Tracheostomy Technique Research Articles

Walking the line between benefit and harm from tracheostomy in COVID-19

Walking the line between benefit and harm from tracheostomy in COVID-19

Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19

BackgroundCoronavirus 2019 (COVID-19) is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy is not recommended by current guidelines as it is considered a superspreading event owing to aerosolization that unduly risks health care workers.MethodsPatients with severe COVID-19 who were on mechanical ventilation for 5 days or longer were evaluated for percutaneous dilational tracheostomy. We developed a novel percutaneous tracheostomy technique that placed the bronchoscope alongside the endotracheal tube, not inside it. That improved visualization during the procedure and continued standard mechanical ventilation after positioning the inflated endotracheal tube cuff in the distal trachea. This technique offers a significant mitigation for the risk of virus aerosolization during the procedure.ResultsFrom March 10 to April 15, 2020, 270 patients with COVID-19 required invasive mechanical ventilation at New York University Langone Health Manhattan’s campus; of those, 98 patients underwent percutaneous dilational tracheostomy. The mean time from intubation to the procedure was 10.6 ± 5 days. Currently, 32 patients (33%) do not require mechanical ventilatory support, 19 (19%) have their tracheostomy tube downsized, and 8 (8%) were decannulated. Forty patients (41%) remain on full ventilator support, and 19 (19%) are weaning from mechanical ventilation. Seven patients (7%) died as a result of respiratory and multiorgan failure. Tracheostomy-related bleeding was the most common complication (5 patients). None of health care providers has had symptoms or tested positive for COVID-19.ConclusionsOur percutaneous tracheostomy technique appears to be safe and effective for COVID-19 patients and safe for health care workers.

Técnica quirúrgica de la traqueostomía percutánea en el paciente con COVID-19

Generalidades. Desde diciembre de 2019 se detectó una nueva infección respiratoria, causada por el virus denominado SARS-CoV-2, decretada posteriormente como pandemia, lo cual ha exigido al personal de salud replantear la forma de prestar sus servicios en salud y garantizar la auto-protección con recursos que han sido insuficientes incluso en los países más desarrollados.
 Dado que la transmisión del SARS-CoV-2 ocurre a través de aerosoles expulsados de la vía aérea, que pueden ser inhalados o llevados a las mucosas por contacto con las manos contaminadas, se requiere minimizar la posibilidad de contagio para los equipos de atención en salud.
 Objetivos. Brindar herramientas a los cirujanos que les permitan elegir la técnica con menor probabilidad de exposición a aerosoles. Describir el paso a paso de la técnica quirúrgica de la traqueostomía percutánea, enfatizando en el control sobre la generación de aerosoles en pasos críticos.
 Aspectos técnicos. La técnica completamente percutánea con kit de traqueostomía permite un mejor sello entre tejidos y dispositivos. Los escenarios más frecuentes para realizar una traqueostomía son: el paciente intubado con ventilación mecánica y el paciente con falla en la intubación que requiere una intervención de emergencia.
 Conclusión. El alto contagio del COVID-19 al practicar intervenciones en la vía aérea nos obliga a hacer énfasis en las estrategias que reduzcan la formación de aerosoles y permitan la contención de los mismos durante la realización de traqueostomías.

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

Percutaneous dilational tracheostomy: current techniques and evidence of safety

Tracheostomy has transitioned from being the complete domain of surgeons, as described by Chevalier Jackson in early 20th century, to a procedure shared by intensivists and interventional pulmonologists in form of percutaneous dilatational tracheostomy. This procedure is commonly performed in intensive care units to facilitate long-term mechanical ventilation for chronic respiratory failure, but other less frequent indications also exist. The commonly practiced techniques for percutaneous dilational tracheostomy rely on passage of tools over a guidewire, with the Ciaglia technique being the most popular and having the best safety profile. Adjunctive techniques include use of bronchoscopy, bedside ultrasonography, and laryngeal mask airway (LMA). In properly selected patients, percutaneous dilational tracheostomy carries a good safety profile, but some patient characteristics may increase the risk of complications; thus, the procedure is complimentary to surgical tracheostomy (ST) and not a complete replacement. Bedside ultrasound and bronchoscopy are routinely available instruments in most intensive care units, although there is limited evidence of improved safety with these adjuncts. In properly selected patients, percutaneous dilational tracheostomy can be a safe and cost-effective alternative to ST.

