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1.
Thorac Surg Clin ; 30(1): 91-99, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761288

RESUMO

The article describes an anesthetic management strategy for resection of the cervical trachea due to benign stenosis without using an endotracheal tube. The strategy includes: (1) insertion of an airway stent in the stenotic area, (2) insertion of a supraglottic airway device (SGAD), and (3) advancing a jet ventilation catheter through the SGAD. The stent is removed during surgery together with the resected part of the trachea. The technique of nonintubated tracheal resection allows the surgeon to work most comfortably and helps the anesthesiologist properly maintain the patient's vital functions in the operating room.


Assuntos
Manuseio das Vias Aéreas , Anestesia/métodos , Estenose Traqueal/cirurgia , Traqueotomia , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/métodos , Humanos , Stents , Traqueotomia/instrumentação , Traqueotomia/métodos
2.
Anaesthesia ; 74(9): 1153-1157, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31165475

RESUMO

Emergency front-of-neck access to achieve a percutaneous airway can be a life-saving intervention, but there is debate about the preferred technique. This prospective, observational study was designed to compare the two most common emergency surgical airway techniques in a wet lab simulation using an ovine model. Forty-three doctors participated. After providing standardised reading, a lecture and dry lab benchtop training, participants progressed to a high-fidelity wet lab simulation. Participants entered an operating theatre where a 'cannot intubate, cannot oxygenate' situation had been declared and were directed to perform emergency front-of-neck access: first with a cannula technique (14-gauge cannula insertion with ventilation using a Rapid-O2® cricothyroidotomy insufflation device); and subsequently, a scalpel-bougie technique (surgical incision, bougie insertion into trachea and then tracheal tube passed over bougie, with ventilation using a self-inflating bag). The primary end-point was time from declaration of 'cannot intubate, cannot oxygenate' to delivery of oxygen via a correctly placed percutaneous device. If a cannula or tracheal tube was not placed within 240 s, the attempt was marked as a failure. There was one failure for the cannula approach and 15 for the scalpel-bougie technique (OR 0.07 (95%CI 0.00-0.43); p <0.001). Median (IQR [range]) time to oxygenation, if successful, was 65 (57-78 [28-160]) s for the cannula approach and 90 (74-115 [40-265]) s for the scalpel-bougie technique (p=0.005). In this ovine model, emergency front-of-neck access using a cannula had a lower chance of failure and (when successful) shorter time to first oxygen delivery compared with a scalpel-bougie technique.


Assuntos
Manuseio das Vias Aéreas/métodos , Cânula , Cartilagem Cricoide/cirurgia , Traqueotomia/instrumentação , Traqueotomia/métodos , Animais , Serviços Médicos de Emergência , Humanos , Modelos Animais , Estudos Prospectivos , Ovinos
3.
Ann Otol Rhinol Laryngol ; 128(3_suppl): 94S-105S, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30843431

RESUMO

INTRODUCTION:: Endotracheal (ET) intubation is a common cause of acquired glottic stenosis. Severe cases often require an irreversible arytenoidectomy/cordectomy, which typically results in poor voice quality. Adult human cadaver larynges were studied to gain insights about ET tube-induced posterior glottic injuries, hoping to create a less invasive remedy. STUDY DESIGN:: Human cadaver investigation and case reports. METHODS:: Microlaryngeal assessments were done on 10 human cadaver larynges (5 men, 5 women) with and without ET tubes. After supracricoid soft tissue resection, measurements were obtained, including the distance between the outer diameter of the ET tube and the medial aspect of the cricoarytenoid joint facet. Additionally, measurements of the circumferential arc of differently sized ET tubes were made alongside both cricoarytenoid joint capsules. This information was used to design a silastic stent that would function as a self-retaining interarytenoid spring to treat posterior glottic stenosis in 5 patients. Four of 5 patients included in the clinical study were tracheotomy dependent, primarily because of glottic stenosis. The human surgical technique is described in detail. RESULTS:: The shortest distance between the outer diameter of the ET tube to the medial cricoid facet averaged 5.02 mm in men and 3.62 mm in women. On the basis of the diameter of the intralaryngeal component of the initially round stent, and the position of the cricoarytenoid joint facets, the interarytenoid spring would have a subtended arc between 110° and 175°. These data helped fashion parameters for modifying a conventional T-tube to form a new self-retaining silastic interarytenoid spring. The first 5 human cases have been successful, allowing effective tracheotomy tube decannulation and excellent voice quality. CONCLUSIONS:: The anatomic investigation herein provided key insights into ET tube-induced glottic stenosis and facilitated a new straightforward procedure to surgically improve the airway yet preserve excellent vocal function in patients with acquired glottic stenosis. Level of Evidence: NA.


