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 confl...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,P<0.001)and in ICU in general(18.8±9.1 vs 25.4±11.5,P<0.001).Percutaneous dilatation tracheostomy(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 ventilation and were transferred out of the ICU(100%vs 17.4%,P<0.001).CONCLUSION PDT was performed more frequently in our cohort.This technique did not affect mechanical ventilation days,ventilator-associated pneumonia(VAP),ICU length of stay,or survival.No complications were observed in the percutaneous or surgical tracheostomy groups.Patients undergoing early tracheostomy benefited in terms of mechanical ventilation days and ICU length of stay but not of discharge status,presence of VAP,or survival.展开更多
Objective: Since its inception, the use of the percutaneous dilational tracheostomy (PDT) has been contraindicated in the setting of an emergent airway. Emerging in the literature are several cases of successful emerg...Objective: Since its inception, the use of the percutaneous dilational tracheostomy (PDT) has been contraindicated in the setting of an emergent airway. Emerging in the literature are several cases of successful emergent PDTs. Here we present our experience with the use of PDT in managing emergent airways. Study Design: All patients who underwent emergent PDT, using the Ciaglia Blue Rhino Introducer Set (Cook Critical Care, Bloomington,IN), in an academic county hospital setting between February 2010 and May 2012 were included in the study. Electronic medical records were reviewed for demographic and procedural data. Results: Twelve patients were included in the study with ages ranging from 20 to 87 (mean 57) years-old. The most common reason for emergent airway was trauma (7 patients), followed by obstructing neck mass (2 patients), septic shock (2 patients), and angioedema (1 patient). Seven PDTs were performed in the OR, four at bedside and one in the ER. Three of the 12 patients had emergent cricothyroidotomies in place that malfunctioned, requiring emergent conversion. No patients suffered from short term complications. One patient developed a neck abscess at the site of the PDT one month post operatively, two patients had accidental decanulation post operatively, and both were replaced without complication. Conclusions: PDT can be used in the emergent setting in the hands of trained practitioners with minimal complications. A larger, prospective trial is needed to make conclusions regarding patient care.展开更多
BACKGROUND The usage of bronchoscopy during percutaneous dilatational tracheostomy remains under debate.The proponents of bronchoscopy advocating safety of the procedure,whereas the critics raising the concerns about ...BACKGROUND The usage of bronchoscopy during percutaneous dilatational tracheostomy remains under debate.The proponents of bronchoscopy advocating safety of the procedure,whereas the critics raising the concerns about the cost,possible delay in the procedure,and waiting for the device.CASE SUMMARY We are highlighting a case of percutaneous dilatational tracheostomy where bronchoscopy aided in diagnosing a rare situation of wire entrapment within the endotracheal tube,treated by withdrawing the wire from the endotracheal tube with good outcome.CONCLUSION The bronchoscopy guided approach permitted early diagnosis and helped to end the procedure without complication or possible major surgery in a case of accidental wire puncture of the endotracheal tube.展开更多
The article presents a new technique developed by RSCS named after acad. V. Vakhidov for performing percutaneous dilatational tracheostomy by using the improved Howard-Kelly forceps, which ensures stable traction of t...The article presents a new technique developed by RSCS named after acad. V. Vakhidov for performing percutaneous dilatational tracheostomy by using the improved Howard-Kelly forceps, which ensures stable traction of the guidewire and reduces the risk of trauma to surrounding tissues. In order to assess the feasibility and necessity of carrying out a modified method of tracheostomy, a comparative analysis of the frequency and structure of complications after various options for tracheostomy was carried out, taking into account the presence or absence of risk factors for an adverse outcome.展开更多
文摘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,P<0.001)and in ICU in general(18.8±9.1 vs 25.4±11.5,P<0.001).Percutaneous dilatation tracheostomy(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 ventilation and were transferred out of the ICU(100%vs 17.4%,P<0.001).CONCLUSION PDT was performed more frequently in our cohort.This technique did not affect mechanical ventilation days,ventilator-associated pneumonia(VAP),ICU length of stay,or survival.No complications were observed in the percutaneous or surgical tracheostomy groups.Patients undergoing early tracheostomy benefited in terms of mechanical ventilation days and ICU length of stay but not of discharge status,presence of VAP,or survival.
文摘Objective: Since its inception, the use of the percutaneous dilational tracheostomy (PDT) has been contraindicated in the setting of an emergent airway. Emerging in the literature are several cases of successful emergent PDTs. Here we present our experience with the use of PDT in managing emergent airways. Study Design: All patients who underwent emergent PDT, using the Ciaglia Blue Rhino Introducer Set (Cook Critical Care, Bloomington,IN), in an academic county hospital setting between February 2010 and May 2012 were included in the study. Electronic medical records were reviewed for demographic and procedural data. Results: Twelve patients were included in the study with ages ranging from 20 to 87 (mean 57) years-old. The most common reason for emergent airway was trauma (7 patients), followed by obstructing neck mass (2 patients), septic shock (2 patients), and angioedema (1 patient). Seven PDTs were performed in the OR, four at bedside and one in the ER. Three of the 12 patients had emergent cricothyroidotomies in place that malfunctioned, requiring emergent conversion. No patients suffered from short term complications. One patient developed a neck abscess at the site of the PDT one month post operatively, two patients had accidental decanulation post operatively, and both were replaced without complication. Conclusions: PDT can be used in the emergent setting in the hands of trained practitioners with minimal complications. A larger, prospective trial is needed to make conclusions regarding patient care.
基金Supported by the Medical Research Center,Hamad Medical Corporation,No.MRC-04-18-474.
文摘BACKGROUND The usage of bronchoscopy during percutaneous dilatational tracheostomy remains under debate.The proponents of bronchoscopy advocating safety of the procedure,whereas the critics raising the concerns about the cost,possible delay in the procedure,and waiting for the device.CASE SUMMARY We are highlighting a case of percutaneous dilatational tracheostomy where bronchoscopy aided in diagnosing a rare situation of wire entrapment within the endotracheal tube,treated by withdrawing the wire from the endotracheal tube with good outcome.CONCLUSION The bronchoscopy guided approach permitted early diagnosis and helped to end the procedure without complication or possible major surgery in a case of accidental wire puncture of the endotracheal tube.
文摘The article presents a new technique developed by RSCS named after acad. V. Vakhidov for performing percutaneous dilatational tracheostomy by using the improved Howard-Kelly forceps, which ensures stable traction of the guidewire and reduces the risk of trauma to surrounding tissues. In order to assess the feasibility and necessity of carrying out a modified method of tracheostomy, a comparative analysis of the frequency and structure of complications after various options for tracheostomy was carried out, taking into account the presence or absence of risk factors for an adverse outcome.
