Prolonged Tracheostomy Research Articles

Four-layer technique for tracheostomy scar treatment.

One important complication of the tracheostomy procedure is the depressed scar left after the tube is removed. A depressed tracheostomy scar can be aesthetically and functionally unacceptable. Tracheostomy scar treatment aims to fill lost soft tissue volume and correct tracheal skin tug. There are various techniques described to manage post-tracheostomy scars, including the use of autologous tissue or allogenic material and the creation of muscle flaps. In this article, the authors introduce a surgical method using four layers: the scar, the strap muscles, the platysma muscle, and the skin. This procedure has been used in two patients with depressed scar after prolonged tracheostomy placement. The tracheal tug was eliminated in each patient, and an imperceptible cutaneous scar remained. In each case, patient satisfaction was complete. The authors recommend this technique as a simple and effective method of closure for these troublesome tracheostomy scars.

Oesotracheal Fistula Complicating Prolonged Tracheal Intubation

Esophageal fistula is a rare complication of tracheal intubation. Its mechanisms of occurrence are multiple, suggesting ischaemia of the tracheo-oesophageal wall. Diagnosis is difficult and sometimes delayed, and tracheoesophageal endoscopy remains the examination of choice. Imaging, particularly cervico-thoracic CT scans, can confirm a positive diagnosis by showing communication between the tracheal and oesophageal lumina. Treatment depends on the clinical picture and the severity of associated pulmonary lesions. Prognosis is correlated with the extent and nature of secondary complications. We report an exceptional case of an oesotracheal ¬fistula complicating a prolonged tracheostomy.

Decannulation Dilemmas - Timing Tracheostomy Tube Removal in Children with Craniofacial Deformities - A Retrospective Study.

Tracheostomy decannulation in children with craniofacial deformities poses challenges due to airway obstruction and the developing brain. This study aimed to compare decannulation outcomes based on age at tracheostomy and duration of cannulation so as to identify the best time for decannulation for children with long-term tracheostomy. This retrospective study included 12 children at a single centre who underwent decannulation after prolonged tracheostomy for craniofacial deformities. Data on demographics, clinical features, decannulation process and outcomes were collected. Children were divided into two groups: ≤6 years (n = 7) and >6 years (n = 5) at tracheostomy insertion. All children underwent successful decannulation without immediate complications. One case of mild tracheomalacia and one of subglottic stenosis were treated pre-decannulation. Children ≤6 years demonstrated better post-operative adaptation in swallowing and speaking compared to the >6 years group. Notably, early and prolonged tracheostomy in the ≤6 years group was associated with easier adaptation post-decannulation. Social interaction was another challenge, particularly for the >6 years group. The timing and duration of tracheostomy significantly impacts post-decannulation adaptation, likely due to factors such as neuroplasticity, muscle memory and psychological adjustment. This emphasises the need for comprehensive care, especially for older children. Early tracheostomy in children may allow them to adapt speech and swallowing skills, easing post-decannulation regain of skills. Conversely, older children with fully developed skills may struggle to relearn them after tracheostomy and decannulation. Age at tracheostomy and duration of cannulation influences decannulation outcomes in children with craniofacial deformities. Further research is crucial to develop targeted interventions for better post-operative care, particularly for older children.

Predictors and Associations of Prolonged Tracheostomy in Pediatric Cardiac Surgical Patients

Objectives: To describe the predictors and associations of prolonged tracheostomy duration in pediatric cardiac surgical patients. Method: Prospective study. All pediatric patients below 10 years of age who underwent tracheostomy after cardiac surgery from January 2019 to December 2019, were subdivided into short and long groups according to the tracheostomy duration during the intrahospital stay if more than 21 days. Different variables were compared. Results:1084 pediatric patients who underwent cardiac surgery during study period, 41 (3.7%) received tracheostomy. LT group was associated with univentricular repair (p=0.03) and sepsis (p=0.04), longer days of ventilation (p=0.0005), higher number of extubation trials (p=0.02), higher accidental tracheostomy tube dislodgement (p=0.048), ventilator-associated pneumonia (p=0.013), more days of feed interruption (p=0.0089), higher days of hospital stay (p=0.0001) and intensive care unit stay (p=0.0001). ST was associated with significantly higher anticipated longer duration of ventilation and earlier liberation from the ventilator as an indication for tracheostomy than LT (p=0.02). Conclusions: Univentricular repair, sepsis, longer mechanical ventilation, longer duration of intensive care unit and hospital stay, a higher number of extubation trials, higher number of accidental tracheostomy tube dislodgement, ventilator-associated pneumonia, higher days of feed interruption were found to be significant associations with a long duration tracheostomy.

