Complications Of Tracheostomy Research Articles

Five-Years Intensive Care Percutaneous Tracheostomy Results

Aim: Tracheostomy is an interventional procedure frequently performed on critically ill patients in the intensive care unit (ICU). The purpose of this study is to report the characteristics of patients undergoing percutaneous tracheostomy in intensive care.
 Material and Methods: Cases admitted to intensive care between 2018 and 2022 and subjected to percutaneous tracheostomy were included. Cases involving surgical tracheostomy were excluded. We scanned the patients’ demographic and clinical characteristics, follow-up characteristics in intensive care, tracheostomy complications, and discharge characteristics. Patients were also divided into surviving and non-surviving groups and compared.
 Results: One hundred seven patients were included in the study. Men represented 64.5% of the patients, and the mean age of the entire patient group was 61.5 years. Tracheostomies were most frequently performed due to prolonged endotracheal intubation. Neurological diseases were the most common diagnoses, and the most frequent complication was bleeding. The groups differed in terms of age, comorbidity, presence of tracheostomy at time of discharge from intensive care, and anticoagulant use. The mortality rate was 69.2%.
 Conclusion: We think that percutaneous tracheostomy can be employed because it can be performed at the point of care in intensive care, and due its ease of application and low complication rate.

Tracheostomy Complications: Insights from a Two-Year, 15-Case Analysis at a Tertiary Care Facility.

The objective of this case series was to analyse the complications that arise from tracheostomy procedures conducted in a tertiary healthcare facility throughout a two-year timeframe. Fifteen occurrences of complications were observed out of the 100 tracheostomies that were studied, suggesting a prevalence rate of 15%. The detected complications included subcutaneous emphysema, misplacement of the tube, infection at the surgical site, and tracheal stenosis, among various others. Considerable indications of complication were identified, encompassing variables such as age and a history of head and neck cancer. The findings of this study highlight the significance of personalized patient care, vigilant monitoring, and proactive measures for individuals receiving tracheostomy. Further investigations are necessary to validate these findings and improve patient safety and outcomes in the realm of tracheostomy surgeries.

Subcutaneous emphysema after tracheostomy accompanied by Oral & maxillofacial surgery : Case report

In oral and maxillofacial surgery, tracheostomy is an occasional procedure in patients with inflammatory diseases, neo-plastic diseases, and trauma. Subcutaneous emphysema is one of the complications of tracheostomy, and is consequence of air introduction or other gases into soft tissues. It is not a common complication, but it does occur occasionally. In 3 cases, Subcutaneous emphysema occurred after tracheostomy accompanied by oral and maxillofacial surgery. And it improved in 2, 3, and 13 days after the occurrence. The purpose of this study is to analyze the treatment and results of clinical cases of subcutaneous emphysema after tracheostomy in patients who underwent oral and maxillofacial surgery and use them as indicators of future treatment.

Çocuk Yoğun Bakım Ünitesinde Trakeostomi Uygulamaları, Tek Merkez Deneyimi

Background/Aims: Tracheostomy is one of the most frequently performed surgical procedures in the pediatric intensive care unit (PICU). While it used to be an emergency treatment method in patients with laryngeal obstruction, it is now mostly used in patients with prolonged mechanical ventilation under elective conditions. In this study, we aimed to evaluate patients who underwent tracheostomy in our PICU, indications, and complications.
 Methods: This retrospective study was conducted from February 2018 through April 2022. Data was collected from the patient’s records and analyzed.
 Results: Forty-three patients were included in the study. The median age of the patients was 5±4.99 (0-17 years) and 30 patients (69.8%) were male. During the four-year study period, the tracheostomy rate was 2.4% and the decannulation rate was 7%. All of the patients were discharged home with the home ventilator. The most common indication for tracheostomy was prolonged mechanical ventilation (88.3%). The median time of mechanical ventilation before tracheostomy was 111.6±57.22 (range 0-240) days. No surgical complications were observed during the PICU follow-up. All patients were discharged from PICU with a home-type mechanical ventilator. The median number of outpatient controls after discharge was 7.28±1.89 (range 3-10), and the median number of annual cannula replacements was 3.62±0.76 (range 1-5). 14 patients died after discharge from the PICU. None of the patients died due to tracheostomy complications. The median time of death was 30±13.97 (range 11-56) days after discharge from the PICU. When the surviving and deceased patients were compared according to age, mechanical ventilation time, and length of stay in the PICU, no significant difference was found (p=0.291, p=0.115, and p=0.291, respectively).
 Conclusions: In our study, long mechanical ventilation time was the most common indication for tracheostomy, and our result is consistent with the literature. Although the timing of tracheostomy was long, no significant correlation was observed with mortality.

