Tracheostomy In Intensive Care Unit Research Articles

The Safety of Pediatric Bedside Tracheostomy.

Traditionally, pediatric tracheostomy has been viewed as a technically demanding procedure with a high complication rate, requiring the routine use of a formal operating room. Pediatric bedside tracheostomy in an intensive care unit (ICU) setting has not been widely reported, in contrast to the widespread adult bedside ICU tracheostomy. Transport of these critically ill, multiple life support systems dependent patients can be technically difficult, labor intensive, and potentially risky for these patients. Our study aimed to demonstrate the safety and efficacy of bedside tracheostomy in the pediatric ICU. A retrospective analysis of all pediatric patients undergoing tracheostomy at a tertiary care center, between 1st of January 2013 and 31st of December 2019. During the study period, 117 pediatric patients underwent tracheostomy, 57 (48.7%) were performed bedside while 60 (51.3%) were performed in the operating room. Patients' ages ranged from 2 weeks to 17 years of age, with a median age of 16 months. No case of bedside tracheostomy necessitated a shift to the operating room. There was no difference in 30-day morbidity and mortality between the 2 groups. Our results suggest that pediatric open bedside tracheostomy in an ICU setting is a safe procedure, with similar complications and outcomes compared to tracheostomy performed in the operating room.

Fiberoptic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units: A Comment.

How to cite this article: Bandyopadhyay A, Puri S, Ashok V. Fiberoptic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units: A Comment. Indian J Crit Care Med 2023;27(1):78.

Our experiences of percutaneous tracheostomy in intensive care unit

Aim We aimed to evaluate the indications for tracheostomy and early complications in patients who underwent percutaneous tracheostomy with the Griggs method in our clinic. Material and Method This study is retrospective and observational. Demographic data, hospitalization diagnoses, days of opening tracheostomy, days of intensive care hospitalization, indications for tracheosotomy and early complications of tracheostomy were recorded and evaluated in a total of 78 patients between the ages of 23-93 who underwent percutaneous tracheostomy with the Griggs method between January 2021 and September 2022. Results A total of 78 patients were included in the study. Of the patients, 42 (54%) were female and 36 (46%) were male. In the patients included in the study, the earliest tracheostomy day was the 7th day of intubation and the latest tracheostomy day was the 32nd day of intubation. The mean day in terms of tracheostomy day was 23rd day of intubation. In terms of early complications, bleeding was observed in 5 (6.5%) patients, tracheoesophageal fistula in 1 (1.3%) patient, and pneumothorax in 1 (1.3%) patient. No complications were encountered in 71 (90.9%) patients.

ICU nurses´ lived experience of caring for adult patients with a tracheostomy in ICU: a phenomenological-hermeneutic study

BackgroundThe care of adult patients with a tracheostomy in intensive care unit is complex, challenging and requires skilled intensive care unit nurses. ICU nurses’ live experience is scarcely known. This study aimed to describe the lived experience of intensive care unit nurses of caring for adult patients with a tracheostomy in intensive care unit.MethodsThis study employs a qualitative design. In-depth interviews were conducted with a purposive sampling of 6 intensive care unit nurses from a medical-surgical ICU of a university hospital in Norway who were interviewed. Data was analyzed and interpreted using a phenomenological-hermeneutic approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ).ResultsThe interpretation yielded the following themes and subthemes: 1) theme: ‘challenges of caring for patients with a tracheostomy’ consisted of the sub-themes: ‘difficult to communicate/interpret and understand the patient’s different forms of expression’, ‘complicated professional assessments’, ‘caring with patience’, and ‘collaborating with patient regarding challenges. 2) theme: ‘the satisfaction from providing care to patients with a tracheostomy’ consisted of the sub-themes: ‘working with intensive care patients is instructive’ and ‘importance to motivate’.ConclusionsICU nurses experienced ambivalent feelings while caring for adult patients with a tracheostomy in ICU. They perceived caring as demanding owing to communication and collaboration at the same time, they experienced satisfaction while they strived to provide proper care and motivation. The identified challenges would lead to further improvement in nurses’ experiences and, in turn, the quality-of-care for patients with a tracheostomy. Awareness of these challenges is crucial to understand the need for an effective communication strategy to improve the quality and safety of adult patients with tracheostomy in ICU.

