Open Tracheostomy Research Articles

Postoperative Complications in Obese Patients After Tracheostomy.

ObjectiveTo determine the prevalence of varying classes of obesity in patients undergoing tracheostomy and the associated complication rates as compared with nonobese patients.Study DesignA retrospective chart review was performed from 2012 to 2018 on all patients who underwent open tracheostomy by the Department of Otolaryngology–Head and Neck Surgery.SettingAll tracheostomies were performed at a single tertiary care center.MethodsPatients were classified by body mass index (BMI) according to the World Health Organization classification system: underweight (<18.5), normal-overweight (18.5-29.9), class I (30-34.9), class II (35-39.9), and class III (>40). Charts were reviewed for patient demographic information, Charlson Comorbidity Index score, surgical indication, operative time, tracheostomy tube type, and postoperative complications.ResultsA total of 387 patients (mean ± SD BMI, 31.3 ± 14.2) were identified per the inclusion/exclusion criteria. Of patients with BMI >30 (n=153), 34.6% were categorized as obesity class I, 29.4% as class II, and 35.9% as class III. The most common indication for tracheostomy was malignancy in nonobese patients (41.5%) and respiratory failure for obese patients (58.2%). Operative time was significantly longer in obese patients, and most of these patients required an extended-length tracheostomy tube. Patients with a BMI >40 had higher rates of multiple postoperative complications or death (P = .009). Underweight patients also had a higher rate of complication than normal-overweight patients (P = .016).ConclusionClass III and underweight patients had higher rates of postoperative complications, which should be taken into consideration during perioperative counseling.

Our algorithms for organizing and performing tracheostomy of COVID-19 patients who are put on a prolonged invasive artificial ventilation

The coronavirus COVID-19 pandemic, caused by virus SARS-CoV-2, is the greatest challenge of modern healthcare. The COVID-19 pandemic is changing the common medical and surgical approaches to the general procedures, some of them are radically modified to facilitate safety and minimize the risk of viral spread. So, there is great controversy around the role of tracheostomy as a part of the treatment process of COVID-19 patients. Severe acute respiratory infection, caused by coronavirus SARS-CoV-2, is characterized by the rapid respiratory decompensation. Statistical calculation shows that 3-17% of hospitalized patients need endotracheal intubation and a ventilator. According to the operational data of the Ministry of Healthcare of Ukraine on pandemic situation of outbreaks of COVID-19 in Ukraine by May, 7, 2020 (the date when the article was written), on average, 1,89-4,17% of hospitalized patients with COVID-19 have been in the past, are at present and will be in future potential candidates for tracheostomy. Surgical (open) tracheostomy is an aerosol generating procedure and carries a very high risk of contamination by exposing the airway secretions to the clinical staff involved. That’s why, this procedure should be thoroughly and appropriately planned and carefully executed to minimize the risk of viral spread and to ensure clinical staff safety. For this reason, drawing on the experience of our colleagues, taking into consideration “Recommendations for examination and treatment of patients with ENT pathology during the COVID-19 pandemic” developed by State Institution «O.S. Kolomiychenko Institute of otolaryngology of National academy of medical sciences of Ukraine», guidance of the University of Pennsylvania Health System and ENT UK’s Recommendations regarding tracheostomy in a COVID-19 patient and taking into account the realities of our life and medicine in COVID-19 pandemic we developed our own rules and algorithm of performance of tracheostomy for COVID-19 patients who are put on prolonged invasive artificial ventilation. The COVID-19 pandemic has changed us as personalities and professionals, made us adapt to different work environments. The need for surgical tracheostomies will be increasing for the next weeks or even months. That’s why, we should execute them confidently and observe safety rules. Our experience has let us detect some critical moments and weaknesses and take them into consideration to ensure clinical staff safety since low staff number in hospitals because of self-isolation can be really tangible and the need for clinical staff is constantly increasing.

Safe and effective management of tracheostomy in COVID-19 patients.