Assuntos
Glote/lesões , Intubação Intratraqueal/efeitos adversos , Laringoestenose/terapia , Complicações Pós-Operatórias/terapia , Stents , Traqueotomia/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Cartilagem Aritenoide , Cadáver , Feminino , História do Século XIX , Humanos , Intubação Intratraqueal/história , Intubação Intratraqueal/instrumentação , Laringoestenose/etiologia , Laringoestenose/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Traqueotomia/história
5.
Int J Pediatr Otorhinolaryngol ; 116: 192-195, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30554697

RESUMO

OBJECTIVES: To compare the rates of skin-related complications and accidental decannulation in pediatric patients who received Velcro® ties versus twill ties during the early postoperative period following tracheotomy. The rates of skin-related complications and accidental decannulation in patients with Velcro® ties was hypothesized to differ from those in patients with twill ties. METHODS: Medical records of 109 patients ≤18 years old who underwent elective tracheotomy were reviewed: 70 received twill ties and 39 received Velcro® ties. Patients were followed for the first seven postoperative days. The primary outcome was skin-related complications, which were further categorized into mild (irritation) and severe (breakdown). The secondary outcome was accidental decannulation. Rates of skin-related complication and accidental decannulation were compared across the two groups using chi-square analysis. RESULTS: Skin irritation occurred in 32 patients (45.7%) with twill ties and 10 patients (25.6%) with Velcro®. Skin breakdown occurred in 20 patients (28.6%) with twill ties and 6 patients (15.4%) with Velcro®. There were no accidental decannulation events. The use of Velcro® ties was associated with a decreased rate of skin irritation (OR: 0.41; 95% CI: 0.17-0.97; P = 0.039). CONCLUSIONS: The use of Velcro® ties was associated with a decrease in the rate of skin irritation. There were no accidental decannulation events. These findings support the use of Velcro® ties at the time of pediatric tracheotomy placement.


Assuntos
Extubação/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Dermatopatias/etiologia , Traqueotomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Desenho de Equipamento/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Dermatopatias/epidemiologia , Traqueotomia/instrumentação , Traqueotomia/métodos
6.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 53(11): 825-829, 2018 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-30453401

RESUMO

Objective: To observe the clinical course of children with juvenile-onset recurrent respiratory papillomatosis (JORRP) until 14 years old. Methods: The clinical data of one hundred and twenty cases treated between Januray 1, 2002 and September 30, 2017 in Beijing Tongren Hospital were analyzed retrospectively. Excluding the deaths and the lost, patients who could be ≥ 5 years without recurrence, were defined as the cured group, and < 5 years with recurrence defined as the recurrent group. Furthermore, using statistical methods to analyze the differences of the age of initial operation, total number of operations, invasive lesion, HPV infection, tracheotomy, airway dissemination after tracheotomy and time of tube wear between the two groups. Results: One hundred and three cases were followed up, except for the six deaths.Numbers of operations in eight cases were ≤2, and ≥3 in eighty nine cases.Peak of the primary surgical age were about 4.5 years old, while the self-healing trend occurred at nine years old. In the cured group, forty three cases were cured, with a curative rate of 41.7% (43/103), and there were all fifty four survivors in the recurrent group.The total number of operations, invasive cases, HPV positive cases and the G score of hoarseness in the recurrent group were higher than those in the cured group (F=13.02, χ(2)=13.04, χ(2)=17.37, Z=-4.59, P<0.05). The number of tracheal dissemination caused by tracheotomy in the recurrent group (66.7%, 27.8%)was more than that in the cured group (χ(2)=16.01, P<0.05). Compared with the time of wearing a tracheostomy tube in cured group, the recurrent group was longer ((3.4±3.1) years vs (8.3±6.7) years, χ(2)=7.19, P<0.05). Conclusions: 41.7% of the patients had no relapse for at least five years.There exsisted differences between the cured and recurrent group in the following aspects: the total numbers of surgery, the agression of the lesions, tracheal intratracheal dissemination after tracheotomy, the time of tracheotomy, the HPV typing and the G grading of hoarseness.