Management of patients who underwent classical and percutaneous tracheostomy in intensive care units

Objectives. The article summarizes the indications for surgical tracheostomy (STS) and puncture dilatation tracheostomy (PDT) in patients who underwent mechanical ventilation in the intensive care units (ICU). Based on analysis of 502 case histories, the advantages and disadvantages of different types of tracheostomies were determined. The microbiota of the tracheobronchial tree of 40 patients after PDT was studied, the algorithm of postoperative management of patients who underwent tracheostomy in the ICU was described. We also reviewed endoscopic diagnostic and treatment methods for postintubation changes in the larynx and trachea and the main aspects of postoperative care. The revised approach to decannulation of patients allowed to reduce the duration of hospital stay.Results: Among patients after PDT (group 1; n = 164), 25 complications (15.2 %) were observed. Intraoperative complications (n = 4, 16 %): 3 technically difficult cases (12 %), when PDT had to be continued as an open surgical procedure; 1 case (4 %) of subcutaneous emphysema. Postoperative complications (n = 21, 84 %): 4 cases (16 %) of tracheoesophageal fistulas (TEF), 2 cases (8 %) of tracheomediastinal fistulas(TMF), 2 cases (8 %) of bleeding, 2 cases (8 %) of bilateral paresis of the larynx and 2 cases (8 %) of grade III ulcerative tracheitis, 6 cases (24 %) of a granulation process in the cervical trachea; 3 patients (12 %) required retracheostomy in the late postoperative period. According to the microbiological study, Klebsiella pneumoniae and Pseudomonas aeruginosa prevailed on days 1–3, Proteus mirabilis and Acinotobacter sp. on days 5–7, and Candida sp. was noted on day 10. Among patients after STS (group 2; n = 338), complications were noted in 20 (5.9 %), including 3 (15 %) intraoperative: 1 case (5 %) of pneumothorax, 2 cases (10 %) of damage to the membranous wall of the trachea with thedevelopment of TMF. Postoperative complications were observed in 17 cases (85 %), including 4 cases (20 %) of tracheal stenosis, 2 cases (10 %) of retracheostomy; 2 cases (10 %) of TMF; 3 cases (15 %) of a granulation process in the tracheostomy area, 1 case of bilateral paresis of the larynx (5 %), 3 cases (15 %) of grade III ulcerative tracheitis; 1 case (5 %) of mucosal pressure ulcer of the upper third of the posterior wall of the trachea, 1 case (5 %) of TEF.

Post-Acute COVID-19 Syndrome after a Critical COVID-19: A Case Report

Introduction: The COVID-19 pandemic has caused many impacts in health, economic and social aspect worldwide. Infection of SARS-CoV-2 affects many organ systems. Post-COVID-19 syndrome is a condition when some of those infected with SARS-CoV-2 are complaining symptoms that persist for weeks to months even the PCR was negative. Case Illustrations: We present a case of post-acute COVID-19 syndrome in a 59 years old man with persistent respiratory symptoms for 3 months since the onset of a critical COVID-19. He was admitted to the hospital with critical COVID-19 which he received treatment for COVID-19 according to protocol and mechanical ventilation via tracheostomy in intensive care unit (ICU). In the post-acute COVID-19 conditions, he complained of persistent fatigue, shortness of breath, cough, limited walking activity and palpitations. Discussion: In most cases of asymptomatic, mild and moderate COVID-19 symptoms, patients usually resolve without complications. However, in cases with severe symptoms, systemic hyperinflammation of the immune system occurs due to activation of the SARS-CoV-2 virus which causes various complications in several organs. The management of patients with post-COVID-19 syndrome is determined based on clinical assessment of the patient, radiological examination, and laboratory and pulmonary function tests if possible. Patients with radiological abnormalities without clinical symptoms, evaluation is carried out 8 to 12 weeks after therapy and can be earlier if patients have any complains. Meanwhile patients with clinical symptoms with or without radiological abnormalities, need to evaluate after 4 weeks to see if there is any improvements. In addition to symptomatic treatment, oxygen therapy, rehabilitation, psychotherapy and nutritional therapy can also be given in patients with post-COVID-19 syndrome. Conclusion: Post-COVID-19 syndrome is a condition that affected almost all of the organ system in the body. The most common symptoms are persistent fatigue, shortness of breath, cough, myalgia, malaise and headache. This condition impact both physical and mental health that persists for weeks or months after being infected with SARS-CoV-2. Patient with post-COVID-19 syndrome should be prioritized due to their impact on the global health burden. Those who diagnosed with post-COVID-19 syndrome also needed psychological and emotional support to deal with persistent symptoms caused by post-COVID-19 condition so the survivors can return to living their lives as before. Keywords: Post-COVID-19 Syndrome, Long COVID, Post-Acute COVID-19 Syndrome, Critical COVID.