BackgroundAn increasing number of COVID‐19 patients worldwide will probably need tracheostomy in an emergency or at the recovering stage of COVID‐19. We explored the safe and effective management of tracheostomy in COVID‐19 patients, to benefit patients and protect health care workers at the same time.MethodsWe retrospectively analyzed 11 hospitalized COVID‐19 patients undergoing tracheostomy. Clinical features of patients, ventilator withdrawal after tracheostomy, surgical complications, and nosocomial infection of the health care workers associated with the tracheostomy were analyzed.ResultsThe tracheostomy of all the 11 cases (100%) was performed successfully, including percutaneous tracheostomy of 6 cases (54.5%) and conventional open tracheostomy of 5 cases (45.5%). No severe postoperative complications occurred, and no health care workers associated with the tracheostomy are confirmed to be infected by SARS‐CoV‐2.ConclusionComprehensive evaluation before tracheostomy, optimized procedures during tracheostomy, and special care after tracheostomy can make the tracheostomy safe and beneficial in COVID‐19 patients.

Open tracheostomy for COVID-19-positive patients: A method to minimize aerosolization and reduce risk of exposure.

IntroductionThe COVID-19 virus is highly contagious and thus there is a potential of infecting operating staff when operating on these patients. This case series describes a method of performing open tracheostomy for COVID-19 patients while minimizing potential aerosolization of the virus using typically available equipment and supplies.MethodsThis is a case series of 18 patients who were COVID-19 positive and underwent open tracheostomy in the operating room under a negative pressure plastic hood created using readily available equipment and supplies. Patients had to be intubated for at least 14 days, be convalescing from their cytokine storm, and deemed to survive for at least 14 more days. Other indications for tracheostomy were altered mental status, severe deconditioning, respiratory failure and failed extubation attempts.ResultsThere were 14 men and 4 women with severe SARS-CoV2 infection requiring long-term intubation since March 23 or later. The mean age was 61.7, BMI was 32.6, and the pre-tracheostomy ventilator day was 20.4. The indications for tracheostomy were altered mental status, severe deconditioning and continued respiratory with hypoxia. Failed extubation attempt rate was 16.7% and hemodialysis rate was 38.9%. All patients were hemodynamically stable, without any evidence of accelerating cytokine storm. To date there was one minor bleeding due to postoperative therapeutic anticoagulation.ConclusionThis report describes a method of performing open tracheostomy with minimal aerosolization using readily available equipment and supplies in most hospitals.

Percutaneous Dilatational Tracheostomy: Experience of 100 Cases at a Tertiary Care Centre

Tracheostomy has been accepted as standard of care for patients requiring prolonged mechanical ventilation. There has been a shift from the era of open surgical tracheostomy to percutaneous tracheostomy. Some studies have reported certain advantages of percutaneous tracheostomy over open tracheostomy, yet some centres debate about its effectiveness and, hence, have not adopted it as a routine technique. We present our centre’s experience of performing 100 bedside percutaneous tracheostomies, including those in 27 patients of cervical spine injury. The aim of the study is to demonstrate the safety and efficacy of percutaneous tracheostomy such that it can be embraced as a routine technique. One hundred consecutive neurosurgical patients requiring tracheostomy for prolonged ventilation were included in the study. Patients requiring emergency tracheostomy were excluded. A prospective database was created which included demographic profile of the patient, diagnosis and related indications, procedure time and complications. Ciaglia multiple dilator technique was used for performing percutaneous tracheostomy using Cook set. Time taken was measured from skin incision to insertion of tracheostomy tube. All related complications were noted. Mean duration of procedure was 7.92 ± 0.17 min and 7.14 ± 0.1 min in patients of cervical spine injury. Cannula misplacement occurred in 5 patients and minor bleeding occurred in 4 patients, including 3 complications in patients of cervical spine injury(2 had bleeding while 1 had cannula misplacement corrected during the procedure). Conversion to open procedure was required in one patient. Percutaneous tracheostomy is a safe and effective alternative to open tracheostomy. It can be considered the first line of care in patients requiring tracheostomy, especially in patients of cervical spine injury.

Barrier device prototype for open tracheotomy during COVID-19 pandemic

ObjectiveTo present a low-cost prototype for a barrier enclosure device which can be used during open surgeries such as tracheotomy. MethodsWe provide detailed description of a novel device called COVID-Box, developed by The Surgical Airway Team for COVID-19 Pandemic, a temporary task force formed by Walter Cantídio University Hospital. Safety guidelines for performing tracheotomies in COVID-19 patients are also stated. ResultsOur prototype device provides greater hand mobility than previous barrier devices reported, making it more suitable for airway surgical procedures, such as tracheotomy. The curved shaped format and the customizable access ports provides ergonomics, without compromising safety. ConclusionThe COVID-Box appears to be an efficient, reproduceable, low-cost barrier enclosure device that can be used for open tracheotomies in ICU patients during the COVID-19 pandemic.

