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The effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation:A randomized,physiological,crossover study

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Journal of Intensive Medicine 2024年第2期4卷 202-208页

作者： Elena Lytra Stelios Kokkoris Ioannis Poularas Dimitrios Filippiadis Demosthenes Cokkinos Dimitrios Exarhos Spyros Zakynthinos Christina Routsi 1st Department of Intensive Care Medical SchoolNational and Kapodistrian University of AthensEvangelismos HospitalAthensGreece Radiology Department Evangelismos HospitalAthensGreece 2nd Radiology Department Medical SchoolNational and Kapodistrian University of AthensAttikon HospitalAthensGreece

Background Compared to conventional oxygen devices,high-flow oxygen treatment(HFOT)through the nasal cannulae has demonstrated clinical benefits.Limited data exist on whether such effects are also present in HFOT through tracheostomy.Hence,we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical ventilation.Methods A randomized,crossover,physiological study was conducted in our ICU between December 2020 and April 2021,in patients with tracheostomy and prolonged mechanical ventilation.The patients underwent a 30-min spontaneous breathing trial(SBT)and received oxygen either via T-piece or by HFOT through tracheostomy,followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover manner.At the start and end of each session,blood gasses,breathing frequency(f),and tidal volume(VT)via a Wright's spirometer were measured,along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction,which expressed the inspiratory muscle effort.Results Eleven patients were enrolled in whom 19 sessions were uneventfully completed;eight patients were studied twice on two different days with alternate sessions;and three patients were studied once.Patients were randomly assigned to start the SBT with a T-piece(n=10 sessions)or with HFOT(n=9 sessions).With HFOT,VT and minute ventilation(VE)significantly increased during SBT(from[465±119]mL to[549±134]mL,P<0.001 and from[12.4±4.3]L/min to[13.1±4.2]L/min,P<0.05,respectively),but they did not change significantly during SBT with T-piece(from[495±132]mL to[461±123]mL and from[12.8±4.4]mL to[12.0±4.4]mL,respectively);f/VT decreased during HFOT(from[64±31]breaths/(min∙L)to[49±24]breaths/(min∙L),P<0.001),but it did not change significantly during SBT with T-piece(from[59±28]breaths/(min∙L)to[64±33]breaths/(min∙L));partial pressure of arterial oxygen incre

关键词： Diaphragm Diaphragm ultrasonography High-flow 0Xygen Prolonged mechanical ventilation tracheostomy

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World Journal of Methodology 2024年第2期14卷 75-87页

作者： Maria Papaioannou Evdoxia Vagiana Serafeim-Chrysovalantis Kotoulas Maria Sileli Katerina Manika Alexandros Tsantos Nikolaos Kapravelos 1^(st)Intensive Care Unit G Papanikolaou General HospitalExohiThessaloniki 57010Greece 2^(nd)Intensive Care Unit G Papanikolaou General HospitalExohiThessaloniki 57010Greece Intensive Care Unit Hippokration General HospitalThessaloniki 54642Greece Department of Pulmonary Medical SchoolAristotle University of ThessalonikiG.Papanikolaou General HospitalExohiThessaloniki 57010Greece 2^(nd)Department of Internal Medicine General Hospital of Thessaloniki“Ippokration”Thessaloniki 54642Greece

BACKGROUND tracheostomy is commonly used in intensive care unit(ICU)patients who are expected to be on long-term mechanical ventilation or suffer from emergency upper airway obstruction.However,some studies have conflicting findings regarding the optimal technique and its timing and benefits.AIM To provide evidence of practice,characteristics,and outcome concerning tracheostomy in an ICU of a tertiary care hospital.METHODS This was a retrospective cohort study including adult critical care patients in a single ICU for two consecutive years.Patients’demographic characteristics,severity of illness(APACHE II score),level of consciousness[Glasgow Coma Scale(GCS)],comorbidities,timing and type of tracheostomy procedure performed and outcome were recorded.We defined late as tracheostomy placement after 8 days or no tracheotomy.RESULTS Data of 660 patients were analyzed(median age of 60 years),median APACHE II score of 19 and median GCS score of 12 at admission.tracheostomy was performed in 115 patients,of whom 63 had early and 52 late procedures.Early tracheostomy was mainly executed in case of altered level of consciousness and severe critical illness polyneuromyopathy,however there were no significant statistical results(47.6%vs 36.5%,P=0.23)and(23.8%vs 19.2%,P=0.55)respectively.Regarding the method selected,early surgical tracheostomy(ST)was conducted in patients with maxillofacial injuries(50.0%vs 0.0%,P=0.033),whereas late surgical tracheostomy was selected for patients with goiter(44.4%vs 0.0%P=0.033).Patients with early tracheostomy spent significantly fewer days on mechanical ventilation(15.3±8.5 vs 22.8±9.6,Ptracheostomy(PDT)vs ST was preferable in older critical care patients in the case of Central Nervous System underlying cause of admission(62.5%vs 26.3%,P=0.004).ST was the method of choice in compromised airway(31.6%,vs 7.3%P=0.008).A large proportion of patients(88/115)with tracheostomy managed to wean from mechanical vent