Assuntos
Infecções por Papillomavirus/cirurgia , Infecções Respiratórias/cirurgia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Seguimentos , Humanos , Infecções por Papillomavirus/mortalidade , Complicações Pós-Operatórias/etiologia , Recidiva , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Fatores de Tempo , Traqueotomia/efeitos adversos , Traqueotomia/instrumentação , Resultado do Tratamento
7.
Artigo em Inglês | MEDLINE | ID: mdl-28673655

RESUMO

OBJECTIVES: Quantitative evaluation of upper airway obstruction cannot be commonly performed under acute dyspnea, especially in head and neck cancer (HNC); the decision whether or not to perform airway control surgery may be difficult to reach. Peak inspiratory flow (PIF) has been previously demonstrated to be a useful tool to decide on decannulation after HNC surgery. The aim of the present study was to assess the role of PIF as a standardized non-invasive tool in quantifying severe inspiratory dyspnea requiring emergency tracheostomy. MATERIALS AND METHODS: A single-center prospective observational pilot study analyzed PIF measurements in 22 patients exhibiting acute dyspnea due to upper airway obstruction. MAIN OUTCOME MEASURES: The decision whether or not to perform tracheotomy was taken prior to PIF measurement. PIF was measured with a hand-held PIF meter (In-Check method), and laryngeal fiberoscopy was then performed. Obstruction severity was defined by PIF values. RESULTS: PIF could be measured prior to tracheotomy (imminent in 21 cases, postponed in 1) in all cases. PIF values below 53.1 L/min (i.e., 18.3% of theoretic value) correlated with necessity for emergency tracheotomy. This threshold is concordant with that previously found for the feasibility of decannulation (60L/min). CONCLUSIONS: PIF is a non-invasive quantitative parameter assessing severity of upper airway obstruction, that may be helpful in decision-making for tracheostomy. Testing is simple, quick and reproducible.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Neoplasias de Cabeça e Pescoço/complicações , Capacidade Inspiratória , Traqueotomia , Adulto , Idoso , Obstrução das Vias Respiratórias/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Traqueotomia/instrumentação , Traqueotomia/métodos , Resultado do Tratamento , Desmame do Respirador
9.
J Crit Care ; 42: 25-29, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28662378

RESUMO

PURPOSE: By comparing flexible lightwand-assisted and conventional endotracheal tube (ETT) withdrawal in percutaneous dilatational tracheotomy (PDT), this paper aims to provide guidance for precise ETT withdrawal by anesthesiologists and accurate determination of the incision site by surgeons. METHODS: Sixty patients who underwent PDT in our hospital were randomly divided into the lightwand group (Group L, n=30) and the withdrawal group (Group W, n=30) using the envelope method. For Group L patients, a flexible lightwand was inserted into an ETT (based on the patient's size), the light source was positioned at the root of the cuff, and the depth from the root of the cuff to the end of the ETT was marked. The flexible lightwand was inserted into the patient's ETT to the marked depth. The ETT along with the flexible lightwand was withdrawn until the highlighted spot was located at the level of the thyroid cartilage. The incision site was approximately 3 finger widths (approximately 4.8cm) below the highlighted spot. For Group W patients, the ETT was withdrawn to a tube depth of 17cm at the upper incisors in males and 15cm in females, and surgeons determined incision sites without assistance. The following metrics were recorded for the two groups: occurrences of inadvertent extubation, ETT puncture and cuff rupture; success rate of first puncture; hypoxia rate; SpO2 at the time of tracheostomy cannula intubation (T1); and postoperative hemorrhage rate. RESULTS: Inadvertent extubation, ETT puncture and cuff rupture occurred significantly less frequently in Group L than in Group W, and the success rate of first puncture and SpO2 at T1 were markedly higher in Group L than in Group W. Moreover, significant between-group differences in hypoxia rate and postoperative hemorrhage rate were observed. CONCLUSIONS: The use of a flexible lightwand in PDT is a safe and effective approach. This approach can effectively and directly guide precise ETT repositioning and provide incision site confirmation with few intra- and postoperative anesthesia-related or operative complications compared with the traditional technique of ETT withdrawal to a pre-determined depth.


Assuntos
Tecnologia de Fibra Óptica , Intubação Intratraqueal/métodos , Traqueotomia/instrumentação , Idoso , Estado Terminal , Feminino , Tecnologia de Fibra Óptica/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Traqueotomia/métodos , Resultado do Tratamento
10.
Otolaryngol Head Neck Surg ; 156(5): 966-968, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28457216

RESUMO

The objective of this study was to investigate a new technique for tracheal puncture during percutaneous dilatational tracheotomy (PDT). A new invention, known as SafeTrach, was used: this instrument allows exact localization of the puncture site with built-in protection of the posterior tracheal wall. Surgery was performed on 17 patients with this technique, and our experience is described in this report. The results showed that this new technique minimizes known risk factors compared with existing PDT techniques, including patients with disadvantageous anatomy.