A clinical study on the outcomes of tracheostomy in a tertiary care center: a prospective observational study

Background: Tracheostomy is most commonly performed in patients who have difficulty in weaning off a ventilator. This surgical procedure is associated with complications. The present study was aimed to evaluate the outcomes of tracheostomy with primary and secondary objectives. Methods: This study was done in department of ENT, KIMS Health, Trivandrum, Kerala. Based on the inclusion and exclusion criteria 81 patients were included in the study. Study procedure was explained and informed consent was obtained from close relatives or kin of patients. Demographic, clinical and complication data was collected from the patients and analysed with Statistical Package for Social Sciences (20.0 version) software. Correlation was done between complications and period of decanulation. Results: The study was done in 81 patients under gone tracheostomy. Maximum number of patients had age between 61-80 years. Males were more number than females. Portex type of tube used in maximum patients. 70 patients underwent elective and 11 underwent emergency tracheostomy. 74 patients underwent surgery in operation theatre and 5 in an ICU. Prolonged ventilation is the major indication for tracheostomy. Out of 81 patients 55 did not show any complications. 9 patients developed granulations. Significant correlation was observed between complications with period of decanulation. Conclusions: Postoperative care, regular follow up and proper nursing home care is essential for the patients who require prolonged tracheostomy and also to prevent complications with speedy recovery.

Differential immunophenotypes of neuronal cytoplasmic inclusions in the dentate gyrus of multiple system atrophy and their association with clinicopathological features.

Although hippocampal pathologies of multiple system atrophy (MSA) and their association with dementia have been reported, no studies have reported clinicopathological differences among MSA patients with and without neuronal cytoplasmic inclusions (NCIs) in the dentate gyrus (dntNCIs). We investigated hippocampal NCI pathology in 18 MSA patient autopsies, focusing on phosphorylated α-synuclein (pAS)- and phosphorylated tau (pT)-positive dntNCIs. There were 8 MSA patients without and 10 with dntNCIs. The latter group was subclassified by immunophenotype: those with pAS-positive dntNCIs (pAS-dntNCI subtype), those with pT-positive dntNCIs (pT-dntNCI subtype), and those with both types of dntNCIs. MSA patients with dntNCIs survived longer with prolonged tracheostomy and had dementia more frequently than those without dntNCIs. The brain weights of patients with dntNCIs were lower than those without dntNCIs. The presence of dementia was similar among the dntNCI subtypes. The pAS-dntNCI subtype was associated with longer survival and smaller brain weights; the pT-dntNCI subtype exhibited more frequent tau pathologies than the pAS-dntNCI subtype. Thus, MSA with dntNCIs is a possible pathological subtype of longer survivors that correlates with longer disease duration, prolonged tracheostomy, and high frequency of dementia. Understanding clinicopathological differences in MSA patients with and without dntNCIs may lead to improved personalized management strategies.

Severe secretion retention: a predictor of decannulation outcome in severe brain injury patients with tracheostomy.