关键词： tracheostomy Early tracheostomy Late tracheostomy Percutaneous dilatation tracheostomy Surgical tracheostomy Weaning Survival Mechanical ventilation

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tracheostomy and venovenous extracorporeal membrane oxygenation for difficult airway patient with carinal melanoma:A case report and literature review

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World Journal of Clinical Cases 2022年第35期10卷 13088-13098页

作者： I-Liang Liu An-Hsun Chou Chien-Hung Chiu Yu-Ting Cheng Huan-Tang Lin Department of Anesthesiology Chang Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan College of Medicine Chang Gung UniversityTaoyuan 333Taiwan Division of Thoracic and Cardiovascular Surgery Department of SurgeryChang Gung Memorial HospitalLinkou Medical CenterTaoyuan 333Taiwan Graduate Institute of Clinical Medical Sciences Chang Gung UniversityTaoyuan 333Taiwan

BACKGROUND Anesthesia for tracheal tumor resection is challenging,particularly in patients with a difficult upper airway.We report a case of a difficult upper airway with a metastatic tracheal tumor causing near-total left bronchial obstruction and requiring emergency tracheostomy and venovenous extracorporeal membrane oxygenation(VV-ECMO)support for rigid bronchoscopy-assisted tumor resection.CASE SUMMARY A 41-year-old man with a history of right retromolar melanoma treated by tumor excision and myocutaneous flap reconstruction developed progressive dyspnea on exertion and syncope episodes.Chest computed tomography revealed a 3.0-cm tracheal mass at the carinal level,causing 90%tracheal lumen obstruction.Flexible bronchoscopy revealed a pigmented tracheal mass at the carinal level causing critical carinal obstruction.Because of aggravated symptoms,emergency rigid bronchoscopy for tumor resection and tracheal stenting were planned with standby VV-ECMO.Due to limited mouth opening,tracheostomy was necessary for rigid bronchoscopy access.While transferring the patient to the operating table,sudden desaturation occurred and awake fiberoptic nasotracheal intubation was performed for ventilation support.Femoral and internal jugular vein were catheterized to facilitate possible VV-ECMO deployment.During tracheostomy,progressive desaturation developed and VV-ECMO was instituted immediately.After tumor resection and tracheal stenting,VV-ECMO was weaned smoothly,and the patient was sent for intensive postoperative care.Two days later,he was transferred to the ward for palliative immunotherapy and subsequently discharged uneventfully.CONCLUSION In a difficult airway patient with severe airway obstruction,emergency tracheostomy for rigid bronchoscopy access and standby VV-ECMO can be life-saving,and ECMO can be weaned smoothly after tumor excision.During anesthesia for patients with tracheal tumors causing critical airway obstruction,spontaneous ventilation should be maintained at least initially,and ECMO deployment should

关键词： tracheostomy Extracorporeal membrane oxygenation Tracheal tumor Melanoma Case report

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tracheostomy manipulations: Impact on tracheostomy safety

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Pediatric Investigation 2019年第3期3卷 141-145页

作者： Alexandra G Espinel Kelly Scriven Rahul K Shah Division of Otolaryngology Children's National Medical CenterWashington DCUSA