Surgical Infection Society Guidance for Operative and Peri-Operative Care of Adult Patients Infected by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2).

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated viral infection (coronavirus disease 2019, COVID-19) is a virulent, contagious viral pandemic that is affecting populations worldwide. As with any airborne viral respiratory infection, surgical and non-surgical patients may be affected. Methods: Review and synthesis of pertinent English-language literature pertaining to COVID-19 infection among adult patients. Results: COVID-19 disease that requires hospitalization results in critical illness approximately 25% of the time and requires mechanical ventilation with positive airway pressure. Acute kidney injury, a marked hypercoagulable state, and sometimes myocarditis can be features of COVID-19 in addition to the characteristic severe acute lung injury. Even if not among the most seriously afflicted, older patients with medical comorbidities are both predisposed to infection and risk increased morbidity and mortality, however, all persons presenting for surgical intervention should be suspected of infection (and thus transmissibility) even if asymptomatic. Although most elective surgery has been curtailed by administrative or governmental fiat, patients will still need urgent or emergency operative intervention for time-sensitive disease processes such as malignant neoplasia or for true emergencies such as perforated viscus or traumatic injury. It is possible to provide safe surgical care for SARS-CoV-2-positive patients and minimize nosocomial transmission to healthcare workers. Conclusions: This guidance will facilitate appropriate protection of patients and staff, and maintenance of infection control measures to assist surgical personnel and facilities to prepare for COVID-19-infected adult patients requiring urgent or emergent operative intervention and to provide optimal patient care.

Percutaneous dilatational tracheostomy in patients with head and neck tumors: literature review and institutional experience

Introduction. Patients with head and neck tumors are often require tracheostomy. This procedure represents complex surgical manipulation and is associated with risk of certain complications, including life-threatening. The study objective is to essess the results of percutaneous tracheostomy with the new SafeTrach technique. Materials and methods. The study included 21 patients. All patients had a tracheostomy performed using the SafeTrach technique. Results. Mean duration of tracheostomy with SafeTrach technique was 11.8 ± 3.4 minutes independently of patients’ body mass index or previous treatment (correlation coefficients r = 0.08, p = 0.7 and r = 0.08, p = 0.73, respectively). Among all possible complications of tracheostomy only 1 (4.7 %) case of bleeding in postoperative period was noted in our study. Conclusion. The SafeTrach technique combines all the benefits of open and percutaneous tracheostomy. It is characterized by simplicity, it does not require endoscopic control, that indicates the feasibility of its widespread implementation.

Audit of open pediatric tracheostomies at the University College Hospital, Ibadan

Background: Tracheostomy is the creation of a communication between the trachea and the overlying skin, maintained by a tube. This is done either by an open or percutaneous technique. Anatomical and physiological variation of the paediatric trachea and adjoining structures necessitates finite skills and consistent competence in performing pediatric tracheostomies, lack of which may cause higher mortality and morbidity outcome in tracheostomies in the pediatric age group. Objectives: There are inadequate local data on the outcomes of pediatric tracheostomies; therefore, we conducted a local audit of pediatric tracheostomy to describe our experience. Methods: A retrospective study of pediatric patients who had tracheostomies from June 2011 to December 2017 was done. Results: Thirty‑four patients were identified, all of whom had an open tracheostomy. The age range was 3 weeks to 16 years; M: F ratio was 2.4:1. Indications for surgery were obstructive (88.2%) and prolonged‑assisted intubation (11.8%). Recurrent respiratory papillomatosis, retropharyngeal abscess, and foreign‑body aspiration were the main obstructive causes. Three patients (8.8%) had repeat procedures, and these patients were initially discharged on tracheostomy tube and instructions were given for home care. Conclusion: Despite the evolving local challenges peculiar to clinical practice in developing countries, the outcome of pediatric tracheostomy in our hospital is good. Keywords: Audit, pediatric, tracheostomy

Tracheostomy in Patients With COVID-19: A Single-center Experience.

