Tracheostomy Cannula Research Articles

Application of a ventilator associated pneumonia prevention guideline and outcomes: A quasi-experimental study

ObjectiveVentilator associated pneumonia is the most frequent health-care-associated infection in Intensive Care Units, causing increased antibiotic consumption and resistance, length of stay, plus multiple health and economic costs. The aim of the study was to assess whether a customised guideline implementation would improve ventilator-associated pneumonia incidence and associated intensive care outcomes. DesignThis was a quasi-experimental, before-after study consisting of pre-intervention, intervention and post-intervention periods. SettingThree intensive care units at a well-known Portuguese hospital centre. InterventionA set of eight recommendations was implemented after a guideline adaptation process. PatientsAdult patients admitted to the intensive care units over the study periods, aged 18 years or older and under invasive ventilation through an endotracheal tube or tracheostomy cannula. Measurements and main resultsData related to patient characterisation, guideline compliance and health outcomes were analysed. From a population of 1970 patients, a study sample of 828 was studied. Compliance with the recommendations was high. We identified a significant reduction in the incidence of ventilator-associated pneumonia in two of the units (p = 0.020 and p = 0.001) and a reduction in duration of invasive ventilation, intensive care unit length of stay and mortality in all the three units. We found associations between some recommendations and the implementation of the set of recommendations and intensive care unit length of stay, duration of invasive ventilation and mortality. ConclusionThe implementation of an evidence-based, locally customised guideline may improve ventilator associated pneumonia incidence and several outcomes.

Management of Tracheal Agenesis with Esophageal Intubation Can Save Lives: A Reminder for Anaesthesiologist and Neonatologist

Introduction: Tracheal agenesis (TA) is a rare congenital anomaly presenting at birth with respiratory distress and difficult airway management. Polyhydramnios and premature labor are often pathologies associated with these pregnancies, which makes patient management more difficult. TA is often associated with other organ system anomalies (such as cardiovascular, renal and limb anomalies). Hereby, we report a case of tracheal agenesis who is presenting to our pediatric surgery and anesthesiology clinics. Case Presentation: An 30 weeks’ premature infant was transferred to our neonatal intensive care unit, with the diagnosis of tracheal agenesis. He had failed attempts at intubations because of failing to visualize the vocal cords. It was learned that immediately, his respiratory tract was secured via cervical oesophagostomy using long tracheostomy cannula and the infant was subsequently stabilized by gently ventilated. The diagnosis was confirmed on CT scan. It was performed distal oesophageal banding at the upper gastroesophageal junction with gastrostomy. On postoperative day 12 in intensive care unit, the baby further got complicated with a developing cyanosis and circulatory insufficiency. Cardiorespiratory arrest was developed and the infant died after 40 minutes after resuscitation. Conclusions: Successful approach at tracheal agenesis depends on, either prenatal diagnosis or recognition of this situation immediately after birth. In recent years, long time survival has been reported in tracheal agenesis through various surgical approaches. Therefore, it should be remembered that early esophageal ventilation is a life-saving alternative.

Management strategies of granulation in tracheal post-tracheostomy caused by prolonged mechanical ventilation

Objective:To analyze the effect and safety of treatment in patients with airway stenosis caused by tracheotomy for mechanical ventilation. Method: We treated the patients with airway stenosis caused by granulation tissue. The patients with grade Ⅰ,Ⅱ airway stenosis were treated with adjustable flange tracheostomy tube, and the holmium laser under a fibro-laryngoscope were applied for the patients with grade Ⅲ airway stenosis.Two hundred and sixteen patients were enrolled in this study. Forty-four patients had been found tracheal stenosis caused by granulomatous hyperplasia, accounting for 20.4% of all patients, including 12 cases of gradeⅠ, 18 cases of grade Ⅱ, and 14 cases of grade Ⅲ.Result:Thirty patients with grade Ⅰ and Ⅱ were replaced with adjustable flange tracheostomy cannula. Fourteen cases of grade Ⅲ airway stenosis were treated with Ho:YAG laser under a fibro laryngoscope. All cases were completed operation successfully. None of cases bleeding, perforated and asphyxia during operation. The clinical symptoms disappeared after operation, and endoscopy showed that airways of patients were smooth. No recurrence were found after operation.Conclusion: Replacement of adjustable flange tracheostomy tube and Ho:YAG laser can safely and effectively treat airway obstruction caused by tracheal granulation tissue hyperplasia after tracheotomy.