Tracheostomy-Assisted Foreign Body Removal: Insights From a Case Series and Literature Review.

Foreign body aspiration into the trachea is a common occurrence in children. While most foreign bodies in the airways can be removed using rigid tracheoscopy, there are instances where tracheostomy or tracheotomy is needed. This article presents a series of cases in which tracheostomy was necessary to remove foreign bodies, and summarizes the relevant experiences and lessons learned. We reviewed a total of 7 cases in which tracheostomy and rigid tracheoscopy were combined for foreign body removal out of a larger cohort of 1559 cases at Shenzhen Children's Hospital in Guangdong, China over a 20-year period. The combined use of tracheostomy and rigid tracheoscopy resulted in successful removal of foreign bodies in all 7 patients reviewed in this study. Six patients developed complications of tracheotomy, mainly including mediastinal emphysema (5/7), subcutaneous emphysema (3/7), and pneumothorax (1/7). Tracheotomy was temporary in all patients. In cases where a foreign body in the trachea is too large or has irregular, sharp edges, is embedded in submucosal tissues with edema, cannot be passed smoothly through the vocal cords, or local endoscopic facilities are inadequate, a tracheotomy may be necessary. However, this approach should be used with caution, and close collaboration with anesthesiologists and careful management of intraoperative emergencies are crucial for improving the success rate of the procedure. Additionally, the complications should be noted, paying particular attention to early complications such as pneumothorax, pneumomediastinum, and bleeding.

Retrospective Analysis of Our Experience with Percutaneous Tracheostomy in Our Intensive Care Unit

Aim: Percutaneous tracheostomy (PT) application has advantages such as being able to be applied at the bedside in a short time and less bleeding. It is frequently preferred in intensive care units with indications such as prolonged artificial respiration requirement, facilitating weaning, and providing emergency airway. It is an alternative method to surgical tracheostomy. In this study, we aimed to retrospectively evaluate the percutaneous tracheostomy cases we performed in the Intensive Care Unit (ICU) in the last three years.
 Material and Methods: Patients who underwent percutaneous tracheostomy in the 3rd Level our Hospital between January 2018 and December 2022 were examined. Demographic data of the patients, diagnosis of hospitalization, Acute Physiology and Chronic Health Evaluation II Score (APACHE II score), hospitalization time, intubation time, time from intubation to tracheostomy, early and late complications of tracheostomy were retrospectively analyzed.
 Results: Ninety-seven patients were analyzed. The mean age of the patients was 77.6±10.9 (range, 41-100) years and the female-male ratio was 40/57. The most common hospitalization diagnosis was neurological reasons (54.6%). The patients were intubated for 20.3±7.9 (range, 7-48) days and the total length of stay in the ICU 65.3±30.3 (range, 17-175) days. The number of patients who developed complications related to the PT procedure was 17 (12.9%).
 Conclusion: Percutaneous tracheotomy, which is performed in the ICU with indications such as the need for prolonged mechanical ventilation, facilitating weaning, and providing an emergency airway, is a simple, minimally invasive procedure with a low complication rate.

Tracheostomy complications in children: Single center experience

Objective: To evaluate the frequency and the type of complications in children with tracheostomy in our center
 Materials and Methods: Single-center retrospective study of pediatric patients undergoing tracheostomy between 2017 and 2022. Age, sex, indication of tracheostomy, tracheostomy time, the features of complications and presence of mortality were evaluated.
 Results: Fifty children (22 girls, 28 boys) were included the study. The mean age of patients 93.5 months. The tracheostomy time was before one year of age for 27 patients. The most common indication for tracheostomy was long-term ventilation. There were 30 complications for 23 patients.(46%) We did not report any early complication. The most common late complication was the development of granulation tissue. The second most common complication was cannula obstruction. Only one patient died due to massive bleeding associated with tracheostomy. We decannulated 7 patients (14%).
 Conclusion: The rates of complication may vary in the literature. The reason for this differentiation may be related to the different study design and population features.Also socio-economic level of the family and the responsibility awareness of the parents may contribute to these factors. Education of parents and caregivers about the appropriate postoperative management is very important for preventing complications rates.

