Objective To estimate the relative effect of early vs. late tracheotomy on clinical end-points in unselected intensive care unit （ICU） patients undergoing mechanical ventilation. Methods We searched electronic data...Objective To estimate the relative effect of early vs. late tracheotomy on clinical end-points in unselected intensive care unit （ICU） patients undergoing mechanical ventilation. Methods We searched electronic databases （up to February 27, 2013） for both randomized control trials and observational studies satisfying the predefined inclusion criteria.展开更多
BACKGROUND： Few studies have reported the effects of early tracheotomy in acute severe asthmatic patients. We report two patients with acute severe asthma who were successfully treated with early tracheotomy. METHOD...BACKGROUND： Few studies have reported the effects of early tracheotomy in acute severe asthmatic patients. We report two patients with acute severe asthma who were successfully treated with early tracheotomy. METHODS：The two patients with acute severe asthma were retrospectively reviewed. They had been treated at the Department of Emergency and Critical Care, Renji Hospital, Shanghai Jiaotong University School of Medicine. RESULTS： They developed progressively hypercapnia and severe acidosis, and were not improved after conventional therapies. Early tracheotomy after mechanical ventilation decreased airway resistance and work of breathing, and corrected hypercapnia and acidosis. Adequate gas exchange was maintained after tracheotomy. The two patients were subsequently weaned from mechanical ventilation and discharged. CONCLUSION：Early tracheotomy could be a valuable approach in certain patients with severe asthma.展开更多
<strong>Introduction: </strong>Tracheotomy is a commonly performed procedure, but with very large disparities according to the teams, both in terms of frequency and modality (percutaneous or surgical), tra...<strong>Introduction: </strong>Tracheotomy is a commonly performed procedure, but with very large disparities according to the teams, both in terms of frequency and modality (percutaneous or surgical), tracheotomy has been evolved with medical advances. The objective of this study was to clarify the indications and complications of emergency tracheotomies at the National hospital center (CHN) in Nouakchott Mauritania. <strong>Materials and Methods: </strong>It is a retrospective study of tracheotomies performed in the ENT department of the CHN during the period from January 1, 2010 to December 31, 2018. The indications and complications were noted, as well as the modalities and time of decannulation. <strong>Results:</strong> Tracheotomy was motivated by upper airway obstruction (UAO) in 139 (94%) cases (mean age 32.5 years), or the need for prolonged ventilation in 8 patients (median age 46 years). Sixteen (7%) early complications were noted with 5 untimely decannulations including one fatal and 5 obstructive plug responsible for another death. Six pneumothorax was observed. Fifteen (26%) late complications required additional surgery;7% (n = 11) of patients were decannulated with a mean duration of tracheotomy 26 months. In 19 (28%) cases of decannulations, the persistence of a tracheocutaneous fistula required surgery. <strong>Conclusion:</strong> Emergency tracheotomy is a survival gesture that is sure to be effective. A tracheotomy is not deprived of complications. Familiarity with the technique, the right choice of equipment, perfect knowledge of the anatomical relationships of the trachea, rigorous monitoring and postoperative care represent the main conditions for minimizing the risk of complications.展开更多
<strong>Background:</strong> known since more than 5000 years, tracheotomy is indicated in severe obstructions of the upper airways or in improvement of ventilation in cases of problematic tracheal intubat...<strong>Background:</strong> known since more than 5000 years, tracheotomy is indicated in severe obstructions of the upper airways or in improvement of ventilation in cases of problematic tracheal intubation. Its usefulness and efficiency are certain, but it needs regular assessments. <strong>Aim:</strong> to determine the frequency of tracheotomies in ENT at CNHU of Cotonou, identify the indications, surgical technics and the postoperative course. <strong>Materials and methods:</strong> the study was retrospective, based on files of patients who have had tracheotomies for ten years since 2010. <strong>Results:</strong> in 10 years, 105 tracheotomies were performed for 99 patients, average 10 to 11 per year. Patients were male in 61.9%. Extreme of age where 09 months and 80 years old. Children under15 were concerned in 41.9%, while patients from 45 to 64 years old in 33.3%. Emergency tracheotomy represented 76%. Causes were tumors in 62.8%. Laryngeal papillomatosis was the predominant tumor in children;28 cases or 26.67%. In adults, larynx cancer represented 20%. Skin incisions were horizontal in 94.3%. Tracheal opening was “H-shaped” in 92.4%. Complications occurred in 28.6%. They included granuloma (13.3%) and oeso-tracheal fistula (1.9%). Decanulation was possible in 87.6%, but it was more difficult in children. <strong>Conclusion:</strong> tracheotomy was an act of rescue in our practice.展开更多