Tracheostomy performed on patients with Coronavirus disease 2019 (COVID-19) may lead to the infection of operators and medical staff. To date, there are no established methods of infection control. The aim of this study was to provide helpful and useful information regarding tracheostomy during the COVID-19 pandemic. We performed a retrospective analysis on 12 patients with severe COVID-19 who were intubated and underwent tracheostomy in our hospital. Percutaneous tracheostomy was performed in eight cases, and open tracheostomy was performed in four cases. Open tracheostomy in the operating room was performed under a negative pressure closed-space system using a surgical drape to prevent aerosolization. Our experience suggests that bedside percutaneous tracheostomy may be a useful option in patients with COVID-19. In cases where percutaneous tracheostomy is anticipated to be difficult, open tracheostomy using a negative pressure closure may be useful in preventing aerosolization and reducing the risk of infection of healthcare workers.

Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic

The coronavirus SARS-CoV-2 (COVID-19) pandemic has offered a unique set of challenges to the medical community often requiring prolonged treatment algorithms. The illness, afflicting more than 7.3 million people worldwide with estimates of 5-20% requiring critical care, has become a burden on the healthcare community. These critically ill patients who acquire the severe form of the disease routinely require prolonged invasive mechanical ventilation. The questions then arise, “when and for whom does tracheostomy become indicated,” and “how to safely perform a tracheostomy in this patient population.” With consideration to aerosolization of the virus, we have derived and instituted a protocol at a community institution with aims of reducing provider risk while safely performing a tracheostomy. An open tracheostomy was performed at bedside, within a negative pressure intensive care unit (ICU) setting, utilizing a closed-circuit technique as described in this text. A total of 17 tracheostomies were performed employing the described technique. Minimal complications were noted throughout the study and no adverse oxygenation events were observed with an average total apneic time of 106 seconds. An acceptable mortality rate of 23% was observed given the lethal nature of this disease in ventilated, critically ill patients. No nosocomial transmission of the virus was documented for all team members. This protocol can be used to determine efficacy and safely execute a tracheostomy in COVID-19 patients. As information about COVID-19 continues to unfold, protocols for high risk procedures will need to fluidly evolve.

Tracheostomy Is Safe During Extracorporeal Membrane Oxygenation Support.

Patients receiving extracorporeal membrane oxygenation (ECMO) often require prolonged mechanical ventilation. Providers may be reluctant to perform tracheostomies on patients during ECMO due to their tenuous clinical status and systemic anticoagulation. We report our experience with performing open and percutaneous tracheostomies on patients supported on ECMO from August 2009 to December 2017. Of the 127 patients who underwent tracheostomy during ECMO support, the median age was 42 years (interquartile range [IQR], 29-54), 99 (78%) patients had venovenous (VV) cannulation, 22 (17%) patients had venoarterial (VA) cannulation, and six (5%) patients had hybrid configurations. Percutaneous tracheostomy was performed in 110 (87%) patients. Median-activated partial thromboplastin time (aPTT) at the time of tracheostomy was 47.5 seconds (IQR, 41-57.6 seconds). The median time from ECMO initiation to tracheostomy was 7 days (IQR, 4-11 days). A total of 55 patients (43%) received packed red blood cell (pRBC) transfusions within 48 hours after tracheostomy with a median transfusion of 2 units (IQR, 1-3). There was no procedural mortality. Overall, 88 (69%) patients survived to decannulation and 74 (58%) survived to hospital discharge. Our experience with the largest published series of tracheostomies during ECMO demonstrates that excellent outcomes can be achieved without significant morbidity.

Impact of bedside percutaneous dilational and open surgical tracheostomy on intracranial pressure, pulmonary gas exchange, and hemodynamics in neurocritical care patients.

Aim was to compare the impact of bedside percutaneous dilational tracheostomy (PDT) and open surgical technique (ST) on intracranial pressure (ICP), pulmonary gas exchange and hemodynamics.We retrospectively analyzed data of 92 neurocritical care patients with invasive ICP monitoring during either PDT (43 patients) or ST (49 patients).Peak ICP levels were higher during PDT (22 [17-38] mm Hg vs 19 [13-27] mm Hg, P = .029). Mean oxygen saturation (SpO2) and end-tidal carbon dioxide partial pressure (etCO2) did not differ. Episodes with relevant desaturation (SpO2 < 90%) or hypercapnia (etCO2 > 50 mm Hg) occurred rarely (5/49 during ST vs 3/43 during PDT for SpO2 < 90%; 2/49 during ST vs 5/43 during PDT for hypercapnia). Drops in mean arterial pressure (MAP) below 60 mm Hg were seen more often during PDT (8/43 vs 2/49, P = .026). Mean infusion rate of norepinephrine did not differ (0.52 mg/h during ST vs 0.45 mg/h during PDT). No fatal complications were observed.Tracheostomy can be performed as ST and PDT safely in neurocritical care patients. The impact on ICP, pulmonary gas exchange and hemodynamics remains within an unproblematic range.