Clinical and epidemiological profile of COVID-19 patients hospitalized in the North of Mato Grosso: A cross-sectional study

Objective: Studies have shown that obesity, age, presence of chronic disease, respiratory disease and cancer are risk factors for COVID-19, increasing the risk of hospitalization, complications, and the mortality rate. Thus, the objective of this study was to compare and evaluate the clinical and epidemiological profile of COVID-19 patients admitted to the nursery or Intensive Care Unit (ICU) of the Hospital Regional Jorge de Abreu (HRJA) in Sinop-MT. Methods: This was a cross-sectional study with data collected from medical records of patients diagnosed with COVID-19 and admitted between March 2020 and March 2021. Results: Data from 399 patients hospitalized in a nursery and 389 in ICU were evaluated. Days of symptoms, age and body weight were significantly higher in ICU patients compared to nursery. Furthermore, it was observed that patients admitted to the ICU had a higher prevalence of obesity, diabetes, cardiovascular diseases, and other non-transmitted chronic diseases (NTCD). There was no difference between the groups regarding the presence of previous respiratory diseases. 82.2% of ICU patients and 18.8% of nursery patients required assisted mechanical ventilation. Percentage of patients requiring tracheostomy and presenting complications was also higher in the ICU. The mortality rate was significantly higher in ICU patients (75.2%) compared to nursery patients (13.9%). Conclusion: It was observed that the clinical and epidemiological profile of COVID-19 patients admitted to the ICU was more severe compared to those admitted to the nursery which can be associated with age, obesity and NTCD in these patients.

Adverse Events Associated With Tracheostomy: A MAUDE Database Analysis.

Tracheotomy is one of the most common procedures. Although tracheostomy complications have been extensively studied, literature related to device complications is scarce. The objective of this study is to describe complications associated with tracheostomies utilizing the Manufacturer and User Facility Device Experience (MAUDE) database. Retrospective cross-sectional study. The US Food and Drug Administration's (FDA) MAUDEdatabase (2015-2020). The FDA's MAUDE database was queried for all reports on adverse events related to tracheostomy from January 1, 2015 to December 31, 2020. A total of 3086 adverse events related to open tracheostomy and 52 related to percutaneous tracheostomy were identified. For open tracheostomy, 2872 (93%), were related to device malfunction, and 214 (7%) consisted of patient-related factors. The most frequently reported device-related adverse event was cuff malfunction, with 1834 (59%) reported events, which includes cuff deflation, pilot balloon malfunction, and cuff inflation line malfunction. The most frequently reported patient-related adverse events were tracheostomy tube obstruction with 67 events (2%). For percutaneous tracheostomy, 38 (73%) events were related to device malfunction, and 14 (27%) were related to patient injury. The most frequently reported adverse events were cuff malfunction (29%), safety ridge malfunction (17%), and bleeding (10%). The MAUDE database is a useful tool that can be utilized to complement existing literature in identifying common and rare adverse events associated with tracheostomy device-related failures, which are mostly reliant on isolated, published case reports.

Epidemiology and characteristics of emergency department utilization by patients with amyotrophic lateral sclerosis in Korea from 2016 to 2020: A nationwide study.