Assuntos
Dilatação/instrumentação , Punções/instrumentação , Traqueotomia/métodos , Adulto , Estudos de Coortes , Desenho de Equipamento , Segurança de Equipamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade , Traqueostomia/instrumentação , Traqueostomia/métodos , Traqueotomia/instrumentação
11.
Laryngoscope ; 127(9): 1996-2001, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28480522

RESUMO

OBJECTIVES/HYPOTHESIS: Tracheotomy is a common procedure. A reliable method of securing the tracheotomy tube is essential to minimize accidental decannulation. However, skin breakdown has been reported in ∼30% of patients. We sought to evaluate rates of skin-related complications and accidental decannulation with the use of Velcro ties compared to twill ties. STUDY DESIGN: A nonblinded, randomized controlled trial comparing Velcro versus twill ties in patients undergoing tracheotomy between July 1, 2014 and January 31, 2016. METHODS: Patients ≤21 years of age were recruited and randomized to receive either Velcro or twill ties. The primary outcome measure was skin-related complications. The secondary outcome measure was accidental decannulation. Outcome measures were followed through postoperative day 5. RESULTS: Ninety-three patients were eligible, and 63 were enrolled. No patients were withdrawn. Fifty-seven patients were included in the analysis. Twenty-seven (47.4%) received Velcro, and 30 (52.6%) received twill. Five enrolled patients did not undergo tracheotomy (one Velcro, four twill). One was diagnosed with a genetic skin condition after enrollment but prior to undergoing tracheotomy. Patient characteristics were similar between groups. No significant differences were found with respect to skin-related complications (P = .59). Six patients (20%) with twill ties required early tie change compared to two (7.4%) with Velcro ties (P = .5). Two accidental decannulations occurred in the twill group compared to one in the Velcro group (P = 1.0). CONCLUSIONS: Our study demonstrated no differences in skin-related complications or accidental decannulation between Velcro and twill tracheotomy ties in the immediate postoperative period following tracheotomy. Our study suggests that Velcro ties are a viable alternative to twill ties. LEVEL OF EVIDENCE: 1b Laryngoscope, 127:1996-2001, 2017.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Cateterismo/instrumentação , Desenho de Equipamento/efeitos adversos , Dispositivos de Fixação Cirúrgica/efeitos adversos , Traqueotomia/instrumentação , Cateterismo/efeitos adversos , Cateterismo/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Dermatopatias/etiologia , Dermatopatias/prevenção & controle , Traqueotomia/efeitos adversos , Traqueotomia/métodos , Resultado do Tratamento
12.
Biomed Res Int ; 2017: 4215159, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29359151

RESUMO

Objectives: Cricothyrotomy is a rescue procedure in "cannot intubate, cannot oxygenate" scenarios where other methods of nonsurgical airway management have failed. We compared 2 cuffed cricothyrotomy sets, bougie-assisted cricothyrotomy (BACT) and novel percutaneous TracheoQuick Plus, on a live porcine model in a simulated periarrest situation. Methods: Thirty-four anesthetized minipigs were randomly allocated into two groups: BACT technique (n = 17) and TracheoQuick Plus (n = 17). The primary outcome was duration of cricothyrotomy while secondary outcomes were total success rate, number of attempts, location of incision, changes in heart rate, oxygen saturation, and the incidence of complications. Results: BACT was significantly faster than TracheoQuick Plus cricothyrotomy, with a median time of 69 sec (IQR 56-85) versus 178 sec (IQR 152-272). The total success rate was without difference. 94% of BACT was performed successfully on the first attempt, while in the TracheoQuick Plus group, it was only 18% (P < 0.001). Trauma to the posterior tracheal wall was observed once in the BACT group and 5 times in the TracheoQuick Plus group. Oxygen saturation was significantly higher in the BACT group both during and after the procedure. Conclusions: BACT is superior to TracheoQuick Plus cricothyrotomy on a live animal model.


Assuntos
Cartilagem Cricoide/cirurgia , Intubação Intratraqueal , Traqueotomia , Animais , Frequência Cardíaca/fisiologia , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/instrumentação , Intubação Intratraqueal/métodos , Intubação Intratraqueal/estatística & dados numéricos , Modelos Animais , Oxigênio/sangue , Distribuição Aleatória , Suínos , Porco Miniatura , Fatores de Tempo , Traqueotomia/efeitos adversos , Traqueotomia/instrumentação , Traqueotomia/métodos , Traqueotomia/estatística & dados numéricos
13.
Rev. patol. respir ; 19(2): 44-47, abr.-jun. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-154395