The Comparison Between the Early Tracheostomy and Orotracheal Intubation in COVID-19 Patients Required Mechanical Ventilation

Background: Supportive respiratory care and airway management are very important in treating COVID-19 patients with respiratory failure. There are two techniques for supporting patients with respiratory failure. Objectives: The current study aims to evaluate the efficacy and quality of patient care with early tracheostomy in intensive care unit (ICU) and compare mortality, hospital stay, and outcome between intubation and early tracheostomy. Methods: This study is conducted on total patients with confirmed COVID-19 in the ICU centers of a tertiary hospital. At the beginning of the study, all patients were intubated and connected to a mechanical ventilator. Within three days, the intensivists randomly performed bedside percutaneous dilational tracheostomy (PDT) for half of the patients. Early tracheostomy was defined as conducting tracheostomy within three days from intubation. Results: The total number of 36 patients was included in the study and categorized into two groups, including 18 patients in the early tracheostomy and 18 in orotracheal intubation. Half of the patients (50%) in the tracheostomy group were recovered from COVID-19 respiratory failure and discharged from ICU and hospital. All patients in the intubation group were expired. The length of staying alive in ICU in patients with an early tracheostomy was 26.47±3.79 compared with 7.58±2.36 days in intubated patients. Conclusion: The early tracheostomy compared with orotracheal intubation in respiratory failure patients with COVID-19 can significantly decrease mortality. However, airway management with an early tracheostomy increases the hospitalization stay and can increase recovery. So, conducting the early tracheostomy is recommended in this study.

Fiber-optic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units.

ABSTRACTBackgroundPercutaneous dilatational tracheostomy (PCDT) using fiber-optic bronchoscope (FOB) is a widely practiced technique, but its availability and cost remain a concern in nations with limited resources. Mini-surgical technique of PCDT incorporating minimal blunt dissection has shown improved results even without the use of FOB. The study is primarily intended to compare these two techniques and establish a safer cost-effective alternative to FOB-guided PCDTs.Patients and methodsThis randomized comparative study [registered (CTRI/2018/04/013191)] was conducted on 120 mechanically ventilated patients. In 60 patients, mini-surgical PCDT (group-M) was performed with 2 cm longitudinal skin incision and blunt dissection till pretracheal fascia without FOB guidance using Portex-Ultraperc™ sets. In remaining 60 patients, PCDT was performed under FOB vision with similar skin incision (without blunt dissection) using Portex-Ultraperc™ sets (group-F). Two techniques were compared with regard to procedural time and percentage of complications occurred during or after the procedure.ResultsProcedure time [group-M: 6.30 ± 1.28 minutes; group-F: 14.43 ± 1.84 minutes (p <0.001)] and mean blood loss [group-M: 5.33 ± 1.69 mL; group-F: 6.87 ± 3.11 mL (p = 0.001)] was significantly less in group-M. Higher incidence of desaturation [group-M: 16.7%; group-F: 35% (p = 0.022)] was noted in group-F, whereas arrhythmias [group-M: 21.7%; group-F: 6.7% (p = 0.018)] were higher in group-M. There was no statistical difference in incidence of pneumothorax and subcutaneous emphysema. There was no incidence of posterior tracheal wall perforation in any of the patients.ConclusionMini-surgical technique is a faster alternative of FOB-guided PCDT with comparable incidence of complications. It can safely be used in intensive care units (ICUs) where FOB is not available.Clinical trial registration numberCTRI/2018/05/014307Name of registryClinical Trials Registry of India (CTRI), URL—http://ctri.nic.in How to cite this articleKumar A, Kohli A, Kachru N, Bhadoria P, Wadhawan S, Kumar D. Fiber-optic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units. Indian J Crit Care Med 2021;25(11):1269–1274.