Patients with amyotrophic lateral sclerosis (ALS) inevitably visit the emergency department (ED) due to their increased risk of respiratory failure and mobility limitations. However, nationwide data on ED visits by patients with ALS are limited. This study investigated the characteristics of patients with ALS-related ED visits. We conducted a cross-sectional study from 2016 to 2020, utilizing a nationwide ED database. The total number of patients with ALS who visited the ED and their primary reasons for visiting/diagnoses were analyzed. In total, 6036 visits to the ED were made by patients with ALS. Of these, 41.8% arrived by ambulance and 27.7% spent >9 h in the ED. Following ED treatment, 57.4% were hospitalized, including 19.3% admitted to the intensive care unit (ICU) and 5.4% who died in the hospital. The primary reasons for ALS-related ED visits were dyspnea (35.2%), feeding tube problems (10.1%), fever (7.8%), and mental status changes (3.6%). The most common diagnoses were pneumonia (14.5%), respiratory failure (5.7%), dyspnea (5.5%), aspiration pneumonia (4.3%), and tracheostomy complications (3.4%). Reasons for ED visits for patients with ALS include acute respiratory distress, as well as concerns related to tube feeding and tracheostomy. To reduce the risk of patients with ALS requiring ED visits, it is essential to ensure the provision of timely respiratory support and high-quality home-based medical care teams that can support and address patients before their condition deteriorates.

Travails of tracheostomy

Background: Tracheostomy is a surgical procedure which consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea. Methods: This was a prospective study which included 50 patients who underwent tracheostomy between September 2020 to April 2022. Our study was aimed to report the most common indications, complications, outcomes in tracheostomised patients. For evaluation of patients undergoing tracheostomy, a database was created which included demographic profile of the patient such as age, gender, diagnosis as well as indication, complications which were divided into early, intermediate and late complications and day of decannulation. Results: Among 50 patients, 41 (82%) were males and 9(18%) patients were females. The age of the patients included in this study ranged from 20 to 80 years. Majority were in age group between 40 to 60 years (48%). Out of 50 patients, 39 (78%) patients underwent tracheostomy due to prolonged intubation (CVA, head injury, organophosphorus poisoning, respiratory failure), 11 (22%) for upper airway obstruction due to malignancy. Conclusions: In this study 40 to 60 years was the most common age group for which tracheostomy was done. It was done more in males. Most common indication for tracheostomy was prolonged ventilation followed by malignancy. Incidence of complications was 76%. Most common early complication observed was haemorrhage, most common intermediate complication was tube blockage and most common late complication was tracheoesophageal fistula. Mortality occurred in 6 patients. To conclude even today tracheostomy remains the lifesaving procedure and complications of tracheostomy are largely preventable.

Open Versus Percutaneous Tracheostomy in Patients With Liver Cirrhosis: Analysis of a Nationwide Database.

Evidence for the appropriate type of tracheostomy in patients with liver cirrhosis is lacking. A retrospective analysis of the National Inpatient Sample (NIS) was performed. Adult patients with liver cirrhosis undergoing tracheostomy while on mechanical ventilation for respiratory failure were abstracted from the NIS database between 2016 and 2018 and analyzed. Patients were divided according to the type of tracheostomy performed into open tracheostomy (OT) and percutaneous tracheostomy (PT) and analyzed for tracheostomy complications and clinical outcomes. Subgroup analyses were performed for patients with compensated cirrhosis (CC) and decompensated cirrhosis (DC). A total of 44745 cases were analyzed. The OT group had a higher rate of overall tracheostomy-related complications (TC) (5.1% vs 3.5%; P < .001), hemorrhage from the tracheostomy site (HC) (2.7% vs 1.8%; P = .008) and other complications (OC) (2.7% vs 1.8%, P = .003). Multivariate analyses showed that OT was a risk factor for TC (Adjusted odds ratio (AOR) 1.50, P < .001), HC (AOR 1.46, P = .009), and OC (AOR 1.55, P = .003). Similarly, in subgroup analyses, OT cases, compared to PT, were associated with increased TC (5.0% vs 3.4%, P < .001), HC (2.7% vs 1.7%, P = .002) and OC (2.6% vs 1.8%, P = .020) in DC patients. OT is associated with a significantly higher rate of complications. OT was also associated with more complications in DC patients, suggesting that a percutaneous approach may be the best option in cirrhotic patients when feasible.