Identifying accurate predictors of decannulation outcome is essential to ensure safe and timesaving decannulation. Studies indicated hypopharyngeal secretion retention is closely associated with compromised airway protection and patients with it are less likely to be decannulated. However, data verifying the link between secretion retention and decannulation outcome are lacking. The aim of this study was to identify the association between hypopharyngeal secretion-retention (indicated by Murray Secretion Scale [MSS]) and decannulation outcomes in a large cohort of severe acquired brain injury (sABI) patients with tracheotomy. To test the diagnostic performance of secretion retention in decision making of decannulation. Retrospective cross-sectional study. The setting of the study is neurorehabilitation department in a tertiary teaching hospital. A total of 144 adult patients with sABI and tracheostomy were retrospectively selected from the database from September 1, 2019, to August 31, 2021. The results of hypopharyngeal secretion-retention observed by fiberoptic endoscopy on the day that decision on decannulation was made were collected. The association between severity of secretion retention and decannulation outcomes was investigated through logistic regression, which was used to adjust covariates, including presence of food/liquid aspiration, decreased laryngeal sensation and conscious level. The optimal cut-off values of MSS for decannulation status prediction was determined by maximizing the Youden Index. One hundred twenty-one patients were included in the sample. The age was 55.6±15.2 years, 84 (69.4%) patients were male. Eighty-four (69.4%) of them were successfully decannulated during their hospital stay. Multivariable logistic regression analysis indicated severe secretion retention (MSS level3) was independently associated with prolonged tracheostomy (adjusted odds ratio 65.23, 95% CI 6.58-646.35, P<0.001). The sensitivity and specificity of MSS level3 to assess the probability of prolonged decannulation were 78.4% and 96.4%, respectively. The area under the curve was 0.894 (95% CI 0.819-0.969). Our results add to the evidence supporting screening of secretion retention severity in sABI population to identify patients at risk of prolonged tracheostomy. Whether decreasing secretion retention increases probability of successful decannulation deserves to be investigated by further study. This study could provide evidence for establishing objective decannulation criteria based on fiberoptic endoscopy and be helpful for implementing targeted rehabilitation interventions to promote successful decannulation.

The Predictors of Persistent Posttracheostomy Tracheocutaneous Fistula and Successful Surgical Closure.

Persistent tracheocutaneous fistula is a well-described complication of prolonged tracheostomy, with a prevalence of about 70% when decannulation is performed after more than 16 weeks. Predictors of its occurrence and outcome of treatment in adults remain unclear. The aim of the study was to describe our experience with the treatment of persistent posttracheostomy tracheocutaneous fistula in adults and to investigate factors associated with its formation and with the success of surgical closure. Retrospective cohort. Tertiary medical center. Patients who underwent open-approach tracheostomy between 2000 and 2020 were identified by database review. Data on background, need for surgical closure, and the surgical outcome was collected from the medical files and analyzed statistically between groups. Of 516 patients identified, 127 with sufficient long-term follow-up data were included in the study. Compared to patients whose fistula closed spontaneously (n = 85), patients who required surgical closure (n = 42) had significantly higher rates of smoking, laryngeal or thyroid malignancy, and airway obstruction as the indication for tracheostomy, on both univariate and multivariate analysis. In a comparison of patients with successful (n = 29) or failed (n = 11) surgical closure, factors significantly associated with failure were prior radiotherapy and lower preoperative albumin level, on univariate analysis. Smoking, thyroid or laryngeal malignancy, and airway obstruction indication are risk factors for persistent posttracheostomy tracheocutaneous fistula. Patients should be closely followed after tracheostomy and referred for surgery if the fistula fails to close. Before surgery, careful evaluation of the patient's nutritional status and consideration of prior radiation treatment is mandatory.

Tracheostomy decannulation rates in Japan: a retrospective cohort study using a claims database

Despite the exponential increase in the use of tracheostomy worldwide, rates of tracheostomy decannulation are unknown. We conducted a retrospective cohort study to investigate tracheostomy decannulation rates among adult patients over a two-year period and explored factors associated with prolonged tracheostomy. A health insurance claims database including 3,758,210 people in Japan was used. The primary outcome was time to decannulation. Assessed patient and hospital factors included age, sex, emergency endotracheal intubation, disease, and hospital size. A total of 917 patients underwent tracheostomy, and 752 met the eligibility criteria. Decannulation rates were 40.8% (95% confidence interval 36.8–44.9) at 3 months, 63.9% (58.4–69.0) at 12 months, and 65.0% (59.2–70.3) at 24 months. Hazard ratios of patient and hospital factors for tracheostomy decannulation were 0.44 for age (65–74 years) (95% confidence interval 0.28–0.68), 0.81 (0.63–1.05) for female sex, and 0.59 (0.45–0.76) for emergency endotracheal intubation. Cerebrovascular disease, head injuries, and cardiac arrest had lower hazard ratios compared to other diseases. Decannulation rates among adult patients in Japan increased rapidly up to 3 months after tracheostomy, reaching a plateau after 12 months. Older age, female sex, emergency endotracheal intubation, cerebrovascular disease, head injuries, and cardiac arrest were associated with prolonged tracheostomy.

