estenose Traqueal/etiologia , Traqueostomia/efeitos adversos
10.
J Craniofac Surg ; 30(6): 1667-1670, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31335579

RESUMO

The aim of the present study was to present a single center's experience with mandibular distraction osteogenesis (MDO) in Pierre Robin sequence (PRS) patients. A retrospective chart review was performed to identify patients with PRS that underwent MDO at our institution from 2003 to 2012. Inclusion criteria were as follows:Evaluation included demographic information, postoperative complications, and surgical outcomes. Twenty-four patients met the inclusion criteria. No complications related to our distraction technique were reported. Most of the patients who had a tracheostomy were successfully decannulated and the rest were able to avoid a tracheostomy. Two patients had superficial infections that were treated conservatively with topical antibiotics. One patient, who was our first case in the series, required 3 episodes of distraction osteogenesis. Another patient demonstrated recurrent symptoms of obstructive sleep apnea after MDO and was treated with continuous positive airway pressure. Over-correction during MDO in PRS is an efficient method for preventing future airway problems. Patients who required a tracheotomy pre-distraction and cases in whom distraction was performed at older age (>2 months of age), had a lower success rate in achieving de-cannulation and a higher rate of complications. Laryngomalacia, gastro-esophageal reflux disease, cardiac, and GI anomalies are not associated with increased failure rates of MDO in PRS.


Assuntos
Síndrome de Pierre Robin/cirurgia , Extubação , Pré-Escolar , Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Humanos , Lactente , Recém-Nascido , Mandíbula/cirurgia , Osteogênese por Distração , Complicações Pós-Operatórias , Estudos Retrospectivos , Apneia Obstrutiva do Sono , Traqueostomia/efeitos adversos , Traqueotomia/efeitos adversos , Resultado do Tratamento
11.
J Craniofac Surg ; 30(7): 2168-2170, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31274818

RESUMO

BACKGROUND: Tracheotomy has played an important role in the treatment of patients with severe traumatic brain injury (TBI), the appropriate tracheotomy time will affect the prognosis of patients. However, the timing of tracheostomy after severe TBI remains controversial. To find the optimal time for tracheostomy, the authors compared the effects of early tracheostomy (ET) versus late tracheostomy (LT) on TBI-related outcomes and prognosis. METHODS: The clinical data of 98 patients with severe TBI treated by tracheotomy at NICU, First Affiliated Hospital of Xi'an Medical University, January 2017 to January 2018, were analyzed retrospectively. According to the time of the tracheotomy during the treatment, the patients were divided into ET group (after admission <3 days) and LT group (>3 days after admission). The NICU stay, hospital stay, long duration of antibiotic use, pneumonia rates, mortality rates, improvement of nerve function, complications of tracheotomy, and treatment cost were compared between the 2 groups. RESULTS: The NICU stay, hospitalization stay, and antibiotic use time of patients in the ET group were shorter than those in the LT group (P < 0.05). The pneumonia rates and the cost of hospitalization in the ET group were lower than those in the LT group (P < 0.05). The complications of the tracheostomy, mortality, and neurologic function improvements were not statistically significant in the 2 groups (P > 0.05). CONCLUSION: For severe TBI, ET can reduce the NICU stay, hospitalization stay, length of antibiotic use, and reduce the incidence rates of pneumonia and the cost of hospitalization compared with LT, but there is no significant improvement in the mortality rates and neurologic function of patients during hospitalization.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Traqueostomia/efeitos adversos , Adulto Jovem
12.
J Laryngol Otol ; 133(7): 632-635, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31196251

RESUMO

BACKGROUND: Obstructive sleep apnoea occurs consequent to partial or complete upper airway obstruction, caused mostly by the collapse of upper airway musculature. Drug-induced sleep endoscopy represents the 'gold standard' in identifying the obstruction site, from the palatal level to laryngeal entry. Breathing impairment in sleep caused by the collapse of cervical trachea after previous tracheostomy has not yet been described in the literature. METHODS: This report presents two patients with severe obstructive sleep apnoea, in whom pre-operative drug-induced sleep endoscopy revealed upper airway and cervical trachea collapse at the level of previous tracheostomy. RESULTS: The female patient was successfully treated with resection of hypertrophic tissue of the tongue base via lateral pharyngectomy, and resection of the collapsed segment of the trachea with primary reconstruction of the trachea by end-to-end anastomosis. The male patient was recommended continuous positive airway pressure therapy because of serious co-morbidities and high operative risk. CONCLUSION: Drug-induced sleep endoscopy should always be used for visualisation of anatomical structures below the vocal folds in patients with a history of cervical trachea surgery. These two cases demonstrate the importance of drug-induced sleep endoscopy in planning conservative and surgical treatments, contributing significantly to operative success.