Preliminary experience on the safety and tolerability of mechanical \u201cinsufflation-exsufflation\u201d in subjects with artificial airway

BackgroundCatheter suctioning of respiratory secretions in intubated subjects is limited to the proximal airway and associated with traumatic lesions to the mucosa and poor tolerance. “Mechanical insufflation-exsufflation” exerts positive pressure, followed by an abrupt drop to negative pressure. Potential advantages of this technique are aspiration of distal airway secretions, avoiding trauma, and improving tolerance.MethodsWe applied insufflation of 50 cmH2O for 3 s and exsufflation of − 45 cmH2O for 4 s in patients with an endotracheal tube or tracheostomy cannula requiring secretion suctioning. Cycles of 10 to 12 insufflations-exsufflations were performed and repeated if secretions were aspirated and visible in the proximal artificial airway. Clinical and laboratory parameters were collected before and 5 and 60 min after the procedure. Subjects were followed during their ICU stay until discharge or death.ResultsMechanical insufflation-exsufflation was applied 26 times to 7 male and 6 female subjects requiring suctioning. Mean age was 62.6 ± 20 years and mean Apache II score 23.3 ± 7.4 points. At each session, a median of 2 (IQR 1; 2) cycles on median day of intubation 11.5 (IQR 6.25; 25.75) were performed. Mean insufflation tidal volume was 1043.6 ± 649.9 ml. No statistically significant differences were identified between baseline and post-procedure time points. Barotrauma, desaturation, atelectasis, hemoptysis, or other airway complication and hemodynamic complications were not detected. All, except one, of the mechanical insufflation-exsufflation sessions were productive, showing secretions in the proximal artificial airway, and were well tolerated.ConclusionsOur preliminary data suggest that mechanical insufflation-exsufflation may be safe and effective in patients with artificial airway. Safety and efficacy need to be confirmed in larger studies with different patient populations.Trial registrationEudraCT 2017-005201-13 (EU Clinical Trials Register).

Role of Swallowing Function of Tracheotomised Patients in Major Head and Neck Cancer Surgery.

Tracheotomy is a frequent procedure in extended head and neck cancer surgery and known to be a risk factor for prolonged hospitalization. The authors hypothesized that the clinical course and delayed decannulation of patients are not only influenced by airway narrowing, but also by a compromised postoperative swallowing function. The investigators implemented a retrospective cohort study. The sample was composed of a tertiary care center patients who underwent major head and neck cancer surgery, each receiving a tracheostomy. Data collected include general clinical data as well as endoscopical evaluation of swallowing function and aspiration rate. Descriptive and bivariate statistics were computed and the P value was set at.05. The sample was composed of 96 patients with an average age of 64.2 and sex ratio of 1.4:1 (m:f). There was a strong statistically significant relation between swallowing function and timing of decannulation (P < 0.001) and duration of hospitalization (P < 0.001). Age (P = 0.55), sex (P = 0.54), tumor size (P = 0.12), general diseases (P = 0.24), distant metastases (P = 0.15), or extent of neck dissection (P = 0.15) were not significantly associated to swallowing function. Permanent cannulation was significantly correlated to a primary cancer of the soft palate or base of the tonge (P < 0.001). The results of this study confirm the importance of the evaluation of swallowing function before the removal of the tracheotomy cannula in head and neck cancer patients.

Humidification and heating of inhaled gas in patients with artificial airway. A narrative review.

Instrumentation of the airways in critical patients (endotracheal tube or tracheostomy cannula) prevents them from performing their function of humidify and heating the inhaled gas. In addition, the administration of cold and dry medical gases and the high flows that patients experience during invasive and non-invasive mechanical ventilation generate an even worse condition. For this reason, a device for gas conditioning is needed, even in short-term treatments, to avoid potential damage to the structure and function of the respiratory epithelium. In the field of intensive therapy, the use of heat and moisture exchangers is common for this purpose, as is the use of active humidification systems. Acquiring knowledge about technical specifications and the advantages and disadvantages of each device is needed for proper use since the conditioning of inspired gases is a key intervention in patients with artificial airway and has become routine care. Incorrect selection or inappropriate configuration of a device can have a negative impact on clinical outcomes. The members of the Capítulo de Kinesiología Intensivista of the Sociedad Argentina de Terapia Intensiva conducted a narrative review aiming to show the available evidence regarding conditioning of inhaled gas in patients with artificial airways, going into detail on concepts related to the working principles of each one.