Importance: Tracheotomy is one of the riskiest procedures for composite morbidity within pediatric otolaryngology. During the postoperative period, each time the tracheostomy tube is manipulated, there is opportunity for morbidity (e.g. a patient is vulnerable to accidental decannulation and airway loss). Objective: To identify areas of improvement in caring for 'fresh tracheostomy' patients by determining the number of times a tracheostomy tube is manipulated from placement until discharge. The hypothesis is that the more a tracheostomy is manipulated, the higher probability of morbidity. Methods: A quality improvement initiative was conducted to map the care of patients who underwent tracheostomy placement over 12 months. tracheostomy care and manipulation by all providers were reviewed. Complications, wound care, and respiratory treatments were also evaluated. Results: Patients were hospitalized for an average of 39 days (7–140) following tracheostomy. The first tracheostomy tube change occurred on average 6 days (5–10) following placement. tracheostomy tubes were manipulated an average of 6 (2.5–11.9) times a day to amount to 216 (51–1091) times between placement and discharge. Bedside nurses and respiratory therapists were responsible for 95% of these actions;physicians accounted for 4%. There were 6 tracheostomy related complications. Three were accidental decannulations resulting in cardiopulmonary arrest. One of these caused long term patient morbidity. Patients with more than 4 manipulations per day during the 2 weeks following tracheostomy tube placement, were more likely to have a tracheostomy related complication than those with less than 4 (OR: 12.5;95% CI: 1.2–130.6;P = 0.0349). Interpretation: While uncommon, complications related to tracheostomy can have serious long term effects and at best prolongs length of stay for patients. Reducing the number of tracheostomy manipulations may provide safer postoperative care ultimately reducing morbidity and potentially mortality;children on average have 6 t

关键词： Complications Management Pediatric tracheostomy Safety

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Clinical characteristics of COVID-19 patients who underwent tracheostomy and its effect on outcome:A retrospective observational study

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World Journal of Virology 2022年第6期11卷 477-484页

作者： Yudhyavir Singh Kapil Dev Soni Abhishek Singh Nikita Choudhary Fahina Perveen Richa Aggarwal Nishant Patel Shailendra Kumar Anjan Trikha Department of Anesthesiology Pain Medicine and Critical CareAll India Institute of Medical SciencesNew Delhi 110029India Department of Critical and Intensive Care Jai Prakash Narayan Apex Trauma CenterAll India Institute of Medical SciencesNew Delhi 110029India Department of Anesthesia All India Institute of Medical SciencesNew Delhi 110029India

BACKGROUND The exponential rise in Coronavirus disease 2019(COVID-19)cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy.With the limited availability of literature regarding the outcomes of COVID-19 patients with tracheostomy,we attempted to study the clinical characteristics and multiple parameters affecting the outcomes in these patients.AIM To determine all-cause mortality following tracheostomy and its association with various risk factors in COVID-19 patients.METHODS This retrospective study included 73 adult COVID-19 patients admitted to the ICU between 1 April,2020 and 30 September,2021 who underwent tracheostomy as a result of acute respiratory failure due to COVID-19.The data collected included demographics(age,sex),comorbidities,type of oxygen support at admission,severity of COVID-19,complications,and other parameters such as admission to tracheostomy,intubation to tracheostomy,ICU stay,hospital stay,and outcome.RESULTS This study included 73 adult patients with an average age of 52±16.67 years,of which 52%were men.The average time for admission to tracheostomy was 18.12±12.98 days while intubation to tracheostomy was 11.97±9 days.The mortality rate was 71.2%and 28.8%of patients were discharged alive.The mean duration of ICU and hospital stay was 25±11 days and 28.21±11.60 days,respectively.Greater age,severe COVID-19,mechanical ventilation,shock and acute kidney injury were associated with poor prognosis;however,early tracheostomy in intubated patients resulted in better outcomes.CONCLUSION Patients with severe COVID-19 requiring mechanical ventilation have a poor prognosis but patients with early tracheostomy may benefit with no added risk.We recommend that the timing of tracheostomy be decided on a case-by-case basis and a well-designed randomised controlled trial should be performed to elucidate the potential benefit of early tracheostomy in such patients.

关键词： COVID-19 Intubation Mechanical ventilation ICU tracheostomy Oxygen therapy

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Can tracheostomy Improve Outcome and Lower Resource Utilization for Patients with Prolonged Mechanical Ventilation？

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Chinese Medical Journal 2015年第19期128卷 2609-2616页

作者： Ciou-Rong Yuan Tzuo-Yun Lan Gau-Jun Tang Department of Nursing Taipei Veterans General HospitalTaipeiTaiwanChina Institute of Hospital and Health Care Administration National Yang-Ming UniversityTaipeiTaiwanChina Institute of Hospital and Health Care AdministrationNational Yang-Ming UniversityTaipeiTaiwanChina Department of Surgery National Yang-Ming University HospitalIlanTaiwanChina