Efficacy and Safety of Percutaneous Dilatational Tracheotomy in the Head and Neck Cancer Surgery

Background and Objectives Percutaneous dilatational tracheostomy (PDT) is an easy and fast technique that can replace surgical tracheostomy (ST). Less bleeding, easy technique and short procedure time are the main advantages of this tecunique. This study is to evaluate the feasibility of PDT during the head and neck cancer surgery.Subjects and Method The medical records of 12 patients who underwent PDT during a head and neck cancer surgery in the period of September 2019 to September 2021 were reviewed retrospectively. Another medical records of 12 patients who underwent ST during the head and neck cancer surgery were acquired for comparison. PDT was performed using Ciglia Percutaneous Tracheostomy Set&lt;sup&gt;®&lt;/sup&gt; (Cook Critical Care). Parameters of blood loss, procedure time, wound communication between the cervical and tracheostomy incision and complications were compared between the PDT group and the ST group.Results The PDT group showed less blood loss, shorter procedure time and showed fewer incidences of wound communication. As for complications, there was one case of conversion to ST due to procedure failure in the PDT group. The complication rate was not different between the two groups.Conclusion PDT can be used as a safe and effective procedure during the head and neck cancer surgery for selected patients.

Tracheoinnominate Artery Fistula After Tracheostomy: A Systematic Literature Review of Associations With Mortality

Tracheoinnomate artery fistulas (TIF) are a rare but deadly complication of tracheostomy. This study summarizes TIF cases in the literature and seeks to understand associations with mortality. MEDLINE was searched (up to May 2021) for studies reporting individual clinical and demographic characteristics of patients with TIFs after tracheostomy. Exclusion criteria were: no tracheostomy tube in place at the time of fistula or additional procedures performed at the tracheostomy site. This study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 122 TIF patients from 18 case series and 46 case reports were included. The median age was 40.9 years (range: 4-85, interquartile range: 20.9-60.9 years) and 53.3% (64 of 120) were male. Trauma was the leading indication for tracheostomy (26.2%, 32 of 122), followed by head/neck cancer (20.5%, 25 of 122) and structural malformation (19.7%, 24 of 122). Mortality characteristics are summarized in the Table. Overall mortality rate was 64.8% (79 of 122), with a 15.4% higher rate in females than males (P = .077). There was no significant difference in the median number of days between tracheostomy and TIF detection between those who survived their TIF vs those who died (46 days vs 23 days, P = .077). There was a significant difference in mortality between cases that initially presented with vs without sentinel bleeding (50% [25 of 50] vs 75% [54 of 72], P = .005). The presence or absence of frank hemorrhage also showed a significant difference in mortality (59.6% [53 of 89] vs 78.8% [26 of 33], P = .035). Mortality differed in whether or not the tracheostomy cuff was overinflated for temporary hemostasis during resuscitation (52.2% [35 of 67] vs 80% [44 of 55], P < .001). A total of 27 cases received endovascular management, 2 of which ultimately needed open surgery. No difference in mortality was found between endovascular and surgical management, yet both of these were superior to no treatment (48.6% [36 of 74] vs 89.6% [43 of 48], P < .001). Of the 49 cases definitively managed with open surgery, there were 36 innominate artery resections, 15 tracheal reconstructions, and 12 innominate artery reconstructions. Mortality is a major concern and resuscitation paired with endovascular or surgical intervention is imperative. Investigating sentinel bleeds in a timely fashion and intervening upon hemorrhage with temporary cuff overinflation may lead to improved outcomes.TableMortality characteristicsMortalityP valueDied64.7 (79/122)Sex Male57.8 (37/64).077 Female73.2 (41/56)Age, groups in years 4-2563.8 (23/36).756 26-5061.4 (27/44) >5069.0 (29/42)Sentinel bleed Present50 (25/50).005 Absent75 (54/72)Hemorrhage Present59.6 (53/89).035 Absent78.8 (26/33)Cuff over inflation Performed52.2 (35/67)<.001 Not performed80 (44/55)Endovascular vs surgical management Endovascular48.0 (12/25).938 Surgical49.0 (24/49)Definitive treatment vs no treatment Endovascular or Surgical48.6 (36/74)<.001 No treatment89.6 (43/48)Values represented as percentage and count (condition present/total). Open table in a new tab