Virtual 3D planning of tracheostomy placement and clinical applicability of 3D cannula design: a three-step study

AimWe aimed to investigate the potential of 3D virtual planning of tracheostomy tube placement and 3D cannula design to prevent tracheostomy complications due to inadequate cannula position.Materials and methods3D models of commercially available cannula were positioned in 3D models of the airway. In study (1), a cohort that underwent tracheostomy between 2013 and 2015 was selected (n = 26). The cannula was virtually placed in the airway in the pre-operative CT scan and its position was compared to the cannula position on post-operative CT scans. In study (2), a cohort with neuromuscular disease (n = 14) was analyzed. Virtual cannula placing was performed in CT scans and tested if problems could be anticipated. Finally (3), for a patient with Duchenne muscular dystrophy and complications of conventional tracheostomy cannula, a patient-specific cannula was 3D designed, fabricated, and placed.Results(1) The 3D planned and post-operative tracheostomy position differed significantly. (2) Three groups of patients were identified: (A) normal anatomy; (B) abnormal anatomy, commercially available cannula fits; and (C) abnormal anatomy, custom-made cannula, may be necessary. (3) The position of the custom-designed cannula was optimal and the trachea healed.ConclusionsVirtual planning of the tracheostomy did not correlate with actual cannula position. Identifying patients with abnormal airway anatomy in whom commercially available cannula cannot be optimally positioned is advantageous. Patient-specific cannula design based on 3D virtualization of the airway was beneficial in a patient with abnormal airway anatomy.

Application of a flexible lightwand in percutaneous dilatational tracheotomy

Abstract Purpose By comparing flexible lightwand-assisted and conventional endotracheal tube (ETT) withdrawal in percutaneous dilatational tracheotomy (PDT), this paper aims to provide guidance for precise ETT withdrawal by anesthesiologists and accurate determination of the incision site by surgeons. Methods Sixty patients who underwent PDT in our hospital were randomly divided into the lightwand group (Group L, n = 30) and the withdrawal group (Group W, n = 30) using the envelope method. For Group L patients, a flexible lightwand was inserted into an ETT (based on the patient's size), the light source was positioned at the root of the cuff, and the depth from the root of the cuff to the end of the ETT was marked. The flexible lightwand was inserted into the patient's ETT to the marked depth. The ETT along with the flexible lightwand was withdrawn until the highlighted spot was located at the level of the thyroid cartilage. The incision site was approximately 3 finger widths (approximately 4.8 cm) below the highlighted spot. For Group W patients, the ETT was withdrawn to a tube depth of 17 cm at the upper incisors in males and 15 cm in females, and surgeons determined incision sites without assistance. The following metrics were recorded for the two groups: occurrences of inadvertent extubation, ETT puncture and cuff rupture; success rate of first puncture; hypoxia rate; SpO2 at the time of tracheostomy cannula intubation (T1); and postoperative hemorrhage rate. Results Inadvertent extubation, ETT puncture and cuff rupture occurred significantly less frequently in Group L than in Group W, and the success rate of first puncture and SpO2 at T1 were markedly higher in Group L than in Group W. Moreover, significant between-group differences in hypoxia rate and postoperative hemorrhage rate were observed. Conclusions The use of a flexible lightwand in PDT is a safe and effective approach. This approach can effectively and directly guide precise ETT repositioning and provide incision site confirmation with few intra- and postoperative anesthesia-related or operative complications compared with the traditional technique of ETT withdrawal to a pre-determined depth.

