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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 *** 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 *** 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 *** computed tomography revealed a 3.0-cm tracheal mass at the carinal level,causing 90%tracheal lumen *** bronchoscopy revealed a pigmented tracheal mass at the carinal level causing critical carinal *** of aggravated symptoms,emergency rigid bronchoscopy for tumor resection and tracheal stenting were planned with standby *** to limited mouth opening,tracheostomy was necessary for rigid bronchoscopy *** transferring the patient to the operating table,sudden desaturation occurred and awake fiberoptic nasotracheal intubation was performed for ventilation *** and internal jugular vein were catheterized to facilitate possible VV-ECMO *** tracheostomy,progressive desaturation developed and VV-ECMO was instituted *** tumor resection and tracheal stenting,VV-ECMO was weaned smoothly,and the patient was sent for intensive postoperative *** days later,he was transferred to the ward for palliative immunotherapy and subsequently discharged *** 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 *** anesthesia for patients with tracheal tumors causing critical airway obstruction,spontaneous ventilation should be maintaine

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

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tracheostomy is associated with decreased in-hospital mortality during severe COVID-19 infection

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世界耳鼻咽喉头颈外科杂志英文版 2024年第4期10卷 253-260页

作者： Alnemri Ahab Ricciardelli Kaley Wang Stephanie Baumgartner Michael Chao Tiffany N. Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA Department of Otorhinolaryngology-Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA

Objective: tracheostomy is often performed in patients with a prolonged course of endotracheal intubation. This study sought to examine the clinical utility of tracheostomy during severe Coronavirus disease 2019 (COVID-19) *** Design: A retrospective single-system, multicenter observational cohort study was performed on patients intubated for COVID-19 infection. Patients who received intubation alone were compared with patients who received intubation and subsequent tracheostomy. Patient demographics, comorbidities, and hospital courses were ***: The University of Pennsylvania Health System from 2020 to ***: Logistic regression analysis was performed on patient demographics and comorbidities. Kaplan-Meier survival curves were generated depending on whether patients received a ***: Of 777 intubated patients, 452 were male (58.2%) and 325 were female (41.8%) with a median age of 63 (interquartile range [IQR]: 54-73) years. One-hundred and eighty-five (23.8%) patients underwent tracheostomy. The mean time from intubation to tracheostomy was (17.3 ± 9.7) days. Patients who underwent tracheostomy were less likely to expire during their hospitalization than those who did not undergo tracheostomy (odds ratio [OR] = 0.31,P tracheostomy was positively associated with being on extra-corporeal membranous oxygenation (ECMO) (OR= 101.10,P tracheostomy was also associated with a significantly longer hospital length of stay ([57.5 ± 32.2] days vs. [19.9 ± 18.1] days,P tracheostomy was associated with reduced in-hospital mortality, despite also being associated with increased comorbidities. tracheostomy should not be held back from patients with comorbidities for this reason alone a

关键词： ARDS COVID-19 intubation tracheostomy

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Urgent tracheostomy： four-year experience in a tertiary hospital

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World Journal of Emergency Medicine 2016年第3期7卷 227-230页

作者： Liliana Costa Ricardo Matos Sara Julio Fernando Vales Margarida Santos Otorhinolaryngology Sao Joao Hospital Center Porto 4200-319 Portugal

BACKGROUND: Urgent airway management is one of the most important responsibilities of otolaryngologists, often requiring a multidisciplinary approach. Urgent surgical airway intervention is indicated when an acute airway obstruction occurs or there are intubation difficulties. In these situations, surgical tracheostomy becomes extremely ***: We retrospectively studied the patients who underwent surgical tracheostomy from 2011 to 2014 by an otolaryngologist team at the operating theater of the emergency department of a tertiary hospital. Indications, complications and clinical evolution of the patients were ***: The study included 56 patients(44 men and 12 women) with a median age of 55 years. The procedure was performed under local anesthesia in 21.4% of the patients. Two(3.6%) patients were subjected to conversion from cricothyrostomy to tracheostomy. Head and neck neoplasm was indicated in 44.6% of the patients, deep neck infection in 19.6%, and bilateral vocal fold paralysis in 10.7%. Stridor was the most frequent signal(51.8%). Of the 56 patients, 15 were transferred to another hospital. Among the other 41 patients, 21 were decannulated(average time: 4 months), and none of them were cancer patients. Complications occurred in 5(12.2%) patients: hemorrhage in 3, surgical wound infection in 1, and cervico-thoracic subcutaneous emphysema in 1. No death was related to the ***: Urgent tracheostomy is a life-saving procedure for patients with acute airway obstruction or with diffi cult intubation. It is a safe and effective procedure, with a low complication rate, and should be performed before the patient's clinical status turns into a surgical emergency situation.

关键词： tracheostomy Cricothryrostomy Stridor Airway obstruction

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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 ***,some studies have conflicting findings regarding the optimal technique and its timing and *** To provide evidence of practice,characteristics,and outcome concerning tracheostomy in an ICU of a tertiary care *** This was a retrospective cohort study including adult critical care patients in a single ICU for two consecutive ***’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 *** defined late as tracheostomy placement after 8 days or no *** Data of 660 patients were analyzed(median age of 60 years),median APACHE II score of 19 and median GCS score of 12 at *** was performed in 115 patients,of whom 63 had early and 52 late *** 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)*** 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 t

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

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Late Complication of tracheostomy: Larynx-Shaped Reorganization of the Tracheal Rings or the True Larynx?

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Surgical Science 2012年第1期3卷 56-58页

作者： Jacopo Galli Sara Giannantonio Gaetano Paludetti Institute of Otorhinolaryngology Catholic University of the Sacred Heart “A. Gemelli” University Hospital Rome Italy

tracheostomy is a well-established, commonly used surgical procedure, whose early and late complications are widely described in literature. Some of them remain still poorly known, though. One of these rare complications is a peculiar larynx-shaped reorganization of the tracheal rings and cricoid cartilage. This tracheal narrowing seems to be non- symptomatic and not life-threatening, at least as long as the reduction of the lumen is tracheostomy.

关键词： tracheostomy Post-tracheostomy Complications Tracheal Stenosis Optic Fiber Laryngoscopy Double Larynx

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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 *** study aimed to better examine the effect of tracheostomy on clinical outcome among prolonged ventilator ***：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 *** 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 *** proportional hazards and linear regression models were used to examine the associations between tracheostomy and the main ***：The tracheostomy rate was 30％,and 55％ of tracheostomies were performed within 30 days of mechanical *** 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 ***：The beneficial effect for tracheostomy observed in our data was the reduction of ***,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 aeruginos

关键词： tracheostomy Intubation Antibiogram Antibiotics

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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 po

关键词： Complications Management Pediatric tracheostomy Safety

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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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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 *** data exist on whether such effects are also present in HFOT through ***,we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical *** A randomized,crossover,physiological study was conducted in our ICU between December 2020 and April 2021,in patients with tracheostomy and prolonged mechanical *** 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 *** 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 *** 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 *** 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/(m

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

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