Background：It is not clear whether the benefits oftracheostomy remain the same in the population.This study aimed to better examine the effect of tracheostomy on clinical outcome among prolonged ventilator patients.Methods：Data were from the medical claims data in Taiwan.A total of 3880 patients with ventilator use for more than 14 days between 2005 and 2009 were identified.Among them,645 patients with tracheostomy conducted within 30 days of ventilator use were compared to 2715 patients without tracheostomy on death during hospitalization and study period,and successful weaning and medical utilization during hospitalization.Cox proportional hazards and linear regression models were used to examine the associations between tracheostomy and the main outcomes.Results：The tracheostomy rate was 30％,and 55％ of tracheostomies were performed within 30 days of mechanical ventilation.After adjustments,patients with tracheostomy were at a lower risk of death during hospitalization （hazard ratio [HR] =0.51;95％ confidence interval [CI] =0.43-0.61） and 5-year observation （HR =0.73;95％ CI =0.66-0.81）,and a lower probability of successful weaning （HR =0.88;95％ CI =0.79-0.99）.Higher medical use was also observed in patients with tracheostomy.Conclusions：The beneficial effect for tracheostomy observed in our data was the reduction of death.However,patients with tracheostomy were less likely to wean and more likely to consume medical resources.

关键词： Mechanical Ventilation Medical Utilization Mortality tracheostomy Weaning

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tracheostomy colonisation and microbiological isolates of patients in intensive care units-a retrospective study

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2020年第1期6卷 49-52页

作者： Segana Hasan Abdul Cader Fahim Ahmed Shah S.K.G.Reghunandanan Nair Department of ENT Sur HospitalSouth Sharqiya RegionSurSultanate of Oman

Objective: To find out the type of bacteria colonising the tracheostomy tube and to determine the antibiotic sensitivity pattern and resistance in patients who have had tracheostomy in intensive care unit (ICU) set up and to initiate proper empirical treatment in such patients. Methods: The study was a retrospective review of patients who underwent tracheostomy at Ministry of Health, Sur Hospital, Oman January 2005 and December 2015. The Hospital has 4 bedded pediatric intensive care unit (PICU) and 10 bedded adult ICU which is headed by consultant anaesthetists, consultant physicians, ICU trained nurses and respiratory therapists. All patients who required mechanical ventilation and were therefore subject to an orotracheal intubation and those who underwent a conventional tracheostomy were considered for inclusion. Patients who had been intubated in other hospitals or ICUs, other airways infection issues were excluded from this study. Data’s were collected from computer based hospital management system, operation theatre and registers in Medical records department and entered in a preformed questionnaire before thorough analysis. The specimens for swab was obtained from the cut tracheostomy tube tips and the samples were sent to microbiology laboratory for isolation of the organism and obtain an antibiogram to know the susceptibility and resistance to antibiotics. Data were analyzed by Statistical Package for Social Sciences (SPSS, version 16, Chicago, Inc) and the values are reported as number (%). The commonest isolated organism wasPseudomonas followed byAcinetobacter. Results: During the ten year retrospective study, there were 108 patients included in our study with 56 males and 51 females. Fourteen different microorganisms were isolated during our study which includedPseudomonas aeruginosa (n= 39),Acinetobacter baumanii (n= 28),Klebsiella (n= 10) and coagulase negative staphylococcus (n= 6). The most commonest organisms in both genders wasPseudomonas aeruginosa closely followed byAcinetobacter baumanii. In

关键词： tracheostomy Intubation Antibiogram Antibiotics

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A Fatal Arterio-Tracheal Fistula Post-tracheostomy: A Case Report in a Sub-Saharan Setting

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International Journal of Otolaryngology and Head & Neck Surgery 2022年第5期11卷 277-282页

作者： Yannick Mossus Douglas Banga Nkomo Serge Rowling’s Ngouatna Lutresse Thome Roger Christian Meva’a Biouélé Leonel Christophe Atanga Adèle-Rose Ngo Nyeki David Mindja Eko François Djomou Alexis Ndjolo ENT Surgeon Department of Ophthalmology ENT and Stomatology Faculty of Medicine and Biomedical Sciences of University of Yaoundé Yaoundé Cameroon Thoracic Surgeon Department of Surgery and Specialties Faculty of Medicine and Pharmaceutical Sciences of University of Dschang Dschang Cameroon Anesthesiologist Resuscitator Department of Surgery and Specialties Faculty of Medicine and Biomedical Sciences of University of Yaoundé Yaoundé Cameroon