Application of a flexible lightwand in percutaneous dilatational tracheotomy

PurposeBy comparing flexible lightwand-assisted and conventional endotracheal tube (ETT) withdrawal in percutaneous dilatational tracheotomy (PDT), this paper aims to provide guidance for precise ETT withdrawal by anesthesiologists and accurate determination of the incision site by surgeons. MethodsSixty patients who underwent PDT in our hospital were randomly divided into the lightwand group (Group L, n=30) and the withdrawal group (Group W, n=30) using the envelope method. For Group L patients, a flexible lightwand was inserted into an ETT (based on the patient's size), the light source was positioned at the root of the cuff, and the depth from the root of the cuff to the end of the ETT was marked. The flexible lightwand was inserted into the patient's ETT to the marked depth. The ETT along with the flexible lightwand was withdrawn until the highlighted spot was located at the level of the thyroid cartilage. The incision site was approximately 3 finger widths (approximately 4.8cm) below the highlighted spot. For Group W patients, the ETT was withdrawn to a tube depth of 17cm at the upper incisors in males and 15cm in females, and surgeons determined incision sites without assistance. The following metrics were recorded for the two groups: occurrences of inadvertent extubation, ETT puncture and cuff rupture; success rate of first puncture; hypoxia rate; SpO2 at the time of tracheostomy cannula intubation (T1); and postoperative hemorrhage rate. ResultsInadvertent extubation, ETT puncture and cuff rupture occurred significantly less frequently in Group L than in Group W, and the success rate of first puncture and SpO2 at T1 were markedly higher in Group L than in Group W. Moreover, significant between-group differences in hypoxia rate and postoperative hemorrhage rate were observed. ConclusionsThe use of a flexible lightwand in PDT is a safe and effective approach. This approach can effectively and directly guide precise ETT repositioning and provide incision site confirmation with few intra- and postoperative anesthesia-related or operative complications compared with the traditional technique of ETT withdrawal to a pre-determined depth.

PRACTICAL ASPECTS ABOUT TRACHEOSTOMY CANNULA: A SYSTEMATIC REVIEW

Context: Since the first sterling tracheostomy cannula was developed, in the late 1800's, and some modernization has occurred, there have been several reports on flaws surrounding their care. Objetive: Provide a comprehensive review about tracheostomy cannulas. Methods: A systematic search of the PubMed and Medline databases was conducted on closed drainage system using the following keyword combination: tracheostomy AND cannula. Results: From eight hundred eight-three articles retrieved after our preliminary search, 17 articles were chosen for final analysis. Representative schemes were drawn to better understanding of the three distinguished materials types and ten different components (faceplate, cannula, radiopaque line in the cannula, inner cannula, universal hub 15mm, pressure line, pilot balloon, cuff, subglottic aspiration system, obturator), as well as their concerns. Conclusions: Knowing and understanding tracheostomy cannulas. particularities may imply in a better approach to the patients, and in minimizing institutional costs.

Prevalence of skeletal muscle mass loss and its association with swallowing function after cardiovascular surgery.

The aim of this study was to assess the prevalence of skeletal muscle mass loss and its association with swallowing function in patients with dysphagia after cardiovascular surgery. A retrospective cohort study was performed in 65 consecutive patients with dysphagia after cardiovascular surgery who were prescribed speech therapy. Skeletal muscle index (SMI) was calculated as total psoas muscle area assessed via abdominal computed tomography divided by height squared. Cutoff values were 6.36cm2/m2 for men and 3.92cm2/m2 for women. The Food Intake Level Scale (FILS) was used to assess the swallowing function. Univariate and ordered logistic regression analyses were applied to examine the associations between skeletal muscle mass loss and dysphagia. The study included 50 men and 15 women (mean age 73±8y). The mean SMI was 4.72±1.37cm2/m2 in men and 3.33±1.42cm2/m2 in women. Skeletal muscle mass loss was found in 53 (82%) patients. Twelve had tracheostomy cannula. Thirteen were non-oral feeding (FILS levels 1-3), 5 were oral food intake and alternative nutrition (levels 4-6), and 47 were oral food intake alone (levels 7-9) at discharge. The FILS at discharge was significantly lower in patients with skeletal muscle mass loss. Ordered logistic regression analysis of swallowing function showed that skeletal muscle mass loss and tracheostomy cannula were associated independently with the FILS at discharge. The prevalence of skeletal muscle mass loss is very high, and skeletal muscle mass loss is associated with swallowing function.