INDICATIONS AND COMPLICATIONS OF TRACHEOSTOMY AT A TERTIARY CARE INSTITUTE: A PROSPECTIVE AND OBSERVATIONAL STUDY

Objective: The aim of the present study was to present an analysis of indications and complications of tracheostomy in tracheostomized patients. Methods: This was a single center, hospital-based prospective, non-randomized, and non-comparative study involving 60 tracheostomized patients carried out from February 2021 to March 2022 at Geetanjali Medical College and Hospital, Udaipur, India. Results: Out of 60 tracheostomies performed most common indications were Laryngo-tracheal trauma (26.7%), organophosphorus poisoning (25%), malignancy of Larynx (11.67%), post-intubation stenosis (6.7%), bilateral abductor paralysis (6.7%), head injury (6.7%), meningitis (5%), acute laryngo-traheo-bronchitis (3.33%), hypoxic-ischemic-encephalopathy (3.33%), cerebrovascular accidents (1.67%), faucial diptheria (1.67%), and GB syndrome (1.67%). Out of 60 tracheostomies performed, 18 complications were encountered. The most common complication was granulations of tracheostoma which occurred in 5 cases (8.3%), three cases of tube occlusion (5%), three cases had difficult decannulation (5%), three cases developed infection of stoma (5%), two cases developed surgical emphysema (3.3%), one case of tracheostomy scar hypertrophy (1.6%), and one case developed tracheal stenosis (1.6%). Conclusion: Tracheostomy is the procedure of choice especially in cases. Where it is needed to provide prolonged positive pressure ventilation and tracheobronchial toilet. Thorough anatomical knowledge of trachea and adjacent structures, skill of surgeon, sterile technique, meticulous surgery, use of high-volume low pressure cuffed Portex tracheostomy tubes, and good bedside tracheostomy care results in minimal complications. Complications of tracheostomy are largely preventable.

A Cross - Sectional Study of Tracheostomy Complications and its Care in Tertiary Care Centre in Central India

A Cross - Sectional Study of Tracheostomy Complications and its Care in Tertiary Care Centre in Central India

Tracheotomy results in upper airway management

Objectives: The study aimed to discuss the demographic characteristics and tracheotomy indications and complications of the patients who underwent tracheotomy in our clinic in the light of the literature. Patients and Methods: In this study, the records of 323 patients (216 males, 107 females; mean age: 64.9±16.4 years; range, 19 to 108 years) who underwent tracheotomy between January 2017 and December 2022 were reviewed retrospectively. Patients under the age of 18 years, patients who underwent percutaneous tracheotomy, revision tracheotomy, and tracheotomy for the second time were excluded. Demographic characteristics of the patients, comorbidities, and indications and complications of tracheotomy were reviewed from the patient charts. Results: Elective tracheotomy was performed in 170 (52.6%) patients, and emergency tracheotomy was performed in 153 (47.4%) patients. Tracheotomy-related complications were observed in 13% of the patients. When all complications were evaluated, the most common complications were bleeding, subcutaneous emphysema, and granulation tissue. Conclusion: Acute upper airway obstruction is a life-threatening condition, and tracheotomy is of vital importance in this condition. The most common complication is bleeding, and it can be minimized with the appropriate method and hemostasis. Mortality rates due to tracheotomy are very low, and it is a life-saving procedure.

Tracheostomy-related indications, early complications and their predictors among patients in low resource settings: a prospective cohort study in the pre-COVID-19 era

BackgroundTracheostomy is a life-saving procedure whose outcomes may vary between hospitals based on disparities in their existing expertise. We aimed at establishing the indications, early tracheostomy-related complications and their associated factors in Uganda.MethodsIn a prospective cohort study, we consecutively enrolled one-hundred patients, both adults and children 2 h post-tracheostomy procedure. At baseline, information on patients’ socio-demographics, tracheostomy indications, pre- and post-procedural characteristics was collected through researcher administered questionnaires and from medical records. Clinical examination was performed at baseline but also at either day 7 or whenever a tracheostomy-related complication was suspected during the 7 days follow-up. Comparison of patients’ baseline characteristics, tracheostomy indications and complications across two hospitals was done using Pearson’s chi-square. For predictors of early tracheostomy complications, bivariate and multivariate analysis models were fitted using binomial regression in STATA 13.0 software.ResultsAll patients underwent surgical tracheostomy. Majority were adults (84%) and males (70%). The commonest tracheostomy indications were; pulmonary toilet (58%) and anticipated prolonged intubation (42%). Overall, 53% (95% CI: 43.0 – 62.7) had early complications with the commonest being tube obstruction (52.6%). Independent predictors of early tracheostomy-related complications were; anticipated prolonged intubation as an indication (RR = 1.8, 95%CI: 1.19 – 2.76), Bjork flap tracheal incision (RR = 1.6, 95%CI: 1.09 – 2.43), vertical tracheal incision (RR = 1.53, 95%CI: 1.02 – 2.27), and age below 18 years (RR = 1.22, 95%CI: 1.00 – 1.47).ConclusionPulmonary toilet is the commonest tracheostomy indication at major hospitals in Uganda. The incidence of early tracheostomy complications is high and majorly related to post-procedure tracheostomy tube management. Having anticipated prolonged intubation as an indication for tracheostomy, a Bjork flap or vertical tracheal incisions and being a child were associated with increased risk of complications. Emphasis on multidisciplinary team care, standardization of tracheostomy care protocols, and continuous collection of patient data as well as paying attention to patient quality of life factors such as early return to oral feeding, ambulation and normal speech may have great potential for improved quality of tracheostomy care in low resource settings.