Assuntos
Apneia Obstrutiva do Sono/terapia , Traqueostomia/efeitos adversos , Adulto , Idoso , Anastomose Cirúrgica , Comorbidade , Pressão Positiva Contínua nas Vias Aéreas , Endoscopia , Feminino , Humanos , Masculino , Apneia Obstrutiva do Sono/etiologia , Resultado do Tratamento
13.
Int J Pediatr Otorhinolaryngol ; 124: 30-33, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31154120

RESUMO

INTRODUCTION: Swallowing problems in children with a tracheostomy tube seem to be a common problem, although exact prevalence is not known. The aim of this study is to identify the prevalence and type of swallowing problems in children with a tracheostomy tube. METHODS: We retrospectively included 44 children having a tracheostomy tube at Erasmus MC-Sophia Children's hospital. Assessment by a specialized speech and language therapist, the Modified Evans Blue Dye test, Video Fluoroscopic Swallowing Study and a Fiber-optic Endoscopic Evaluation of Swallowing were reviewed with regard to the different phases of swallowing, in particular signs of aspiration. RESULTS: In our cohort, 31 (70%) children with a tracheostomy tube presented with problems in the oral and/or the pharyngeal phase of swallowing. Overall 19 (43%) children aspirated. CONCLUSIONS: The majority of children with a tracheostomy tube have swallowing problems in the different swallowing phases with a high risk for aspiration.


Assuntos
Transtornos de Deglutição/etiologia , Aspiração Respiratória/etiologia , Traqueostomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Transtornos de Deglutição/diagnóstico por imagem , Endoscopia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
14.
Zhonghua Shao Shang Za Zhi ; 35(5): 388-391, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31154739

RESUMO

Objective: To explore the application value of color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns complicated with upper respiratory tract obstruction. Methods: From July 2013 to June 2018, 17 patients with head and neck burns complicated with upper respiratory tract obstruction, including 15 males and 2 females, aged 19-63 years, were hospitalized in our unit and treated with color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps. Before operation, the trachea was examined by color Doppler ultrasonography to specify condition of trachea and peribronchial tissues and organs for comprehensive assessment, so as to confirm optimal incision site of puncture and pathways as well as specify distance from anterior cervical skin to intima of anterior tracheal wall. Then, under real-time guidance of color Doppler ultrasound, percutaneous dilational tracheostomy with dilatation forceps was performed. The position, shape, inner diameter, and intraluminal abnormalities of trachea of patients before operation, abnormal location of peribronchial vessels and thyroid, distance from anterior cervical skin to intima of anterior tracheal wall, success rate of puncture, surgical time (from skin disinfection to successful catheterization), success rate of catheterization, intraoperative blood loss, heart rate, blood pressure, respiration, percutaneous oxygen saturation, and presence or absence of complications such as vascular/thyroid injury, emphysema, pneumothorax, suffocation, postoperative hemorrhea, wound infection after operation were observed and detected. Results: (1)Preoperative color Doppler ultrasonography showed that the trachea of one patient deviated from the anterior median line of neck 13 mm to the right; 17 patients had edema of different degrees in the cervical soft tissue and more secretions in the trachea; 3 patients had the trachea changed from round to oval with reduced anteroposterior diameter; 1 patient had a small artery obstruction at the conventional puncture point; 2 patients had the trachea covered by the congestive and swollen isthmus of the thyroid between the first and the third tracheal cartilage rings; 16 patients had a distance from anterior cervical skin to anterior tracheal wall intima of 17-33 mm, and 1 patient had a distance from anterior cervical skin to anterior tracheal wall intima of 47 mm. (2) Puncture for 17 patients was successful at one time, and success rate of puncture was 100%. The operation time was 5-11 min, with an average of 7 min, and the success rate of catheterization was 100%. (3) Intraoperative blood loss of patients was less, all not exceeding 8 mL. Intraoperative percutaneous oxygen saturation was maintained between 0.90 and 0.99. The heart rate, blood pressure, and respiration were stable. (4) No complications such as vascular/thyroid injury, emphysema, pneumothorax, suffocation, postoperative massive hemorrhage, or wound infection occurred in any patient. Conclusions: Applying color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns combined with upper respiratory tract obstruction can not only open up the airway quickly and effectively, but also reduce the complications related to the operation. It is expected to improve the success rate of rescue and improve the prognosis, making it of good application value.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Queimaduras/complicações , Dilatação/instrumentação , Traqueostomia/métodos , Ultrassonografia Doppler em Cores/métodos , Adulto , Cuidados Críticos , Feminino , Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço , Estudos Prospectivos , Instrumentos Cirúrgicos , Traqueostomia/efeitos adversos , Adulto Jovem
15.
Eur Arch Otorhinolaryngol ; 276(8): 2349-2354, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31152321