Study of the force generated by the curvature and deformation of pediatric tracheostomy cannula

Study of the force generated by the curvature and deformation of pediatric tracheostomy cannula

Airway stenting in the management of iatrogenic tracheal injuries: 10-Year experience.

Iatrogenic tracheal injury (ITI) is a rare yet severe complication of endotracheal tube (ETT) placement or tracheostomy. ITI is suspected in patients with clinical and/or radiographic signs or inefficient mechanical ventilation (MV) following these procedures. Bronchoscopy is used to establish a definitive diagnosis. We conducted a retrospective, single-centre chart review of 35 patients between 2004 and 2014. Depending on the nature and location of ITI and need for MV, patients were triaged to surgical repair, endoscopic management with airway stents or conservative treatment consisting of ETT or tracheotomy cannula (TC) placement distal to the wound and bronchoscopic surveillance. Three of the four patients (11.43%) presenting with tracheoesophageal fistula (TEF) underwent surgery. Seven patients (20%) who did not require MV underwent endoscopic surveillance. Of the 24 ventilated patients (68.57%), 7 with ITI in the lower trachea were treated with silicone Y-stent (ETT or TC was placed inside the stent) and 17 patients with ITI in the upper trachea were managed by placing ETT or TC cuff distal to the injury. Overall management success, defined as complete healing of the ITI, was seen in 88.57% of patients. Four patients (11.43%) died of non-ITI-related comorbidities. Conservative management should be considered in non-ventilated patients with ITI and when ITI is located in the upper trachea of ventilated patients where ETT or TC bypasses the injury. Airway stenting should be considered in ventilated patients with ITI located in the lower trachea. Surgery should be reserved for TEF and conservative and endoscopic management failure.

How to perform a tracheostomy dressing and inner cannula change.

RATIONALE AND KEY POINTS: Proactive tracheostomy management increases patient safety and reduces adverse events. ▶ A cleaning regimen performed every four hours reduces the risk of a blocked tracheostomy cannula, complete tube occlusion and respiratory arrest. ▶ Sterile tracheostomy dressings allow secretions from the stoma to be absorbed and prevent pressure damage from the tracheostomy tube. ▶ Regular dressing changes and skin inspection permit timely identification of inflammatory processes and skin excoriation, enabling prompt treatment to be instigated. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article will change your practice. 2. How you intend to develop your knowledge and skills regarding tracheostomy management.

Alveolocapillary membrane permeability in experimental model of ventilator induced lung injury

Aim: to assess alveocapillary membrane permeability for the whole protein, middle molecular peptides and some lipoperoxidation markers depending on respiratory volume using in reproduction of ventilator induced lung injury model. Material and methods: Experiments were carried out on 15 laboratory rats- males (body mass 180–240 gr.) of “Vistar” line). The mechanical pulmonary ventilation in rats was carried out using tracheostomy cannula ALV Hamilton G 5 apparatus during 2 hours under the total anesthesia with sodium thiopental at a rate of 40 mg|kg of animal body mass. The initial parameters of ventilation were equal in all animals: Inspiratory time = 0,5 seconds; respiratory rate = 60 – 76/minute; pressure at the end of expiration (PEE) = 0 - 2 sm. of water column; inspiration-expiration ratio (I:E) = 1:1 or 1:2. Depending on the size of respiratory volume (RV) animal were divided into 3 groups (n=5). Animals with RV=7 ml/kg of body mass formed the first group (the control one). The second group included animals with RV = 20 ml/kg of body mass (the moderate volutrauma) and the third one included animals with RV = 40 ml/kg of body mass (the heavy volutrauma). The bronchoalveolar lavage was carried out on isolated lungs with the volume of filling at a rate 5 ml of 0,9 % sodium chloride solution for 1 g of pulmonary tissue and there was received nearly 2,5 + 0,5 ml of lavage liquid (sodium chloride solution + bronchoalveolar liquid). The alveolocapillary membrane permeability was assessed by detecting in the received liquid of bronchoalveolar lavage the concentration of whole protein on Lowry, the content of middle mass molecules on extinction at wave lengths 238, 254, 260, and 280 nm; the level of diene conjugates on V.B. Gavrilov and catalase activity on M.A. Koroliuk. The received data were processed using methods of nonparametric statistics. The revealed intergroup differences were assessed on Kruskall-Wallis «ANOVA» criterion. The differences at р < 0,05 were considered as reliable ones. Results: Alveolocapillary membrane permeability for the whole protein at the size of respiratory volume 20 ml/kg of body mass exceeds the values in control group in 12,5 times and at respiratory volume 40 ml/kg- in 20 times. Alveolocapillary membrane permeability for middle molecular peptides at the size of respiratory volume 20 ml/kg exceeds the values in the control group on extinction at 238 nm in 2 times; at 254 nm in 1,5 times; at 260 nm in 1,2 times and at 280 nm in 1,5 times. The double increase of respiratory volume at reproduction of ventilator induced lung injury model is attended with practically double increase of alveolocapillary barrier permeability for middle molecular peptides determined by detection at all wave lengths. The changes of alveolocapillary membrane permeability for diene conjugates in the conditions of ventilator induced lung injury model correspond to the one for protein and middle molecular peptides. The change of catalase activity as alveolocapillary membrane permeability marker is informative only in the model used at respiratory volume 40 ml/kg of animal body mass. Conclusions: The changes of alveolocapillary membrane permeability in ventilator induced lung injury model are proportional to the size of respiratory volume used for reproduction of the model