Development of acute lung injury or acute respiratory distress syndrome after subarachnoid hemorrhage, predictive factors, and impact on prognosis

Acute lung injury or acute respiratory distress syndrome (ALI/ARDS) is a common complication after aneurysmal subarachnoid hemorrhage (aSAH), and is associated with worse neurologic outcomes and longer hospitalization. However, the effect of ALI/ARDS in SAH has not been well elucidated. The purpose of this study was to determine the incidence of ALI/ARDS in a cohort of patients with SAH and to determine the risk factors for ALI/ARDS and their impact on patient prognosis. We performed a retrospective analysis of 167 consecutive patients with aSAH enrolled. ALI/ARDS patients were rigorously adjudicated using North American-European Consensus Conference definition. Regression analyses were used to test the risk factors for ALI/ARDS in patients with SAH. A total of 167 patients fulfilled the inclusion criteria, and 27% patients (45 of 167) developed ALI. Among all 45 ALI patients, 33 (20%, 33 of 167) patients met criteria for ARDS. On multivariate analysis, elderly patients, lower glasgow coma scale (GCS), higher Hunt-Hess grade, higher simplified acute physiology score (SAPS) II score, pre-existing pneumonia, gastric aspiration, hypoxemia, and tachypnea were the strongest risk factor for ALI/ARDS. Patients with ALI/ARDS showed worse clinical outcomes measured at 30 days. Development of ALI/ARDS was associated with a statistically significant increasing the odds of tracheostomy and hospital complications, and increasing duration of mechanical ventilation, intensive care unit (ICU) length and hospitalization stay. Development of ALI/ARDS is a severe complication of SAH and is associated with a poor clinical outcome, and further studies should focus on both prevention and management strategies specific to SAH-associated ALI/ARDS.

Correlation between age, the clinical status of patients, operator characteristics, and surgical landmarks with the incidence of tracheotomy complications

Link of Video Abstract: https://www.youtube.com/watch?v=YTXRefXDzlU Background: Tracheotomy is a surgical procedure often performed in the field of ear, nose, throat-head, and neck surgery. This study aims to analyze the risk factors for tracheotomy complications based on age, clinical status, operator characteristics and surgical landmarks. Methods: This study was analytically observational with a case-control design using secondary data. The study was conducted at Dr. Soetomo Hospital Surabaya. Patients who had a tracheotomy for the period January 1, 2015 to December 31, 2019 and met the research criteria were included as samples. Results: This study obtained 174 patients with 136 men and 38 women. Analysis of the correlation between age and the incidence of tracheotomy complications obtained p=0.008 (p&lt;0.05). The correlation between clinical status of patients with complications of tracheotomy was found to be significant (p=0.001). The correlation between operator characteristics and tracheotomy complications was significant (p=0.000) and the correlation between surgical landmarks and tracheotomy complications was significant (p= 0.000). Conclusion: The correlation between age, the patient's clinical status, operator characteristics and surgical landmarks with the incidence of tracheotomy complications from 174 patients who underwent tracheotomy surgery at Dr. Soetomo Hospital Surabaya showed that these factors mutually influence the postoperative complications of tracheotomy.