Dilatational Percutaneous vs Surgical TracheoStomy in IntEnsive Care UniT: A Practice Pattern Observational Multicenter Study (DISSECT).

IntroductionTracheostomy is among the common procedures performed in the intensive care unit (ICU), with percutaneous dilatational tracheostomy (PDT) being the preferred technique. We sought to understand the current practice of tracheostomy in Indian ICUs.Materials and methodsA pan-India multicenter prospective observational study, endorsed and peer-reviewed by the Indian Society of Critical Care Medicine (ISCCM), on various aspects of tracheostomy performed in critically ill patients was conducted between September 1, 2019 and December 31, 2019. The SPSS software was used for the statistical analysis. Cross tables were generated and the chi-square test was used for testing of association. The p value < 0.05 was considered statistically significant.ResultsOut of 67 ICUs that participated, 88.1% were from private sector hospitals. A total of 923 tracheostomies were performed during the study period; out of which, 666 were PDT and 257 were surgical tracheostomy (ST). Coagulopathic patients received more platelet transfusion [p = 0.037 with platelet count (PC) < 50 × 109, p = 0.021 with PC 50–100 × 109] and fresh frozen plasma transfusion in the ST group (p = 0.0001). The performance of PDT vs ST by day 7 of admission was 28.4% vs 21% (p = 0.023). The single dilator technique (60.4%) was the preferred technique for PDT followed by the Grigg's forceps and then the multiple dilator technique. Fiberoptic bronchoscope (FOB) and ultrasonography (USG) were used in 29.3% and 16.8%, respectively, for guidance during tracheostomy. Most of the PDTs were performed by a trained intensivist (74.2%), whereas ST was mostly done by an ENT surgeon (56.8%). Percutaneous dilatational tracheostomy resulted in less hemorrhagic (2.6% vs 7%, p = 0.002) and desaturation complications (2.3% vs 6.6%, p = 0.001) as compared to ST. The duration of procedure was shorter in the PDT group (average shortening by 9.2 minutes) and the ventilator-free days (VFD) were higher in the PDT group. The cost was less in PDT by approximately Rs. 13,104.ConclusionPercutaneous dilatational tracheostomy, especially the single dilator technique, is preferred by clinicians in Indian ICUs. The incidence of minor complications like hemorrhagic episodes is lower with PDT. Percutaneous dilatational tracheostomy was found to be cheaper on cost per patient basis as compared to ST (with or without complications).How to cite this articleGupta S, Tomar DS, Dixit S, Zirpe K, Choudhry D, Govil D, et al. Dilatational Percutaneous vs Surgical TracheoStomy in IntEnsive Care UniT: A Practice Pattern Observational Multicenter Study (DISSECT). Indian J Crit Care Med 2020;24(7):514–526.

Performing Tracheostomy in Intensive Care Unit- A Challenge duringCOVID-19 Pandemic

COVID-19 is a rapidly spreading infection caused by novel corona virus. It is challenging to the medical community in an unprecedented degree. Clinicians and health care workers are at added risk of infection during the procedure performing at the intensive critical care unit. Tracheostomy is a common surgical procedure performed at ICU for prolonged ventilation of the patient. Performing tracheostomy is currently a challenging for otolaryngologist at the ICU because of high chance of spreads of the virus to the surrounding health care workers and also to the other patients. The location for this procedure in ICU should be well ventilated after the procedure and the pressure in the room must be maintained negative or neutral. The health care personnel particularly Otolaryngologists have a central role for managing this situations where they are assessing the patients, preventing the contamination to other assisting staff and other patients. As there is progressive rise of the COVID-19 patients worldwide, it is surely expected that several patients may need intubation and mechanical ventilation. So, in this condition, patient my require tracheostomy for prolonged ventilation. Because of the very minimum literature available &nbsp;regarding tracheostomy in the COVID-19 pandemic, so this review article will surely increase awareness among health care personnel and surgical team for prevention of the transmission of the infection from tracheostomy to medical staffs and other patients.