RESUMO

Introducción: La traqueotomía como procedimiento para asegurar la vía aérea, se puede realizar de dos formas; mediante cirugía abierta, llamada también traqueotomía estándar. Y de forma percutánea, con el método de Seldinger, popularizado por Ciaglia. Se plantea un análisis descriptivo de una serie de pacientes a los que se les realizó traqueotomía abierta a pie de cama por un servicio de cirugía torácica, en los que se desestimó la técnica percutánea por el equipo medico de cuidados intensivos. Metodología: Se trata de un estudio descriptivo y retrospectivo, de todas las traqueotomías abiertas a pie de cama realizadas por el servicio de Cirugía torácica en las diferentes unidades de cuidados intensivos de un Hospital de tercer nivel, entre junio de 2009 y diciembre de 2013. Los criterios de inclusión para este estudio, fueron todos los pacientes que requerían una traqueotomía en la unidad de reanimación (en esta unidad no se realizan traqueotomías percutáneas) y todos aquellos pacientes que por cualquier tipo de anormalidades; anatómicas y/o funcionales, fueron desestimados para la realización de la traqueotomía percutánea por parte del personal medico de la UCI. Resultados: En total se realizaron 166 traqueotomías abiertas durante el periodo de estudio, de ellas se excluyeron 10 por ser realizadas en quirófano o de forma percutánea. Se realizaron 156 traqueotomías a pie de cama, a 94 varones y 62 mujeres con una edad media de 60,15 años (rango 16-84). La principal indicación para el procedimiento fue la intubación orotraqueal prolongada por dificultad para el destete en pacientes con cirugía cardiaca y pulmonar, seguido del distrés respiratorio en 29 casos. La contraindicación más frecuente para realizar el procedimiento por la vía percutánea fueron las alteraciones de la coagulación en 60 casos, seguida de la dificultad para extender el cuello en 26 casos. No existía contraindicación para realizar el procedimiento de manera percutánea en 26 casos. La principal complicación del procedimiento fue el sangrado en 8 casos, que se solucionó durante el procedimiento y que no requirieron transfusiones. Conclusión: La traqueotomía abierta a pie de cama puede ser realizada de forma segura en todos los pacientes, independientemente de las desventajas anatómicas o funcionales del paciente


Introduction: As an airway stabilizing surgical procedure, tracheotomy can be performed in two ways, by an open surgery as a standard tracheotomy, and by a percutaneous method using the Seldinger technique, popularized by Ciaglia. This paper expose a descriptive analysis of a patient series dismissed for a percutaneous tracheotomy by Intensive Care Unit (ICU) specialists, and then operated by thoracic surgeons with a bedside open tracheotomy. Methods: Descriptive retrospective study of all bedside open tracheotomy performed by the Thoracic Surgery Department in a tertiary Hospital, between June 2009 and December 2013. Inclusion criteria were: 1) patients with a bedside open tracheotomy done in the Post Anesthesia Care Unit (PACU), where no percutaneous tracheotomies are usually performed in this Hospital, and 2) patients who for any anatomic or functional reasons were dismissed for a percutaneous procedure by ICU specialists, and in consequence a bedside open tracheotomy was performed by thoracic surgeons. Results: In the period of the study, a total number of 166 open tracheotomies were performed, and 10 of these were done in a operating room (OR) or percutaneously; these were excluded. A total of 156 bedside open tracheotomies were performed, 94 patients were male and 62 female, with a media age of 60.15 years (range 16-84 years old). Principal indication for the procedure was a prolonged orotracheal intubation due to a difficult weaning, 29 of them due to respiratory distress syndrome. Principal contraindication of the percutaneous procedure were coagulopathies in 60 cases, followed by difficulties in spine extensión in 26 cases. There were no absolute contraindications for the percutaneous tracheotomy in 26 cases. The most frequent complication of the open bedside tracheotomy was bleeding in 8 cases, but it was resolved during the procedure and did not required blood transfusion in any case. Conclusion: Open bedside tracheotomy can be a safe and secure procedure in all patients, nevertheless the tracheal and spine anatomic or functional characteristics of the patient


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Traqueotomia/instrumentação , Traqueotomia/métodos , Traqueotomia/tendências , Procedimentos Cirúrgicos Torácicos/métodos , Intubação Intratraqueal/métodos , Hemorragia/complicações , Estudos Retrospectivos , Cirurgia Torácica/métodos , Cirurgia Torácica/organização & administração , Complicações Intraoperatórias/diagnóstico , Traqueotomia
14.
Pediatr Pulmonol ; 51(8): 838-49, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26934657