Intensive physiotherapic respiratory care in critically ill patients with tracheostomy after cardiac surgery

Background. Patients following major cardiac surgery are increasingly elderly and present many comorbidities. For these reasons their post-operative phase is often burdened by several complications requiring a long stay in Critical Care and prolonged mechanical ventilation. Most of these patients, when transferred to our Intensive Cardiac Rehabilitation Unit, still have a percutaneous tracheostomy due to respiratory mechanical dysfunction. The aim of our work is to present new rehabilitative care strategies in such compromised patients. Methods and materials. We studied 27 elderly critically ill tracheostomized patients who were split into 2 Groups (A = 11 and B = 16). The Groups were homogeneous for age and for left ventricular ejection fraction. Group A received a standard treatment including cautious mobilisation and respiratory unspecific physiotherapy. Group B received an earlier and more aggressive treatment with a specific respiratory physiotherapy including Positive Expiration Pressure (PEP) directly connected to the tracheostomy cannula. A protocol for tracheostomy decannulation by assessment of the Peak Expiratory Flow during cough (PCEF≥ 180 L/min.) has been defined in order to verify the patients ability to develop a mechanically effective cough to obtain weaning from tracheostomy. Besides, in the patients of Group B, we carried out a screening of the swallowing dysfunction. Results. Four patients of Group A deceased while in Group B there were no deaths. Furthermore patients of Group B showed a statistically significant improvement of mobility and respiratory indexes. In Group B only one patient was discharged with tracheostomy cannula in site because he did not reach standard criteria for decannulation and his PCEF value was not satisfactory. This patient underwent percutaneous gastrostomy. Conclusions. A precocious and intensive rehabilitation, based on specific respiratory physiotherapy, significantly improves mobility and respiratory indexes of patients with tracheostomy. The PCEF and the swallowing deficit evaluation allows an earlier tracheostomy decannulation with lower risk of complications.

Feasibility of a single-stage tracheostomy decannulation protocol with endoscopy in adult patients.

Gradual decrease in tube size and tube capping are considered the standard of care for tracheostomy decannulation. Both of these actions result in increased airway resistance. Immediate decannulation may offer a more tolerable approach. To assess the feasibility of immediate tracheostomy decannulation compared with the traditional decannulation methods. This study is a single institute, case-control retrospective study of patients between the years 2009 to 2014. The study group included all patients who underwent immediate decannulation, whereas the control group comprised patients who underwent traditional staged decannulation. An immediate decannulation protocol included admission to the intensive care unit, a comprehensive evaluation, decannulation, 24 hours of monitoring, and observation until discharge. Twenty-nine patients were included in the study group and 20 in the control group. No significant statistical difference was found between the two groups in the patients' medical history and tracheostomy data, except for the Acute Physiology and Chronic Health Evaluation II score and duration of the deflated cuff, which were significantly higher in the control group. A significant difference was found in the complication rate between the groups. In the staged decannulation group, four patients failed decannulation and required reinsertion of the tracheostomy cannula, whereas there were no such failures in the immediate decannulation group. Hospitalization duration after decannulation of the study group patients was significantly shorter than that of the control group. Immediate decannulation may offer a safe alternative for weaning from tracheostomy. It may also reduce the duration of the weaning process and hospitalization. 3b Laryngoscope, 126:2057-2062, 2016.