Indications and outcomes of tracheostomy in intensive care unit

&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tracheostomy is a commonly performed surgical procedure in the intensive care unit (ICU) in which creation of a stoma between the skin and the anterior wall of the trachea where there is need for prolong mechanical ventilation. Tracheostomy has considered a safe procedure in ICU but has been found to lead to life threatening complications intra and post operatively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a cross sectional study, was carried out in ICU, Chittagong Medical College Hospital, Chattogram from January 2018 to December 2019. A total of 120 patients irrespective of age and sex whose tracheostomy has done after admission in ICU by ENT surgeons. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 120 patients maximum 34 (28.33%) were from 21-30 years age group and male to female ratio was 1.79:1, male patients were 77 (64.16%) and female patients were 43 (35.83%). The most common indication for tracheostomy in ICU was head injury and history of RTA 34 (28.33%) followed by post-operative case of intracranial space occupying lesion 30 (25%). Post tracheostomy complication was surgical emphysema 4 (3.33%). The rate of complication of tracheostomy in ICU was 10.83% in this study. Regarding benefits of tracheostomy over endotracheal tube in ICU, we found that 100% patients had greater comfort.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Tracheostomy in ICU is an important and safe procedure if prolonged endotracheal in tubation is advised for varying underlying causes.&lt;/p&gt;

Improving staff safety during tracheostomy in COVID-19 patients.

Dear Editor,At 29th of February the World Health Organization (WHO) reported 85403 confirmed globally confirmed case of COVID-19 [1]. COVID-19 is dramatically increasing in Italy, the last report from the ministry of health on the 9th of march reported the presence of 9172 confirmed cases and 733 patients in intensive care unit (ICU) [2]. We agree with Chan et al that physicians managing airway procedures are at particularly high risk to contract the COVID-19 infection [3]. We support the authors that claimed for a full protective wearing including N95 respirator, gown, cap, eye protection, and gloves, during aerosol generating procedures (AGP) [3]. However, we’d like to focus the attention on the tracheostomy procedures in COVID-19 patients since otolaryngologists, anesthesiologists and intensive care physicians are at high risk of contracting the infection during tracheostomy [3]. Tracheostomy is required in case of prolonged mechanical ventilation and intensive care unit (ICU) stay [4]. Surgical tracheostomy is an AGP associated with an increased risk severe acute respiratory distress (SARS) infection [5]. Strict adherence to infection control guidelines in SARS is mandatory in performing tracheostomy in ICU or operating room [6].Few years ago, we proposed the double lumen endotracheal tube (DLET) for percutaneous tracheostomy in critically ill patients [7]. DLET was equipped with an upper channel that allows passage of a bronchoscope during the percutaneous tracheostomy and with a lower channel exclusively dedicated to patient ventilation [7]. The lower channel is equipped with a distal cuff positioned just above the carina that may allow a safe mechanical ventilation by keeping stable gas-exchange and limiting the spread of aerosol during the procedure [7]. During the percutaneous procedure, the puncture of the anterior tracheal wall, Seldinger insertion, dilatation, and cannula positioning were all performed with the DLET correctly placed in the trachea. The DLET was removed at the end of the tracheostomy when the cannula is inserted and correctly positioned with the FFB [7].Surgical tracheostomy in COVID-19 patients should be done with a close collaboration between otolaryngologists, preforming the surgical procedure, and anesthesiologists or intensive care physicians managing the general anesthesia and the airway.When a surgical tracheostomy is done under general anesthesia, just before the surgeon makes the tracheal stoma, the endotracheal tube is withdrawn, so that the cuff of the tube is not in the surgical field [8]. But when the surgeon makes the tracheal incision, ventilation is lost and the surgeon has to be quick enough to create the soma and insert the tracheostomy tube in a short time [8]. During this procedure a large spread of aerosol may occur. To avoid the aerosol, we suggest to push down the endotracheal tube beyond the site chosen for the tracheal stoma at the beginning of the procedure. The endotracheal tube should reach the tracheal carina so the cuff is surely distal to the tracheostomy site. By checking the airway pressure and the end-tidal CO2, on the mechanical ventilator we can realize if the endotracheal tube is still in the lower tract of the trachea or in the endobronchial tract. Our previous experience with the DLET demonstrated that the endotracheal tube and the tracheal cannula can be simultaneously inserted inside the trachea [7]. According to this, pushing down the endotracheal tube and cuffed it at the level of the carina may avoid the spread of aerosol and, then, may add an extra security for the medical staff during a procedure at high risk of generating aerosol.ReferencesCoronavirus disease 2019 (COVID-19) Situation Report – 40.https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200229-sitrep-40-covid-19.pdfItalian Minister of Health. COVID-19 Italian cases.http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus.jsp?lingua=italianoi19:291-301Tran K, Cimon K, Severn M et al. Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review. . PLoS ONE 2012; 7(4): e35797. doi:10.1371/journal.pone.0035797Chun-Wing A, Yin -Chun L, Kit-Ying L. Management of Critically Ill Patients with Severe Acute Respiratory Syndrome (SARS). Int. J. Med. Sci. 2004 1(1): 1-10Vargas M, Servillo G, Tessitore G, Aloj F, Brunetti I, Arditi E, et al. Percutaneous dilatational tracheostomy with a double-lumen endotracheal tube. A Comparison of Feasibility, Gas Exchange, and Airway Pressures. Chest 2015; 147:1267-74Walts PA, Sudish CM, DeCamp MM. Techniques of surgical tracheostomy. Clin Chest Med 24 (2003) 413 – 422