Long-term outcomes among octogenarians with aneurysmal subarachnoid hemorrhage.

Data evaluating the long-term outcomes, particularly with regard to treatment modality, of aneurysmal subarachnoid hemorrhage (SAH) in octogenarians are limited. The primary objectives were to evaluate the disposition (living at home vs institutional settings) and analyze the predictors of long-term survival and return to home for octogenarians after SAH. Data pertaining to patients age 80 and older who underwent microsurgical clipping or endovascular coiling for SAH were extracted from 100% nationwide Medicare inpatient claims and linked with the Minimum Data Set (2008-2011). Patient disposition was tracked for 2 years after index SAH admission. Multivariable logistic regression stratified by aneurysm treatment modality, and adjusted for patient factors including SAH severity, evaluated predictors of return to home at 60 and 365 days after SAH. Survival 365 days after SAH was analyzed with a multivariable Cox proportional hazards model. A total of 1298 cases were included in the analysis. One year following SAH, 56% of the patients had died or were in hospice care, 8% were in an institutional post-acute care setting, and 36% had returned home. Open microsurgical clipping (adjusted hazard ratio [aHR] 0.67, 95% confidence interval [CI] 0.54-0.81), male sex (aHR 0.70, 95% CI 0.57-0.87), tracheostomy (aHR 0.63, 95% CI 0.47-0.85), gastrostomy (aHR 0.60, 95% CI 0.48-0.76), and worse SAH severity (aHR 0.94, 95% CI 0.92-0.97) were associated with reduced likelihood of patients ever returning home. Older age (aHR 1.09, 95% CI 1.05-1.13), tracheostomy (aHR 2.06, 95% CI 1.46-2.91), gastrostomy (aHR 1.55, 95% CI 1.14-2.10), male sex (aHR 1.66, 95% CI 1.20-2.23), and worse SAH severity 1.51 (95% CI 1.04-2.18) were associated with reduced survival. In this national analysis, 56% of octogenarians with SAH died, and 36% returned home within 1 year of SAH. Coil embolization predicted returning to home, which may suggest a benefit to endovascular treatment in this patient population.

Tracheostomy: Open Surgical or Percutaneous? An Effort to Solve the Continued Dilemma.

Due to lack of globally standardized guidelines and clarity on indications, patient selection, intra-operative preparations, technique, complications, postoperative care and decannulation protocols, percutaneous tracheostomy (PT) has come in vogue as compared to standard open surgical tracheostomy (OST). PercuTwist and guide wire dilatational method (GWDF), techniques of PT, offer lesser operative time and ease of surgery being a bedside procedure. There seems to be paucity of Indian literature on rising trend of increasing indications, post-operative care, management of complications and outcomes of tracheostomy. And thus, there arises a felt need to envisage a study in tertiary care setup targeting these issues and to question the so far unchallenged acceptance of new techniques and technology.Our aim is to study the recent trend of indications, complications, and outcomes of both OST and PT in a cohort of Indian patients who underwent tracheostomy. 80 patients with mean age of 59.0 ± 15years underwent tracheostomy (OST: 48 (60%), PT: 32 (40%), and among PT, PercuTwist: 16 (50%), GWDF: 16 (50%)) for various indications with objectives to compare operative time, complications and decannulation rates of tracheostomy surgery, within the follow up period of 3months. Most common indication of elective tracheostomy was prolonged ventilation, and for emergency ones, upper airway obstruction. Mean operative time taken by all the three techniques was comparable, i.e., 16.3 v/s 15 v/s 15.3min (Open v/s PT GWDF v/s PT PercuTwist). Most common intra-operative complication of OST was haemorrhage (16.3%) and that of PT was false passage (8.8%). Early post-operative complications were haemorrhage (OST: 3.75%, PT: 1.25%) and tube blockage and dislodgement (equal distribution among OST and PT). Late post-operative complications were stomal granulations in PT: 7.5%. Outcomes of tracheostomy were significantly better with OST (36 (45%)) than PT (14 (17.5%)). In PT group, PercuTwist fared better than GWDF in terms of lesser complications (PercuTwist: 10%, GWDF: 18.6%) and better decannulation rates (PercuTwist: 13.6%, GWDF: 3.75%). Most common indication for tracheostomy remains prolonged intubation; complication of OST is intra and early post-operative haemorrhage and that of PT being tube dislodgement and blockage. Outcomes in form of successful decannulation are with OST.