Foreign Body Aspiration from Tracheostomy Inlet

Tracheobronchial foreign body aspiration is an important life-threatening clinical condition that requires emergency intervention. Compared with children, foreign body aspiration is rare in adults and sometimes could be fatal. The most common symptom is severe coughing that appears after choking. Foreign body aspiration should be considered in the diagnosis of patients with wheezing, chronic cough, voice alteration, hoarseness, or recurrent pulmonary infections. A 78-year-old male patient with tracheostomy due to laryngeal cancer was admitted to the emergency department on account of aspiration of tweezers after coughing when he was cleaning the tracheostomy cannula. The patient complained of shortness of breath and coughing. Physical examination revealed decreased breath sounds on the right side of the lung, and he had dyspnea and central cyanosis. There was a foreign body extending from the carina to the right main bronchus on the posteroanterior radiograph of the lung. In the operating room, rigid bronchoscopy was performed from the tracheostomy stoma and the foreign body was removed using forceps. This case shows that patients with tracheostomy and their relatives must be well educated in the care of stoma. Rigid bronchoscopy by an experienced specialist for foreign body aspiration is a safe and effective method for diagnosis and treatment. (Eurasian J Emerg Med 2015; 14: 142-4)

Intervention to Reduce Ventilator-Associated Pneumonia in Individuals on Long-Term Ventilation by Introducing a Customized Bundle.

To evaluate the effectiveness of a modified bundle of preventative measures to decrease ventilator-associated pneumonia (VAP) in chronically ventilated long-term care facility (LTCF) residents. Cohort before-and-after study. Geriatric hospital ward. LTCF residents on long-term ventilation. The modified bundle included hand hygiene before patient care, elevation of the head of the bed to more than 30° for individuals who are supine, chlorhexidine oral care at the beginning of each nursing shift, keeping tracheostomy cannula balloon pressure at 20 to 30 cm H2 O, and measuring nasogastric food remnants before every meal for individuals fed through a nasogastric tube. Number of VAP episodes was determined prospectively, and rates were calculated as episodes per 1,000 ventilation days. VAP rate decreased from 5.97 before the intervention to 2.34 after the intervention (P < .001). The use of broad-spectrum antibiotics decreased from 1,788 defined daily doses before the intervention to 1,093 after (P = .04). A modified bundle successfully decreased VAP rates in chronically ventilated elderly LTCF residents.

Endoscopic repair of laryngotracheoesophageal clefts

Background/PurposeIn Japan, surgical repair of a laryngotracheoesophageal cleft (LTEC) typically consists of the anterior approach, with the lateral approach as an alternative. Endoscopic surgery to repair the tracheoesophageal septum has been reported, and this study reviewed our experience treating several cases of LTEC endoscopically. MethodsEndoscopic repair of LTEC was performed in 7 patients (3 boys, 4 girls; age range 4months to 2years 10months; mean age 11months; mean weight at surgery 7.23kg; weight range 3.85–12.24kg) between 2009 and 2014. LTEC was type I in 5 patients and types II and IV in 1 patient each. The patient with type IV was first operated on by the lateral approach, and the remaining cleft, which level was type III, was repaired endoscopically. Postoperative outcomes were retrospectively studied. ResultsEndoscopic surgery was successful in all patients. All 6 patients with types I and II LTEC were extubated easily, while in the patient with type IV LTEC, it was difficult to remove the tracheostomy cannula because of tracheomalacia. Postoperatively, tracheostomy cannulation became more stable, and the patient is gradually being weaned off the ventilator. All patients could be fed orally without difficulty postoperatively. ConclusionsEndoscopic surgery provides a view from the cephalic aspect permitting the surgeon to form a normal larynx with only minimal risk of complications.