Extubation strategies in neuro-intensive care unit patients and associations with outcomes: the ENIO multicentre international observational study.

BackgroundProlonged invasive ventilation is common in patients with severe brain injury. Information on optimal management of extubation and on the use of tracheostomy in these patients is scarce. International guidelines regarding the ventilator liberation and tracheostomy are currently lacking.MethodsThe aim of ‘Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes’ (ENIO) study is to describe current management of weaning from invasive ventilation, focusing on decisions on timing of tracheal extubation and tracheostomy in intensive care unit (ICU) patients with brain injury. We conducted a prospective, international, multi-centre observational study enrolling patients with various types of brain injury, including trauma, stroke, and subarachnoid haemorrhage, with an initial Glasgow Coma Score equal or less than 12, and a duration of invasive ventilation longer than 24 hours from ICU admission. ENIO is expected to include at least 1,500 patients worldwide. The primary endpoint of the ENIO study is extubation success in the 48 hours following endotracheal tube removal. The primary objective is to validate a score predictive of extubation success. To accomplish this, the study population will be randomly divided to a development cohort (2/3 of the included patients) and a validation cohort (the remaining 1/3). Secondary objectives are: to determine the incidence of extubation success rate according to various time-frames (within 96 hours, >96 hours after extubation); to validate (existing) prediction scores for successful extubation according to various time-frames and definitions (i.e., tracheostomy as extubation failure); and to describe the current practices of extubation and tracheostomy, and their associations.DiscussionENIO will be the largest prospective observational study of ventilator liberation and tracheostomy practices in patients with severe brain injury undergoing invasive mechanical ventilation, providing a validated predictive score of successful extubation.Trial registrationThe ENIO study is registered in the Clinical Trials database: NCT 03400904.

Tracheostomy colonisation and microbiological isolates of patients in intensive care units-a retrospective study.