INTRODUCTION Pediatric foreign body aspiration can be a life-threatening emergency requiring immediate intervention.The standard intervention for the vast majority of airway foreign bodies is rigid bronchoscopy,1 whic...INTRODUCTION Pediatric foreign body aspiration can be a life-threatening emergency requiring immediate intervention.The standard intervention for the vast majority of airway foreign bodies is rigid bronchoscopy,1 which was first performed by Gustav Killian in 1897.However,for some large or irregular airway foreign bodies,endoscopic removal remains challenging,even in the most experienced hands.In such cases,open surgery may be preferred to protect the airway and facilitate foreign body removal.We present a unique case of a 9-cm sharp metallic chain lodged in the lower trachea and right main bronchus of a 16-month-old girl,which was removed using combined low tracheotomy and rigid bronchoscopy.This case highlights the treatment options for large and irregular airway foreign bodies in rare locations.展开更多
Cervical or thoracic trauma, tracheotomy and tracheal intubation for mechanical ventilation tiaerapy are themain reasons of tracheal stenosis. Recently the incidence of tracheal stenosis is gradually increasing. Trach...Cervical or thoracic trauma, tracheotomy and tracheal intubation for mechanical ventilation tiaerapy are themain reasons of tracheal stenosis. Recently the incidence of tracheal stenosis is gradually increasing. Tracheal stenosis is an irreversible, progressive disease and the only effective treatment is surgical removal of stenosis tissue to restore normal tracheal lumen. From January 2008 to April 2011, 6 patients with thoracic tracheal stenosis in our department underwent tracheotomy and T-tube stent implantation by endoscope with good results.展开更多
The tracheocutaneous fistula after tracheostomy is a complex clinical problem. An ideal fistula closure is still difficult at present though a variety of fistula-closing methods have been reported in the literature. W...The tracheocutaneous fistula after tracheostomy is a complex clinical problem. An ideal fistula closure is still difficult at present though a variety of fistula-closing methods have been reported in the literature. We used a turnover skin flap to cover the fistula. All the procedures were completed at bedside under local anesthesia. The fistula was successfully closed and well healed without complications within 7-9 days. It has been proven that this operation is simple, effective, and safe.展开更多
Background Whether early tracheotomy in patients who require prolonged mechanical ventilation after cardiac surgery can shorten post-operation mechanical ventilation(MV)duration,Intensive Care Unit(ICU)length of stay(...Background Whether early tracheotomy in patients who require prolonged mechanical ventilation after cardiac surgery can shorten post-operation mechanical ventilation(MV)duration,Intensive Care Unit(ICU)length of stay(LOS),hospital LOS after surgery and lower hospital mortality remains controversial. Methods Forty-nine patients who undertook tracheotomy after cardiac surgery,were recruited at Guangdong General Hospital from 1stJanuary 2005 to 31 stDecember 2015. Based on the timing of tracheotomy after cardiac surgery,21cases(0～14 days)and 28 cases(≥15 days)were selected as early tracheotomy group and late tracheotomy group. The hospital mortality,duration of MV,ICU LOS and hospital LOS of these two groups were compared.Results The risks of pneumonia,duration of MV,and ICU LOS(P=0.016,0.034,0.006 respectively)were significantly lower in the early tracheotomy group. Early tracheotomy was also associated with lower risks of stroke and renal replacement therapy(P=0.033,0.01 respectively). Kaplan-Meier curves showed that those who underwent early tracheotomy had shorter duration of MV,ICU LOS,and hospital LOS. Conclusion Early tracheotomy after cardiac surgery might lead to lower risk of pneumonia,shorter duration of MV,and shorter ICU LOS.展开更多
文摘Objective To estimate the relative effect of early vs. late tracheotomy on clinical end-points in unselected intensive care unit （ICU） patients undergoing mechanical ventilation. Methods We searched electronic databases （up to February 27, 2013） for both randomized control trials and observational studies satisfying the predefined inclusion criteria.
文摘BACKGROUND： Few studies have reported the effects of early tracheotomy in acute severe asthmatic patients. We report two patients with acute severe asthma who were successfully treated with early tracheotomy. METHODS：The two patients with acute severe asthma were retrospectively reviewed. They had been treated at the Department of Emergency and Critical Care, Renji Hospital, Shanghai Jiaotong University School of Medicine. RESULTS： They developed progressively hypercapnia and severe acidosis, and were not improved after conventional therapies. Early tracheotomy after mechanical ventilation decreased airway resistance and work of breathing, and corrected hypercapnia and acidosis. Adequate gas exchange was maintained after tracheotomy. The two patients were subsequently weaned from mechanical ventilation and discharged. CONCLUSION：Early tracheotomy could be a valuable approach in certain patients with severe asthma.
