EVENTION OF INFECTIOUS COMPLICATIONS OF TRACHEOSTOMY IN PATIENTS WITH HEAD AND NECK CANCER PATHOLOGY

Abstract

Summary. Introduction. A tracheostomy is still widely used in the head and neck oncology practice, but the rate of infectious complications remains high.
 Goal. Optimization of the prevention and treatment of the tracheostomy complications in patients with oncological pathology of the head and neck based on taking into account the flora that is seeded from the tracheostomy.
 Materials and methods. The 1st stage of the study consisted in examining of the 100 patients after tracheostomies performed in the period 2018-2022 (planned — 76, emergency — 24). The age of the patients ranged from 40 to 70 years old. The indication for the tracheostomy was obstruction of the respiratory tract by a tumor process of the larynx and the laryngopharynx. All surgery operations were performed under the local infiltration anesthesia, according to the standard technique for the permanent tracheostomy. At the 2nd stage, the proposed methods of the postoperative management of the patients to prevent the infectious complications were evaluated: processing of the cannula with a combination of 0.01 % solution of the miramistin with 10 mg of the chymotrypsin or a combination of 0.5 % s olution of the dioxidin and 10 mg of the chymotrypsin.
 Results and their discussion. At the 1st stage of the study, various complications were detected, but in all cases there were infectious complications. Most often, after 7 days, Pseudomonas aeruginosa was cultured from the trachea, followed by Acinetobacter baumannii in 2nd place. The use of 0.02% chlorhexidine solution to process the cannula was not effective. The flora that is cultured determines the antiseptic agent that should be used to process the cannula.
 Conclusions. 1. Infectious complications after the tracheostomy are inevitable due to disruption of the natural path of air movement. 2. The flora sown from the tracheostomy cannula within 14 days after the tracheostomy is diverse. 3. It is advisable to use double-lumen tracheostomy cannulas, the inner part of which should be processing with the antiseptics depending on the flora found in the tracheal contents. 4. The combination of the 0.01% miramistin solution with 10 mg chymotrypsin for the cannula processing is effective against P. aeruginosa. A combination of 0.5% dioxidin solution and 10 mg chymotrypsin is effective against S. aureus, A. baumanii and K. pneumoniae.