RESUMO

PURPOSE: Tracheostomy is usually suggested to facilitate airway management of intensive care unit (ICU) patients requiring prolonged translaryngeal intubation (PTLI). While it is not uncommon for physicians to hesitate and delay to perform it for more than 2 weeks, clinically recognizable airway adverse effects following PTLI are rarely discussed. Therefore, we compared retrospectively the PTLI group with control to assess them in adult patients. METHODS: During a period of 1991-2012, patients aged older than 15 years that were admitted to University of Tsukuba Hospital ICU, underwent translaryngeal intubation (TLI) for 14 days or longer, were retrospectively studied as Group P. Patients whose tracheas were intubated for 13 days or less were set up as a control group (Group C). Patients were excluded if they had undergone any procedures that might have affected recurrent laryngeal nerves. RESULTS: Ninety-eight patients (M:F = 58:40) (group P) and 88 patients (M:F = 58:30) (group C) were included. There were no differences in patients' characteristics. Durations of TLI were 20.8 ± 6.8 days in group P and 3.8 ± 3.0 days in group C. There were no differences in the occurrence rates of severe airway adverse events. Although we found higher incidence rates of dysphagia and dysphonia/hoarseness in group P, the symptoms were mild and they were not prolonged. There were no differences in other signs and symptoms. CONCLUSIONS: We found no difference in the occurrence rates of severe airway adverse events in both groups. Translaryngeal intubation may be tolerable in adults even if the duration exceeds 2 weeks.


Assuntos
Transtornos de Deglutição/epidemiologia , Rouquidão/epidemiologia , Intubação Intratraqueal/efeitos adversos , Traqueostomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Traqueostomia/métodos , Adulto Jovem
16.
Eur J Clin Microbiol Infect Dis ; 38(8): 1561-1568, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31119575

RESUMO

Data on respiratory-related illness and respiratory syncytial virus (RSV) infection in children with a tracheostomy are sparse. We determined respiratory illness hospitalization (RIH) and RSV-related hospitalization (RSVH) hazard ratios in children with a tracheostomy following prophylaxis compared with infants' prophylaxed for standard indications (prematurity ≤ 35 weeks' gestational age, bronchopulmonary dysplasia, and significant congenital heart disease) and children with complex medical disorders. Children who received ≥ 1 injection of palivizumab were prospectively enrolled across 32 Canadian sites during the RSV season. Respiratory illness event data were collected monthly. Data were analyzed using t tests, chi-square tests, and Cox proportional hazards adjusted for confounders. A total of 23,597 infants were enrolled; 220 tracheostomy, 19,402 standard indications, 3975 complex medical disorders. Of the 220 tracheostomy infants, 30 had bronchopulmonary dysplasia, 18 were premature, 12 had congenital heart disease, and 160 had other medical complexities. RIH and RSVH incidences (tracheostomy, standard indications, complex medical disorders) were 24.5%, 6.2%, and 9.8% and 2.0%, 1.5%, and 1.8% respectively. RIH hazard was significantly higher in tracheostomy infants compared with standard indications (HR = 1.8, 95% CI 1.1-3.0, p = 0.02) but was similar between the tracheostomy and complex medical disorders groups (HR = 1.3, 95% CI 0.7-2.2, p = 0.37). RSVH hazard was also similar in tracheostomy infants relative to standard indications and complex medical disorders (both p > 0.75). Children with tracheostomies who received palivizumab had an increased RIH hazard compared with the standard indications group. Similar RSVH hazard between tracheostomy, standard indications, and complex medical disorders groups suggests that children with tracheostomies may benefit from palivizumab by reducing RSVH during the RSV season.