RESUMO

BACKGROUND: The prevalence of children requiring outpatient invasive long-term mechanical ventilation is increasing. For some children, liberation from home mechanical ventilation (HMV) and decannulation is the desired outcome. This study describes our experience liberating tracheostomy and HMV (T-HMV) dependent children from respiratory technologies. METHODS: We reviewed charts of T-HMV dependent children who were cared for at our institution and decannulated between July 1999 and December 2011. Patient characteristics, diagnoses, and important steps leading to decannulation were recorded. RESULTS: Forty-six children achieved HMV independence and decannulation. The most common indications for T-HMV were lower airway and parenchymal lung disease. The median ages at tracheotomy, initiation of HMV, initiation of tracheostomy collar (TC) trials, HMV independence, and decannulation were 3.5, 6.0, 12.0, 25.5, and 40.5 months, respectively. Twenty-five children (54%) skipped either using a speaking valve, tracheostomy capping, or both without increased likelihood of recannulation. (P = 0.03). Common procedures prior to decannulation were airway surgery, bronchoscopy, and polysomnography (n = 30, 46, and 46 children, respectively). A median of 9.5 clinic visits and 5 hospitalizations occurred from initial hospital discharge to just prior to decannulation. HMV was primarily weaned as an outpatient. CONCLUSION: Liberation from respiratory technology is a complex, multi-step process that can be accomplished in medically complex children with varying underlying disease processes at relatively young ages. Five major steps (tracheotomy, initiation of HMV, initiation of TC trials, HMV independence, and decannulation) performed in conjunction with clinic visits, procedures, and home nursing support were integral in the successful decannulation process. Pediatr Pulmonol. 2016;51:838-849. © 2016 Wiley Periodicals, Inc.


Assuntos
Remoção de Dispositivo , Traqueostomia/instrumentação , Traqueotomia/instrumentação , Desmame do Respirador , Assistência Ambulatorial , Broncoscopia , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Pneumopatias/terapia , Masculino , Polissonografia , Estudos Retrospectivos
15.
Acta Otolaryngol ; 136(6): 598-605, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26902954

RESUMO

Conclusion SafeTrach is a new simplified and safe technique to perform percutaneous dilatational tracheotomy (PDT) that eliminates known risk factors compared with existing percutaneous techniques. In the present clinical study, also patients with disadvantageous anatomy not suitable for conventional PDT (CPDT) were treated without complications using SafeTrach. PDT with SafeTrach (STPDT) offers an excellent solution for patients who need tracheotomy in connection with elective ear, nose, and throat (ENT) surgery. Objectives To assess a new technique for percutaneous tracheotomy. Methods Seventeen patients were tracheotomized with STPDT using SafeTrach for the initial penetration sequence and single step dilatational techniques for the dilatational sequence. The patients represented a variety of different neck anatomies. Fifteen patients were head- and neck cancer patients that were subjects of free flap transplants. Results This study showed that STPDT was safe and easy to perform and time-efficient. The median duration of the procedure was 11.5 min and the puncture was in all cases located in the midline of the trachea either between the 2nd and 3rd tracheal ring (n = 13) or between the 3rd and 4th ring (n = 4).


Assuntos
Traqueotomia/instrumentação , Traqueotomia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traqueotomia/economia , Traqueotomia/estatística & dados numéricos , Adulto Jovem
16.
An. pediatr. (2003. Ed. impr.) ; 84(1): 18-23, ene. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-147625

RESUMO

Introducción: La traqueotomía es un procedimiento poco frecuente en la Unidad de cuidados intensivos pediátricos (UCIP). Analizamos las complicaciones derivadas de la técnica, la mortalidad atribuible a la misma y la mortalidad global de los pacientes traqueotomizados. Pacientes y métodos: Estudio retrospectivo descriptivo durante el periodo comprendido entre enero del 2003 y diciembre del 2013 de los pacientes ingresados en la UCIP a los que se realiza una traqueotomía a lo largo de su ingreso. Resultados: Durante el periodo analizado se recoge a 25 pacientes. La media de edad es de 31,3 meses (rango 1-144, mediana 14 meses) y la media de estancia en UCIP es de 53 días (rango 1-338 días, mediana 37 días). En su mayoría (68%) son pacientes con comorbilidades previas a su ingreso, destacando en frecuencia las anomalías craneofaciales/síndromes polimalformativos (32%) y problemas asociados a la prematuridad (12%). Las patologías más frecuentes que motivaron la realización del procedimiento fueron la obstrucción congénita de la vía aérea y diversas causas de lesión medular, seguido de traqueobroncomalacia y estenosis subglótica. Se detectaron complicaciones en el 40% de los pacientes, siendo la más frecuente la decanulación accidental. Presentaron durante el curso evolutivo una decanulación accidental el 20% de los pacientes, principalmente en las primeras 24 h del postoperatorio, motivo por el que falleció uno de los pacientes. Conclusiones: La realización de la traqueotomía es un procedimiento poco frecuente en la UCIP, aunque no exento de complicaciones, algunas de ellas de riesgo vital (AU)