Free flap volume changes: can we predict ideal flap size and future volume loss?

Under anticipating free flap volume may lead to deficits in functional and aesthetic outcomes. Alternatively, over anticipating may compromise airway patency, lead to prolonged tracheostomy dependence or poor oral intake, and cause poor cosmetic outcomes. Surgeons face a fine balance in creating a functional reconstruction that accounts adequately for volume changes in the future. Recent studies are elucidating the complex and multifactorial volume changes of free flaps that are dependent on postoperative radiation, flap composition, weight fluctuations, and site of reconstruction. Radial forearm free flaps typically lose about 40% of their volume, regardless of patient-dependent variables. Muscle flaps exhibit significant fluctuations with patient-dependent variables. Adipose-prevalent flaps are likely more resistant to radiation effects but are more dependent on postoperative weight changes in the patient. Free flap volume over anticipation recommendations range from 1.1 to 1.4 times the final volume to account for future atrophy but patient characteristics including postoperative radiation, anticipated weight loss, and flap composition should be incorporated into intraoperative decisions for final flap volume.

Tracheostomy decannulation protocol in patients with prolonged tracheostomy referred to a rehabilitation hospital: a prospective cohort study

BackgroundThe aim of the study was to assess the feasibility of a standardized tracheostomy decannulation protocol in patients with prolonged tracheostomy referred to a rehabilitation hospital.MethodsThis prospective cohort study recruited conscious patients with prolonged tracheostomy who were referred to the pulmonary rehabilitation department of a tertiary rehabilitation hospital between January 2019 and December 2021. A pulmonary rehabilitation team used a standardized tracheostomy decannulation protocol developed by the authors. The primary outcome was the success rate of decannulation. Secondary outcomes included decannulation time from referral and reintubation rate after a follow-up of 3 months.ResultsOf the 115 patients referred for weaning from mechanical ventilation and tracheostomy decannulation over the study period, 80.0% (92/115) were finally evaluated for tracheostomy decannulation. The mean time of tracheostomy in patients transferred to our department was 70.6 days. After assessment by a multidisciplinary team, 57 patients met all the decannulation indications and underwent decannulation. Fifty-six cases were successful, and 1 case was intubated again. The median time to decannulation after referral was 42.7 days. Reintubation after a follow-up of 3 months did not occur in any patients.ConclusionsA standardized tracheostomy decannulation protocol implemented by a pulmonary rehabilitation team is associated with successful tracheostomy decannulation in patients with prolonged tracheostomy. Not every tracheostomy patient must undergo upper airway endoscopy before decannulation. Tolerance of speaking valve continuously for 4 h can be used as an alternative means for tube occlusion. A swallow assessment was used to evaluate the feeding mode and did not affect the final decision to decannulate.Trial registration: 2018bkky-121.