ObjectiveTo find out the type of bacteria colonising the tracheostomy tube and to determine the antibiotic sensitivity pattern and resistance in patients who have had tracheostomy in intensive care unit (ICU) set up and to initiate proper empirical treatment in such patients.MethodsThe study was a retrospective review of patients who underwent tracheostomy at Ministry of Health, Sur Hospital, Oman January 2005 and December 2015. The Hospital has 4 bedded pediatric intensive care unit (PICU) and 10 bedded adult ICU which is headed by consultant anaesthetists, consultant physicians, ICU trained nurses and respiratory therapists. All patients who required mechanical ventilation and were therefore subject to an orotracheal intubation and those who underwent a conventional tracheostomy were considered for inclusion. Patients who had been intubated in other hospitals or ICUs, other airways infection issues were excluded from this study. Data's were collected from computer based hospital management system, operation theatre and registers in Medical records department and entered in a preformed questionnaire before thorough analysis. The specimens for swab was obtained from the cut tracheostomy tube tips and the samples were sent to microbiology laboratory for isolation of the organism and obtain an antibiogram to know the susceptibility and resistance to antibiotics. Data were analyzed by Statistical Package for Social Sciences (SPSS, version 16, Chicago, Inc) and the values are reported as number (%). The commonest isolated organism was Pseudomonas followed by Acinetobacter.ResultsDuring the ten year retrospective study, there were 108 patients included in our study with 56 males and 51 females. Fourteen different microorganisms were isolated during our study which included Pseudomonas aeruginosa (n = 39), Acinetobacter baumanii (n = 28), Klebsiella (n = 10) and coagulase negative staphylococcus (n = 6). The most commonest organisms in both genders was Pseudomonas aeruginosa closely followed by Acinetobacter baumanii. In children under age of 12, it was Pseudomonas aeruginosa and in adults the impending organism was Acinetobacter baumanii. In terms of antiobiograms, 89% of Acinetobacter, 38% of Staphylococcus aureus, 37% of Klebsiella and 54% of Proteus mirabilis were resistant to ciprofloxacin. These organisms were resistant to ceftazidime in 97%, 83%, 89% and 57% of the cases, respectively and resistant to imipenem in 7.4%, 18.2%, 1.8% and 8.1%.ConclusionsIn summary, this study presents the most common microorganisms colonized from tracheostomy of hospitalized patients and their pattern of antibiotic resistance. As our study showed, Pseudomonas is the most common microorganism isolated from tracheostomy tube. Ciprofloxacin was also the most prevalent antibiotic revealing resistant pattern. Moreover, most of the microorganisms were sensitive to imipenem and pipracillin-tazobactam.

The Evaluation of the Complications of Surgical and Percutaneous Tracheostomies in Intensive Care Unit

The Evaluation of the Complications of Surgical and Percutaneous Tracheostomies in Intensive Care Unit

Factors affecting occurrence of post intubation and post tracheostomy tracheal stenosis in intensive care units

Objective: Iatrogenic tracheal stenosis is a life threatening iatrogenic complication of prolonged endotracheal intubation and tracheostomy in intensive care units (ICUs). It is one of the toughest morbidities in otolaryngology.Aim of the Study: This prospective observational study was conducted to detect the factors affecting occurrence of tracheal stenosis in patients subjected to tracheostomy after endotracheal intubation in ICUs.Patients and Methods: Sixty eight patients were included in this prospective study. They were admitted to (ICUs) and were subjected to endotracheal intubation, mechanical ventilation and tracheostomy due to prolonged intubation during their stay in (ICUs). The patients were followed up after being discharged for six months to detect incidence and factors affecting occurrence of tracheal stenosis. They were followed up using flexible fiber optic tracheobronchoscopy under local anesthesia, just after weaning from mechanical ventilation three and six months later.Results: Of the studied patients, 50 patients had no tracheal stenosis until the end of follow up period (without tracheal stenosis (WTS) group) while, 18 patients had tracheal stenosis (TS group). The mean duration of mechanical ventilation in WTS group (12.1 ± 7.6 days) was statistically shorter than that of TS groups (16.6 ± 10.4 days) (P = 0.048). Tracheostomy stoma wound sepsis was recorded in 4 patients in TS group and in 2 patients in WTS group.Conclusion: The main predisposing factors for post intubation and post tracheostomy tracheal stenosis are tracheostomy stomal wound sepsis and prolonged duration of mechanical ventilation. In contrary, tracheal cartilage injury during tracheostomy, age, sex and reason for mechanical ventilation was found to have no role in occurrence of tracheal stenosis.