Assuntos
Antivirais/administração & dosagem , Hospitalização , Palivizumab/administração & dosagem , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Infecções Respiratórias/etiologia , Traqueostomia/efeitos adversos , Canadá , Quimioprevenção/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Modelos de Riscos Proporcionais , Estudos Prospectivos , Sistema de Registros , Infecções por Vírus Respiratório Sincicial/etiologia , Infecções Respiratórias/virologia , Fatores de Risco
17.
Eur Arch Otorhinolaryngol ; 276(6): 1837-1844, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31041516

RESUMO

PURPOSE: To evaluate percutaneous dilatational tracheostomy in patients ≥ 85 years old: its complication rate and possible risk factors. In addition, to assess prognostic factors for short, intermediate and long term survival following the procedure. METHODS: A retrospective case-control study of 72 patients ≥ 85 years who received percutaneous dilatation tracheotomy (PTD), compared to a control group of younger patients (n = 182). Demographics, clinical and laboratory data were collected. Survival and risk for complications were analyzed. RESULTS: The study group's mean age was 89 ± 4. Twelve patients had complications, three (4.2%) were major. No significant difference was found in overall complication rates between the groups. Cerebrovascular disease with neurologic deficits and pre-procedure albumin levels were significantly associated with complications. Survival rates did not differ in 1 week and 1 month following procedure between study and control group. There was a significant difference in the 1-year survival rates between the patients ≥ 85 years and the control groups (18.1% vs. 34.4%, p = 0.01, respectively). Congestive heart failure, a frailty score > 0.27 and failure to wean from a cannula were associated with reduced 1-year survival. CONCLUSION: PTD is safe for patients ≥ 85 years. Complication risk factors and reduced survival should be discussed with patients and families before conducting tracheostomies. LEVEL OF EVIDENCE: 3b.


Assuntos
Dilatação/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Traqueostomia/efeitos adversos , Traqueotomia/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dilatação/métodos , Dilatação/mortalidade , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Traqueostomia/métodos , Traqueostomia/mortalidade , Traqueotomia/mortalidade
18.
Ann Vasc Surg ; 60: 475.e5-475.e10, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31075467

RESUMO

Innominate artery pathology is traditionally treated with open surgical repair and is associated with significant morbidity. No dedicated endovascular solution exists for this anatomic location. We report a series of 3 cases of successful management of innominate artery injuries using an off-label, modified Zenith ESLE stent graft (Cook Medical, Bloomington, IN). Two patients presented with pseudoaneurysms after attempted central venous catheterization, and 1 patient developed a tracheo-innominate fistula. Access was obtained in a retrograde fashion via the right common carotid artery in 2 cases, and via the right axillary artery in the other. Additional anatomic considerations included a prior sternotomy in 2 cases and a bovine arch in 2 cases. Due to the emergent nature of the cases, no cerebral protection maneuvers were taken. The ESLE limbs are of uniform diameter with 3 Z-stent wireforms and measure 55 mm in length. Removal of the distal stent reduces the length to 38 mm. Fourteen- to 18-mm diameter grafts were used. All 3 cases resulted in technical success with complete exclusion of the defect. There were no new neurologic deficits and all patients recovered uneventfully. This approach represents an effective off-label solution for what frequently presents as an emergent problem. In 2 cases, it obviated the need for a complicated redo sternotomy and facilitated endovascular repair in a vessel for which there was no indicated off-the-shelf conduit. Modification of existing devices successfully addressed the need for a nontapered graft of short length and moderate vessel diameter and allowed for minimally invasive treatment of anatomically complex pathology.