DOZ047.86: Open tracheostomy vs percutaneous tracheostomy in pediatrics

Abstract Introduction Tracheostomy is one of the most frequent surgical procedures in chronically ill pediatric patients and mechanical ventilatory assistance. The most widely used technique is open; however, the percutaneous technique guided by endoscopy is becoming increasingly common. Due to the current controversy, this study presents our experience in both techniques. Methodology Retrospective and descriptive analysis was carried out of 100 patients selected between 2010 and 2017. They were divided into two groups: open tracheostomy (TA) and percutaneous tracheostomy (PT), with 50 patients each according to the technique used. The age, diagnosis, indication of tracheostomy, days of intubation, endoscopic findings, cannula size, surgical time, intraoperative complications, and definitive decannulation were analyzed. A bibliographic review was also carried out. Results and Discussion The main indication for tracheostomy in both groups was prolonged orotracheal intubation (TA group 78% and TP group 82%). Children who underwent percutaneous tracheostomy were older in age (median age of 9 years for TA group and 2.5 years for PT group). There were no significant differences regarding the days of previous intubation: 19 days for the TA group and 13 days for the TP group. Weaning was achieved before mechanical ventilation for the TP group (7 days in the TP group and 19 days in the TA group). The surgical time was almost 50% less for the TP group (TA group 80 minutes and TP group 45 minutes). There were no intraoperative complications in any group. Distant complications were more frequent in the TA group (34%). Definitive decannulation was achieved in 17 patients in the TA group (34%) and in 19 patients in the TP group (38%). The long-term follow-up was performed for 8 months by the TA group (r: 1–36 m) and 9 months by the TP group (r: 1–48 m). Conclusions Percutaneous tracheostomy is feasible in children. Simultaneous endoscopic vision is recommended for the control of complications during the procedure. At the same time it allows us to diagnose preexisting injuries. The size of the tracheostomy kit should be adjusted to the age of the patient and the size of the tracheostomy cannula to perform a safe tracheostomy.

Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit

Introduction: Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU.&#x0D; Methods: A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost.&#x0D; Results: There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p&lt;0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p&lt;0.001).&#x0D; Conclusion: Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room.

Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit

Introduction: Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU. Methods: A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost. Results: There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p&lt;0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p&lt;0.001). Conclusion: Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room.

Incidence of tracheostomy in prolonged mechanically ventilated patient in the respiratory intensive care unit

Background Tracheostomy is considered for ill patients with respiratory failure with expected prolonged mechanical ventilation not only to facilitate pulmonary toilet, ventilator weaning but also decrease the direct laryngeal injury of endotracheal intubation. Aim The aim was to assess the incidence, indications, complications, and outcome of tracheostomy for patients with prolonged mechanical ventilation. Patients and methods A retrospective study was carried out over 10 years from January 2009 to December 2018 at the Respiratory Intensive Care Unit, El-Hussein University Hospital. This study included 120 patients who underwent open tracheostomy in the operation theater carried out by otorhinolaryngology surgeons. Complications of tracheostomy were documented. Results The age of the study group ranged from 45 to 82 years. The complications were two cases of bleeding, one case of cardiac arrest, two cases of Pneumothorax, three cases of stomal sepsis, and four cases of surgical emphysema. Laryngotracheal stenosis was observed in five patients and tubal obstruction in three patients. Conclusion Prolonged endotracheal intubation is the first main indication of tracheostomy in the respiratory ICU, although there were minimal complications from this procedure. Recommendation Early tracheostomy is recommended for patients who are expected to have prolonged tracheal intubation.

Anesthesia management of open tracheostomy patients: A single center experience

Anesthesia management of open tracheostomy patients: A single center experience