67 Transient Dysphagia After Burn Injury in Children: An Under-identified Problem

IntroductionSeverely burn injured pediatric patients are at risk of dysphagia (difficulty swallowing) due to prolonged intubation or tracheostomy placement. To improve the early identification and treatment of dysphagia, we implemented a swallowing assessment protocol. We hypothesized that the swallowing assessment protocol is effective for identifying and treating dysphagia after prolonged intubation.MethodsBetween October 2016 and December 2020, pediatric burn patients with facial burn injuries, prolonged mechanical ventilation, tracheostomy, inhalation injury and/or anoxic events were placed on the swallowing protocol. The protocol included a Transitional Swallow Screen (TSS) performed within 24 hours after extubation or decanulation by an advanced practice swallow occupational therapist. If signs of dysphagia were noted, recommendations on diet consistency and treatment for positioning and feeding were implemented. Regular reassessments continued until the patient was determined to have regained premorbid swallowing function. Data on patient demographics, burn characteristics, dysphagia, treatment and outcome were collected. Descriptive statistics were used to describe the population, treatments and outcome.ResultsA total of 33 pediatric burn patients were included. Mean age was 8.1±5.9 years and TBSA was 48.1±26.8%. Median time from injury to swallow assessment was 45 (21-81) days. The majority of patients suffered from flame burns (70%). Almost all of the patients were intubated (97%) and 85% underwent a tracheostomy. Patients had a facial burn (73%), inhalation injury (24%) or anoxic injury (15%). Transient dysphagia was diagnosed in 79% of patients. Subsequent therapeutic procedures as a result of the TSS included: neurologic re-education (30%), swallow therapy exercises (55%), desensitization (42%), and patient/ family training and supervision (79%). All patients eventually returned to normal swallow and regular diet. This occurred at an average of 72.5+46.7 days post injury and 8.2+18.0 days post swallow assessment.ConclusionsPediatric patients with substantial burn injury may not only be at risk for aspiration but also have other forms of dysphasia that require intervention. Implementation of a swallowing protocol can identify patients who required further therapeutic intervention and can guide the recovery of safe swallowing and functional oral intake.

Effects of a modified Singh's algorithm care bundle on cannulation success rate in patients with neurological sequelae.

Prolonged tracheostomy tube placement leads to depression, communicative inconvenience, reduced life quality, and health complications. We retrospectively examined the effects of a modified Singh's algorithm (MOSA) care bundle in tracheostomy tube removal in patients with neurological sequelae. We retrieved medical records of 22 tracheostomized patients admitted to our early rehabilitation ward from 1 January 2018 to 31 December 2020 and compared their clinical outcomes before and after the MOSA introduction. We used a decannulation checklist and outcomes of decannulation training to judge the decannulation opportunity in the intervention group. In the control group, the patients received decannulation based on professional judgments. Age, gender, body mass index, and admission diagnosis were not significantly different between the two groups. While 10 of 13 patients (76.9%) successfully decannulated in the intervention group, only 1 of 9 patients in the control group succeeded (11.1%; p=0.008). The decannulation evaluation checklist revealed no statistically significant difference between the two groups except that the intervention group received more airway patency evaluations (p=0.027). None of the decannulated patients required tracheostomy tube reinsertion before discharge, and no complications appeared. Our study supports the feasibility of MOSA in aiding decannulation among patients with neurological illnesses. Further cluster randomized controlled trials and studies of decision aids and shared decision-making are warranted to help promote active decannulation.

Barriers to Tracheostomy Weaning: A Case Report of Sialorrhea in a Patient with Persistent Seizure Activity and Head Injury

We describe a single case following the acute hospital journey of a 54 year old admitted due to seizure activity and associated traumatic brain injury. The patient was cared for in a specialist neurosurgical centre. The hospital stay was complicated by difficulty managing seizure activity. The patient had several failed extubations due to high oral secretion burden, resulting in a percutaneous tracheostomy. Prolonged tracheostomy weaning ensued due to the impact of seizure activity, pharmacological interventions to manage both seizure activity and secretion management (including the use of Botulinum Toxin to the salivary glands), and dysphagia. Successful decannulation of tracheostomy was achieved 141 days after insertion and was associated with a reduction in anti-epileptic drug administration.

Incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning.