Assuntos
Falso Aneurisma/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Tronco Braquiocefálico/cirurgia , Procedimentos Endovasculares/instrumentação , Fístula do Sistema Respiratório/cirurgia , Traqueia , Fístula Vascular/cirurgia , Lesões do Sistema Vascular/cirurgia , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/lesões , Cateterismo Venoso Central/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fístula do Sistema Respiratório/diagnóstico por imagem , Fístula do Sistema Respiratório/etiologia , Traqueia/diagnóstico por imagem , Traqueia/lesões , Traqueostomia/efeitos adversos , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/etiologia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia
19.
Tuberk Toraks ; 67(1): 55-62, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31130136

RESUMO

Introduction: The most common cause of tracheal stenosis (TS) continues to be traumas according to the intubation and tracheostomy. Bronchoscopy is considered the gold standard for the detection and diagnosis of tracheobronchial pathology. There are several treatment options. We aimed to discuss our tracheal stenosis patients' treatment options, and their follow-up period. Materials and Methods: Consecutive referred patients between 2009 and 2018 presenting with TS were reviewed for the study. Demographic characteristics, localization, length and degree of stenosis, treatment techniques, postoperative complications, and survival were recorded for all patients. Result: A total of 110 patients included. The mean age was 53.7 ± 16.7 (16-98 years) years. Of 110 patients, 54 (49.1%) were female. Most common type of stenosis was complex stenosis (74.5%). Mechanical dilatation was applied to all patients. Stenotic regions of 22 (20%) patients were cut with bronchoscopic scissor. Tracheal stents were inserted into trachea of 49 (44.5%) patients. During follow-up period; 36 of 110 (32.7%) patients had surgical resection. Six of 36 (16.7%) patients died during follow-up period (one of them died during surgery), 17 (47.2%) patients had total recovery after surgery. Thirteen of 36 (36.1%) patients had restenosis after surgery. Conclusions: Tracheal stenosis is a process seen after postintubation or posttracheostomy frequently and it has a wide range of management modalities. Although, it is believed that surgery is the most efficient technique in cases without medical contraindications, we determined that endoscopic interventions can be alternative therapeutic options for inoperable patients. Patients must be followed-up after interventional therapies because complications, and restenosis can usually be seen.


Assuntos
Broncoscopia/métodos , Crioterapia/métodos , Intubação Intratraqueal/efeitos adversos , Estenose Traqueal/etiologia , Traqueostomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Traqueia/diagnóstico por imagem , Estenose Traqueal/diagnóstico , Estenose Traqueal/terapia , Adulto Jovem
20.
Eur Arch Otorhinolaryngol ; 276(7): 2069-2073, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31093734

RESUMO

PURPOSE: To review indications, patient characteristics, frequency, and safety for surgical tracheostomies performed by otolaryngologist-head and neck surgeons in a single tertiary care center. METHODS: Surgical tracheostomies performed by otolaryngologist-head and neck surgeons at Helsinki University Hospital between January 2014 and February 2017 were retrospectively reviewed. Patient demographics, surgical data, and peri- and postoperative mortality information were collected from the hospital charts. Minimum follow-up was 18 months. RESULTS: The total population was 255, with a majority (n = 181; 71%) of males. The majority of patients (n = 178; 70%) were classified as ASA 3 or 4. A total of 198 (78%) patients suffered from head and neck cancer. Multiple (14 altogether) indications for tracheostomy were identified, and simultaneous major head and neck tumor surgery was common (in 58%). Altogether, 163 (64%) patients were decannulated during follow-up with a median cannulation period of 9 days (range 1-425). The surgical mortality was 0.4%. CONCLUSION: Simultaneously performed major tumor surgery was the most common indication for a tracheostomy. A notable number of patients had impaired physical status, but relatively insignificant comorbidities. Almost two-thirds of the patients were decannulated during follow-up, although some patients remained tracheostomy dependent for a prolonged period. Tracheostomy was found to be a safe procedure. LEVEL OF EVIDENCE: 2b.


Assuntos
Neoplasias de Cabeça e Pescoço , Complicações Pós-Operatórias/epidemiologia , Traqueostomia , Adulto , Idoso , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Otolaringologia/métodos , Otolaringologia/estatística & dados numéricos , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Traqueostomia/efeitos adversos , Traqueostomia/métodos , Traqueostomia/estatística & dados numéricos
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