COVID Operation Theatre- Advisory and Position Statement of Indian Society of Anaesthesiologists (ISA National).

COVID Operation Theatre- Advisory and Position Statement of Indian Society of Anaesthesiologists (ISA National).

Application Value of Minimally Invasive Percutaneous Dilational Tracheostomy for ICU Critical Patients.

Objective:To find out the application value of minimally invasive percutaneous dilational tracheostomy in critically ill patients in intensive care unit (ICU).Methods:One hundred and forty critically ill patients who underwent tracheostomy in ICU of our hospital were included in the study from August 2016 to December 2017. They were divided into an observation group and a control group by random number table method, 70 in each group. The control group received conventional tracheotomy, while the observation group received percutaneous dilational tracheostomy. The operation time, incision length, amount of intraoperative bleeding and healing time of incision were compared between the two groups, and the changes of vital signs and complications after operation were recorded. The family members of the patients signed the informed consent.Results:The operation time, healing time and incision length of the observation group were (9.92±4.13) min, (1.31±0.21) cm and (6.91±0.72) d respectively, shorter than (24.09±6.82) min, (3.40±0.65) cm and (67.48±0.61) d in the control group, and the differences were statistically significant (P<0.05). The amount of intraoperative bleeding of the observation group was (7.81±1.83) mL, less than (16.34±2.83) mL in the control group; the difference was statistically significant (P<0.05). The heart rate and oxygen saturation of the observation group before and during the operation were not significantly different (P>0.05). The heart rate of the control group during the operation was significantly higher than that before the operation (P<0.05); the oxygen saturation of the control group before and during the operation had no significant difference (P>0.05). The incidence of complications in the observation group was 24.3%, which was significantly lower than that in the control group (55.7%, X2=8.279, P=0.014).Conclusion:Minimally invasive percutaneous dilational tracheostomy has advantages of small trauma, less infection and beautiful incision, and it will not increase postoperative complications. It is of great value in the treatment of ICU critical patients.

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations.

Background and AimCritically ill patients on mechanical ventilation undergo tracheostomy to facilitate weaning. The practice in India may be different from the rest of the world and therefore, in order to understand this, ISCCM conducted a multicentric observational study “DIlatational percutaneous vs Surgical tracheoStomy in intEnsive Care uniT: A practice pattern observational multicenter study (DISSECT Study)” followed by an ISCCM Expert Panel committee meeting to formulate Practice recommendations pertinent to Indian ICUs.Materials and methodsAll existing International guidelines on the topic, various randomized controlled trials, meta-analysis, systematic reviews, retrospective studies were taken into account to formulate the guidelines. Wherever Indian data was not available, international data was analysed. A modified Grade system was followed for grading the recommendation.ResultsAfter analyzing the entire available data, the recommendations were made by the grading system agreed by the Expert Panel. The recommendations took into account the indications and contraindications of tracheostomy; effect of timing of tracheostomy on incidence of ventilator associated pneumonia, ICU length of stay, ventilator free days & Mortality; comparison of surgical and percutaneous dilatational tracheostomy (PDT) in terms of incidence of complications and cost to the patient; Comparison of various techniques of PDT; Use of fiberoptic bronchoscope and ultrasound in PDT; experience of the operator and qualification; certain special conditions like coagulopathy and morbid obesity.ConclusionThis document presents the first Indian recommendations on tracheostomy in adult critically ill patients based on the practices of the country. These guidelines are expected to improve the safety and extend the indications of tracheostomy in critically ill patients.How to cite this articleGupta S, Dixit S, Choudhry D, Govil D, Mishra RC, Samavedam S, Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations. Indian J Crit Care Med 2020;24(Suppl 1):S31–S42.

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

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