Background:Liberation from prolonged tracheostomy ventilation involves ventilator weaning and removal of the tracheal cannula (referred to as decannulation). This study evaluated the incidence, causes, and predictors of unsuccessful decannulation following prolonged weaning.Methods:Observational retrospective cohort study of 532 prolonged mechanically ventilated, tracheotomized patients treated at a specialized weaning center between June 2013 and January 2021. We summarized the causes for unsuccessful decannulations and used a binary logistic regression analysis to derive and validate associated predictors.Results:Failure to decannulate occurred in 216 patients (41%). The main causes were severe intensive care unit (ICU)-acquired dysphagia (64%), long-term ventilator dependence following weaning failure (41%), excessive respiratory secretions (12%), unconsciousness (4%), and airway obstruction (3%). Predictors of unsuccessful decannulation from any cause were age [odds ratio (OR) = 1.04 year−1; 95% confidence interval (CI), 1.02–1.06; p < 0.01], body mass index [0.96 kg/m2 (0.93–1.00); p = 0.027], Acute Physiology and Chronic Health Evaluation II (APACHE-II) score [1.05 (1.00–1.10); p = 0.036], pre-existing non-invasive home ventilation [3.57 (1.51–8.45); p < 0.01], percutaneous tracheostomies [0.49 (0.30–0.80); p < 0.01], neuromuscular diseases [4.28 (1.21–15.1); p = 0.024], and total mechanical ventilation duration [1.02 day−1 (1.01–1.02); p < 0.01]. Regression models examined in subsets of patients with severe dysphagia and long-term ventilator dependence as the main reason for failure revealed little overlapping among predictors, which even showed opposite effects on the outcome. The application of non-invasive ventilation as a weaning technique contributed to successful decannulation in 96 of 221 (43%) long-term ventilator-dependent patients following weaning failure.Conclusion:Failure to decannulate after prolonged weaning occurred in 41%, mainly resulting from persistent ICU-acquired dysphagia and long-term ventilator dependence following weaning failure, each associated with its own set of predictors.

Артеріотрахеальна нориця як ускладнення пролонгованої трахеостомії

У статті наведений клінічний випадок рідкісного та тяжкого ускладнення пролонгованої трахеостомії у вигляді формування нориці між просвітом трахеї та брахіоцефальною артерією та розвитку масивної кровотечі з неї. Лікування пацієнта було ургентним й успішним. Пацієнту проведене оперативне втручання з наступним алопротезуванням плечоголовного стовбура (використаний судинний протез Vascutec 8 мм) та формуванням анастомозу методикою безперервного шва. На 17-ту післяопераційну добу пацієнта виписали додому в задовільному стані.

Factors associated with short versus prolonged tracheostomy length of cannulation and the relationship between length of cannulation and adverse events

BackgroundTracheostomy management and care is multifaceted and costly, commonly involving complex patients with prolonged hospitalisation. Currently, there are no agreed definitions of short and prolonged length of tracheostomy cannulation (LOC) and no consensus regarding the key factors that may be associated with time to decannulation. ObjectivesThe aims of this study were to identify the factors associated with short and prolonged LOC and to examine the number of tracheostomy-related adverse events of patients who had short LOC versus prolonged LOC. MethodsA retrospective observational study was undertaken at a large metropolitan tertiary hospital. Factors known at the time of tracheostomy insertion, including patient, acuity, medical, airway, and tracheostomy factors, were analysed using Cox proportional hazards model and Kaplan–Meier survival curves, with statistically significant factors then analysed using univariate logistic regression to determine a relationship to short or prolonged LOC as defined by the lowest and highest quartiles of the study cohort. The number of tracheostomy-related adverse events was analysed using the Kaplan–Meier survival curve. ResultsOne hundred twenty patients met the inclusion criteria. Patients who had their tracheostomy performed for loss of upper airway were associated with short LOC (odds ratio [OR]: 2.30 (95% confidence interval [CI]: 1.01–5.25) p = 0.049). Three factors were associated with prolonged LOC: an abdominal/gastrointestinal tract diagnosis (OR: 5.00 [95% CI: 1.40–17.87] p = 0.013), major surgery (OR: 2.51 [95% CI: 1.05–6.01] p = 0.038), and intubation for >12 days (OR: 0.30 [95% CI: 0.09–0.97] p = 0.044). Patients who had one or ≥2 tracheostomy-related adverse events had a high likelihood of prolonged LOC (OR: 5.21 [95% CI: 1.95–13.94] p = ≤0.001 and OR: 12.17 [95% CI: 2.68–55.32] p ≤ 0.001, respectively). ConclusionSome factors that are known at the time of tracheostomy insertion are associated with duration of tracheostomy cannulation. Tracheostomy-related adverse events are related to a high risk of prolonged LOC.