Fatal bleeding in patients with tracheostomy is an uncommon incident, in the order of 0.1% to 1% of cases. It is secondary in 70% of cases to the innominate artery fistula in the tracheal lumen. The fistula is generally created after the necrosis of tracheal rings. The incriminated factors are the type of cannula used, the site of tracheal opening below the 3rd tracheal ring, tracheal infections and the proximity of the innominate artery to the tracheal axis. The outcome of this incident is fatal in most cases. We report the case of a 59-year-old patient with a tracheostomy on the 11th day of his admission to intensive care for severe head trauma secondary to a road accident. On the 22nd day of his admission, the occurrence of a cataclysmic and fatal haemorrhage through the tracheostomy tube evoked an arterio-tracheal fistula of the innominate artery.

关键词： Arterio-Tracheal Fistula Innominate Artery tracheostomy Sub-Saharan Setting Case Report

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Cervical Spondylodiscitis Revealed by tracheostomy Infected: A Rare Case Report Management and Outcome

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Open Journal of Modern Neurosurgery 2023年第1期13卷 18-24页

作者： José Dimbimakoso Djimrabeye Alngar Moune Michèle Yolande Mustapha Hamama Nizaireel Fatemi Rachid El Maaquil Faculty of Medicine and Pharmacy Université Mohamed V Rabat Morocco Department of Neurosurgery CHU ibnSina Rabat Morocco

Background: Spondylodiscitis is a spinal infection rare affecting primarily the intervertebral disk and the adjacent vertebral bodies. His diagnosis is difficult and often delayed or missed due to the rarity of the disease. Cervical spondylodiscitis has quite rare findings regarding the common location of spinal abscesses in the lumbar and thoracic regions. To obtain the best patient outcomes, these spinal infections require prompt diagnosis and appropriate treatment. Case description: A 44-year-old boy was admitted to the neurosurgery department of our hospital for heaviness in 4 limbs without gait disorders in context infected tracheostomy after staying in intensive care. MRI spine showed a spine deformity with lyse C4C5 epiduritis and spinal cord compressed. Antibiotics intravenous were started for 1 month the patient benefited from a corpectomy with an iliac graft and anterior cervical plate. The anatomopathological examination revealed an inflammation not specific. He was therefore put on antibiotics for 6 weeks. Three months later the neck pain and limb pain resolved after treatment and a complete return of lower extremity strength. Conclusion: Cervical spondylodiscitis has increased and become more aggressive. While radical surgical debridement, stable reconstruction together with antibiotic therapy remained a reliable approach to achieve complete healing of the inflammation, anterior alone surgery became more applicable.

关键词： Cervical Spondylodiscitis Spinal tracheostomy Infection

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Pulmonary complications and respiratory management in neurocritical care:a narrative review

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Chinese Medical Journal 2022年第7期135卷 779-789页

作者： Junxian Wen Jia Chen Jianbo Chang Junji Wei Department of Neurosurgery Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeDongcheng DistrictBeijing 100730China

Neurocritical care(NCC)is not only generally guided by principles of general intensive care,but also directed by specific goals and methods.This review summarizes the common pulmonary diseases and pathophysiology affecting NCC patients and the progress made in strategies of respiratory support in NCC.This review highlights the possible interactions and pathways that have been revealed between neurological injuries and respiratory diseases,including the catecholamine pathway,systemic inflammatory reactions,adrenergic hypersensitivity,and dopaminergic signaling.Pulmonary complications of neurocritical patients include pneumonia,neurological pulmonary edema,and respiratory distress.Specific aspects of respiratory management include prioritizing the protection of the brain,and the goal of respiratory management is to avoid inappropriate blood gas composition levels and intracranial hypertension.Compared with the traditional mode of protective mechanical ventilation with low tidal volume(V_(t)),high positive end-expiratory pressure(PEEP),and recruitment maneuvers,low PEEP might yield a potential benefit in closing and protecting the lung tissue.Multimodal neuromonitoring can ensure the safety of respiratory maneuvers in clinical and scientific practice.Future studies are required to develop guidelines for respiratory management in NCC.

关键词： Neurocritical care Pneumonia Respiratory management Multimodel neuromonitoring tracheostomy Mechanical ventilation Positive end-expiratory pressure

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