Introduction: Tracheotomy in pediatric patients is a rare procedure. In this pediatric series, perioperative complications, mortality related to surgical procedure and overall mortality are analyzed. Patients and methods: This is a retrospective study conducted from January 2003 to December 2013. Data were retrieved from patients who were tracheotomized and admitted to our PICU in the postoperative period. Results: Data were collected from 25 tracheotomized patients admitted during the study period. The mean age was 3.3 months (median 14 months, range 1-144 months), and PICU length of stay was 53 days (median 37 days, range 1-338 days). Most patients (68%) had comorbidities before their admission, with a higher prevalene of craniofacial anomalies/polymalformative syndromes (32%) and prematurity related disorders (12%) being obserevd. The most common etiologies related to the procedure were congenital airway obstruction (16%) and several types of spinal cord injury (16%), followed by tracheobronchomalacia (12%) and subglottic stenosis (12%). Some kind of complication was detected in 40% of patients, with accidental decannulation being the most frequent. Accidental or unexpected decannulation was present in a percentage as high as 20% of our patients, mainly in the first 24hours after surgery. One of the patients died as a result of this. Conclusions: The postoperative course of a tracheotomy is associated with a high rate of complications, some of them related to life-threatening events (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Traqueotomia/efeitos adversos , Traqueotomia/métodos , Traqueotomia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Unidades de Terapia Intensiva Pediátrica/organização & administração , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Unidades de Terapia Intensiva Pediátrica , Traqueotomia/instrumentação , Traqueotomia/mortalidade , Comorbidade , Estudos Retrospectivos
17.
Laryngorhinootologie ; 95(1): 29-36, 2016 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-26458036

RESUMO

OBJECTIVE: The pre- and postoperative airway management during surgery of head and neck cancer is a clinically relevant and challenging task. Usually an epithelialised tracheostomy is used. The significance of percutaneous dilatational tracheostomy (PDT) in combination with tumour surgery of the head neck area has not yet been fully considered. MATERIAL AND METHODS: Within a surgical therapy of head neck tumours, 58 patients were treated with a PDT by Ciaglia or Fantoni at the Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle during the period from December 2002 to October 2007. The patient data were retrospective analyzed in a pseudonymous way. In a follow-up examination the resulting conditions of the PDT were reviewed. RESULTS: The median of the length of time till decannulation was 12 days. There were no documented disorders or complications after PDT at 25 patients (43%). As serious complications pneumothorax in 2 patients (3,4%), 9 bleedings (15,5%) and 1 infection (1,7%) were recorded. After occurrence of tracheostomy metastases in 2 patients with tracheostomy by Fantoni, this method was no longer used. For the subsequent follow-up examination 33 patients were included. No tracheal stenosis or serious long term complications were determined. CONCLUSIONS: Under consideration of the indications and contraindications, the percutaneous dilatational tracheostomy by Ciaglia with associated bronchoscopy is a safe method with low complication rate for the airway management of patients with head neck cancer. Long term complications and disorders after PDT are not to be expected. Tracheotomy according to Fantoni cannot be recommended for this treatment.


Assuntos
Manuseio das Vias Aéreas/métodos , Dilatação/métodos , Neoplasias Otorrinolaringológicas/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Traqueotomia/métodos , Manuseio das Vias Aéreas/instrumentação , Terapia Combinada , Dilatação/instrumentação , Seguimentos , Humanos , Inoculação de Neoplasia , Procedimentos Cirúrgicos Otorrinolaringológicos/instrumentação , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Traqueotomia/instrumentação
18.
J Oral Maxillofac Surg ; 74(3): 556-61, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26657394

RESUMO

PURPOSE: To validate the surgical time and propose a new checklist or algorithm to execute a tracheotomy within 12 minutes with optimal outcomes. MATERIALS AND METHODS: The authors designed and implemented a checklist method for tracheotomy based on 6 consecutive patients with respiratory failure and prolonged intubation in a medical intensive care unit. The primary outcome variable was surgical time for a tracheotomy performed by a fifth- or sixth-year resident under the supervision of the senior author (M.Z.). RESULTS: Six consecutive patients undergoing tracheotomy (mean, 48 yr; range, 24 to 55 yr; 4 men and 2 women) were included in the study. The average time recorded from the incision to correct insertion of the tracheotomy tube and confirmation of carbon dioxide return by the anesthesiologist was 10.66 minutes (range, 8 to 12 minutes). CONCLUSION: This checklist facilitates the execution of a time-efficient and safe tracheotomy in less than 12 minutes.