Mechanical power normalized to lung-thorax compliance predicts prolonged ventilation weaning failure: a prospective study

BackgroundMechanical power (MP) of artificial ventilation, the energy transferred to the respiratory system, is a chief determinant of adequate oxygenation and decarboxylation. Calculated MP, the product of applied airway pressure and minute ventilation, may serve as an estimate of respiratory muscle workload when switching to spontaneous breathing. The aim of the study was to assess MP’s discriminatory performance in predicting successful weaning from prolonged tracheostomy ventilation.MethodsProspective, observational study in 130 prolonged mechanically ventilated, tracheotomized patients in a specialized weaning center. Predictive weaning outcome ability of arterial blood gas analyses and indices derived from calculated MP at beginning and end of weaning was determined in terms of area under receiver operating characteristic curve (AUROC) and measures derived from k-fold cross-validation (likelihood ratios, diagnostic odds ratio, F1 score, and Matthews correlation coefficient [MCC]).ResultsForty-four (33.8%) patients experienced weaning failure. Absolute MP showed poor discrimination in predicting outcome; whereas specific MP (MP normalized to dynamic lung-thorax compliance, LTCdyn-MP) had moderate diagnostic accuracy (MCC 0.38; AUROC 0.79, 95%CI [0.71‒0.86], p < 0.001), further improved by correction for corresponding mechanical ventilation PaCO2 (termed the power index of the respiratory system [PIrs]: MCC 0.52; AUROC 0.86 [0.79‒0.92], p < 0.001). Diagnostic performance of MP indices increased over the course of weaning, with maximum accuracy immediately before completion (LTCdyn-MP: MCC 0.49; AUROC 0.86 [0.78‒0.91], p < 0.001; PIrs: MCC 0.68; AUROC 0.92 [0.86‒0.96], p < 0.001).ConclusionsMP normalized to dynamic lung-thorax compliance, a surrogate for applied power per unit of ventilated lung volume, accurately discriminated between low and high risk for weaning failure following prolonged mechanical ventilation.

Nasal Mucociliary Clearance in Prolonged Tracheostomy Patients: A Prospective Case-Control Study.

Prolonged tracheostomy bypasses the upper airways leading to absence or reduction of nasal airflow. This altered nasal physiology not only impairs olfaction but also may cause mucociliary dysfunction and consequent nasal crusting and rhinosinusitis.To objectively evaluate the extent of nasal mucociliary impairment in patients with prolonged duration of tracheostomy.This is a prospective case-control study done in a tertiary care center wherein the nasal mucocilary function was assessed by saccharin test in patients who were tracheostomized for a period of more than 4weeks and the saccharin transit time (time taken to appreciate the sweet taste after endoscopic insertion of saccharin pellet on anterior end of inferior turbinate) was compared by the same test in age and sex matched healthy individuals. The saccharin transit time in the two groups was statistically analyzed using student t-test. Mean saccharin transit time in 30 patients with prolonged tracheostomy was 934.97s with a standard deviation of 75.95s whereas in 30 controls, the meantime was 447.4s with a standard deviation of 63.22s, which was statistically significant (p < 0.001). Conclusion Prolonged duration of tracheostomy leads to impaired nasal mucociliary clearance, which in turn could cause chronic rhinosinusitis.

Tracheocutaneous fistula closure by two hinged turnover flap and a fasciocutaneous pivot flap

Tracheocutaneous fistula is a known complication in patient who are tracheostomised for long duration. A 18-year-old girl presented in our department who was tracheostomised 2 years back, to secure airway, following a road traffic accident and tracheal injury. She underwent multiple surgeries to maintain upper airway, which were successful, but developed a tracheocutaneous fistula due to prolonged tracheostomy. Surgical closure of the fistula was done using a two hinged turnover flap and a fasciocutaneous pivot flap. The patient was discharged on 6 day of the surgery with no complication and no recurrence. Our technique explains one of the many procedures used to close a tracheocutaneous fistula, mentioned in literature. It is minimally invasive and is associated with minimal chance of tracheal stenosis and recurrence.