文摘<strong>Introduction: </strong>Tracheotomy is a commonly performed procedure, but with very large disparities according to the teams, both in terms of frequency and modality (percutaneous or surgical), tracheotomy has been evolved with medical advances. The objective of this study was to clarify the indications and complications of emergency tracheotomies at the National hospital center (CHN) in Nouakchott Mauritania. <strong>Materials and Methods: </strong>It is a retrospective study of tracheotomies performed in the ENT department of the CHN during the period from January 1, 2010 to December 31, 2018. The indications and complications were noted, as well as the modalities and time of decannulation. <strong>Results:</strong> Tracheotomy was motivated by upper airway obstruction (UAO) in 139 (94%) cases (mean age 32.5 years), or the need for prolonged ventilation in 8 patients (median age 46 years). Sixteen (7%) early complications were noted with 5 untimely decannulations including one fatal and 5 obstructive plug responsible for another death. Six pneumothorax was observed. Fifteen (26%) late complications required additional surgery;7% (n = 11) of patients were decannulated with a mean duration of tracheotomy 26 months. In 19 (28%) cases of decannulations, the persistence of a tracheocutaneous fistula required surgery. <strong>Conclusion:</strong> Emergency tracheotomy is a survival gesture that is sure to be effective. A tracheotomy is not deprived of complications. Familiarity with the technique, the right choice of equipment, perfect knowledge of the anatomical relationships of the trachea, rigorous monitoring and postoperative care represent the main conditions for minimizing the risk of complications.
文摘<strong>Background:</strong> known since more than 5000 years, tracheotomy is indicated in severe obstructions of the upper airways or in improvement of ventilation in cases of problematic tracheal intubation. Its usefulness and efficiency are certain, but it needs regular assessments. <strong>Aim:</strong> to determine the frequency of tracheotomies in ENT at CNHU of Cotonou, identify the indications, surgical technics and the postoperative course. <strong>Materials and methods:</strong> the study was retrospective, based on files of patients who have had tracheotomies for ten years since 2010. <strong>Results:</strong> in 10 years, 105 tracheotomies were performed for 99 patients, average 10 to 11 per year. Patients were male in 61.9%. Extreme of age where 09 months and 80 years old. Children under15 were concerned in 41.9%, while patients from 45 to 64 years old in 33.3%. Emergency tracheotomy represented 76%. Causes were tumors in 62.8%. Laryngeal papillomatosis was the predominant tumor in children;28 cases or 26.67%. In adults, larynx cancer represented 20%. Skin incisions were horizontal in 94.3%. Tracheal opening was “H-shaped” in 92.4%. Complications occurred in 28.6%. They included granuloma (13.3%) and oeso-tracheal fistula (1.9%). Decanulation was possible in 87.6%, but it was more difficult in children. <strong>Conclusion:</strong> tracheotomy was an act of rescue in our practice.
文摘INTRODUCTION Pediatric foreign body aspiration can be a life-threatening emergency requiring immediate intervention.The standard intervention for the vast majority of airway foreign bodies is rigid bronchoscopy,1 which was first performed by Gustav Killian in 1897.However,for some large or irregular airway foreign bodies,endoscopic removal remains challenging,even in the most experienced hands.In such cases,open surgery may be preferred to protect the airway and facilitate foreign body removal.We present a unique case of a 9-cm sharp metallic chain lodged in the lower trachea and right main bronchus of a 16-month-old girl,which was removed using combined low tracheotomy and rigid bronchoscopy.This case highlights the treatment options for large and irregular airway foreign bodies in rare locations.
文摘Cervical or thoracic trauma, tracheotomy and tracheal intubation for mechanical ventilation tiaerapy are themain reasons of tracheal stenosis. Recently the incidence of tracheal stenosis is gradually increasing. Tracheal stenosis is an irreversible, progressive disease and the only effective treatment is surgical removal of stenosis tissue to restore normal tracheal lumen. From January 2008 to April 2011, 6 patients with thoracic tracheal stenosis in our department underwent tracheotomy and T-tube stent implantation by endoscope with good results.
文摘The tracheocutaneous fistula after tracheostomy is a complex clinical problem. An ideal fistula closure is still difficult at present though a variety of fistula-closing methods have been reported in the literature. We used a turnover skin flap to cover the fistula. All the procedures were completed at bedside under local anesthesia. The fistula was successfully closed and well healed without complications within 7-9 days. It has been proven that this operation is simple, effective, and safe.
基金Guangdong Province Medical Scientific Research Foundation (No.A2016120).
文摘Background Whether early tracheotomy in patients who require prolonged mechanical ventilation after cardiac surgery can shorten post-operation mechanical ventilation(MV)duration,Intensive Care Unit(ICU)length of stay(LOS),hospital LOS after surgery and lower hospital mortality remains controversial. Methods Forty-nine patients who undertook tracheotomy after cardiac surgery,were recruited at Guangdong General Hospital from 1stJanuary 2005 to 31 stDecember 2015. Based on the timing of tracheotomy after cardiac surgery,21cases(0～14 days)and 28 cases(≥15 days)were selected as early tracheotomy group and late tracheotomy group. The hospital mortality,duration of MV,ICU LOS and hospital LOS of these two groups were compared.Results The risks of pneumonia,duration of MV,and ICU LOS(P=0.016,0.034,0.006 respectively)were significantly lower in the early tracheotomy group. Early tracheotomy was also associated with lower risks of stroke and renal replacement therapy(P=0.033,0.01 respectively). Kaplan-Meier curves showed that those who underwent early tracheotomy had shorter duration of MV,ICU LOS,and hospital LOS. Conclusion Early tracheotomy after cardiac surgery might lead to lower risk of pneumonia,shorter duration of MV,and shorter ICU LOS.