Assuntos
Lista de Checagem , Traqueotomia/métodos , Adulto , Algoritmos , Pontos de Referência Anatômicos/anatomia & histologia , Cartilagem Cricoide/anatomia & histologia , Cuidados Críticos , Dissecação/métodos , Eletrocirurgia/instrumentação , Feminino , Humanos , Intubação Intratraqueal/instrumentação , Masculino , Pessoa de Meia-Idade , Músculos do Pescoço/cirurgia , Duração da Cirurgia , Posicionamento do Paciente , Melhoria de Qualidade , Insuficiência Respiratória/cirurgia , Insuficiência Respiratória/terapia , Segurança , Esterno/anatomia & histologia , Gordura Subcutânea/cirurgia , Fatores de Tempo , Traqueotomia/instrumentação , Resultado do Tratamento , Adulto Jovem
19.
J Commun Disord ; 56: 40-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26176711

RESUMO

OBJECTIVE: To investigate physiologic parameters, voice production abilities, and functional verbal communication ratings of the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves. STUDY DESIGN: Case series with planned data collection. SETTING: Large, urban, tertiary care teaching hospital. SUBJECTS AND METHODS: Referred sample of 30 consecutively enrolled adults requiring a tracheotomy tube and tested with Blom and Passy-Muir valves. Physiologic parameters recorded were oxygen saturation, respiration rate, and heart rate. Voice production abilities included maximum voice intensity in relation to ambient room noise and maximum phonation duration of the vowel/a/. Functional verbal communication was determined from randomized and blinded listener ratings of counting 1-10, saying the days of the week, and reading aloud the sentence, "There is according to legend a boiling pot of gold at one end." RESULTS: There were no significant differences (p>0.05) between the Blom and Passy-Muir valves for the physiologic parameters of oxygen saturation, respiration rate, and heart rate; voice production abilities of both maximum intensity and duration of/a/; and functional verbal communication ratings. Both valves allowed for significantly greater maximum voice intensity over ambient room noise (p<0.001). CONCLUSIONS: The Blom low profile voice inner cannula and Passy-Muir one-way speaking valves exhibited equipoise regarding patient physiologic parameters, voice production abilities, and functional verbal communication ratings. LEARNING OUTCOMES: Readers will understand the importance of verbal communication for patients who require a tracheotomy tube; will be able to determine the differences between the Blom low profile voice inner cannula and Passy-Muir one-way tracheotomy tube speaking valves; and will be confident in knowing that both the Blom and Passy-Muir one-way tracheotomy tube speaking valves are equivalent regarding physiological functioning and speech production abilities.


Assuntos
Voz Alaríngea , Traqueotomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comunicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inteligibilidade da Fala , Voz Alaríngea/instrumentação , Voz Alaríngea/métodos , Traqueotomia/instrumentação , Traqueotomia/métodos
20.
Am J Emerg Med ; 33(5): 708-12, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25791154

RESUMO

BACKGROUND: Needle-based cricothyrotomy is a common procedure for emergency department patients requiring an emergent surgical airway. Percutaneous transtracheal jet ventilation is well studied to provide oxygenation. We propose to combine these procedures into a novel, single, and sequential procedure. METHODS: This study was a prospective manikin/human cadaver procedural feasibility study performed at a medical education center. Forty-eight emergency medicine attending physicians and fellows performed the procedure on a single TraumaMan (Simulab Corporation, Seattle, WA), and 26 were randomly selected to perform the procedure on fresh, unfixed human cadavers. The procedure is as follows: 15 gauge/6F catheter-over-needle punctures cricothyroid membrane, needle is removed, and Enk oxygen flow modulator is attached to the catheter (start to oxygenation). The Enk set is detached, a guide wire introduced, and Seldinger cricothyrotomy is performed (oxygenation to cricothyrotomy). Start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times were recorded. Manikin procedures were verified by direct visualization, and cadaver procedures were verified by video laryngoscopy. RESULTS: All attempts were included in data analysis, and there was a 100% first-pass success rate. For the manikin trials, median start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times with interquartile ranges were 11 (8.5-13), 48 (42-57), and 59 (53-69) seconds, respectively. For the cadaver trials, median start-to-oxygenation, oxygenation-to-cricothyrotomy, and start-to-cricothyrotomy times with interquartile ranges were 12 (10-15), 59 (47-76), and 71 (61-94) seconds, respectively. Student t tests showed significant differences in start-to-oxygenation and oxygenation-to-cricothyrotomy times (P < .01) within the manikin and cadaver groups. CONCLUSION: Percutaneous transtracheal jet ventilation and needle-based Seldinger cricothyrotomy can be performed by emergency medicine physicians, and a single, sequential procedure may significantly reduce time to oxygenation for patients already undergoing surgical cricothyrotomy.


Assuntos
Cartilagem Cricoide/cirurgia , Medicina de Emergência/instrumentação , Oxigênio/administração & dosagem , Traqueotomia/instrumentação , Cadáver , Estudos de Viabilidade , Humanos , Manequins , Agulhas , Punções
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