Current Status of Indications, Timing, Management, Complications, and Outcomes of Tracheostomy in Traumatic Brain Injury Patients.

Tracheostomy is the commonest bedside surgical procedure performed on patients needing mechanical ventilation with traumatic brain injury (TBI). The researchers made an effort to organize a narrative review of the indications, timing, management, complications, and outcomes of tracheostomy in relation to neuronal and brain-injured patients following TBI. The study observations were collated from the published literature, namely original articles, book chapters, case series, randomized studies, systematic reviews, and review articles. Information sorting was restricted to tracheostomy and its association with TBI. Care was taken to review the correlation of tracheostomy with clinical correlates including indications, scheduling, interventions, prognosis, and complications of the patients suffering from mild, moderate and severe TBIs using Glasgow Coma Scale, Glasgow Outcome Scale, intraclass correlation coefficient, and other internationally acclaimed outcome scales. Tracheostomy is needed to overcome airway obstruction, prolonged respiratory failure and as indispensable component of mechanical ventilation due to diverse reasons in intensive care unit. Researchers are divided over early tracheostomy or late tracheostomy from days to weeks. The conventional classic surgical technique of tracheostomy has been superseded by percutaneous techniques by being less invasive with lesser complications, classified into early and late complications that may be life threatening. Additional studies have to be conducted to validate and streamline varied observations to frame evidence-based practice for successful weaning and decannulation. Tracheostomy is a safer option in critically ill TBI patients for which a universally accepted protocol for tracheostomy is needed that can help to optimize indications and outcomes.

Social impact of tracheostomy: Our experiences at a tertiary care teaching hospital of Eastern India

Background: Tracheostomy is a common surgical procedure performed in upper airway obstruction or in critically ill patients requiring prolonged ventilation. Although tracheostomy is a life-saving surgery, it is associated with higher rates of morbidity along with social stigma if stays for longer period. Although there are several studies for indications, complications, and different techniques for tracheostomy, but majority do not provide any insight into social impact of tracheostomy. Objective: The objective of this study is to assess the social impact of tracheostomy at a tertiary care teaching hospital. Materials and Methods: This is a retrospective observational study. The study was carried out from December 2017 to January 2020.There were 34 tracheostomy patients participated in this study. The observed complications in tracheostomy patients such as surgical/medical and social issues were documented. We conducted structured interviews with care givers of patients with tracheostomy. Results: Medical or surgical complications included excess mucus production (61.76'), infections at the stoma site (23.52'), blockage (17.64'), granulations around the stoma (11.76'), and maggots at the stoma (2.94'). The social impacts on tracheostomy patients included family reluctance to accept the patient with tracheostomy tube, unable to communicate and problems in social integration. Conclusion: Tracheostomy has several ranges of effects on quality of life of care givers and patients with tracheostomy. The management of social stigma associated with permanent tracheostomy is more challenging than any other complications due to tracheostomy procedure itself. It can be solved with proper counseling with family members those involved with patients.

Tracheostomy in COVID-19-infected patients

PurposeTo evaluate the modifications in the indications and technique of tracheostomy for prolonged-intubated COVID-19-infected patients.MethodologyCommissioned by the Ministry of Health in Egypt, different guidelines for tracheostomy for COVID-19 patients were revised. A guideline was adopted and modified to meet the equipment provided by facilities assigned to contain the current pandemic. The understanding of staff and the applicability of the new guidelines were evaluated using a mini-summative quiz answered by 117 tracheostomy team members in facilities around Grand Cairo, Egypt.ResultsThe percentages of consistent answers for questions 1–6 were 94, 90.60, 89.70, 95.70, 61.50, and 93.20%, respectively. A total of 86 (73.5%) individuals achieved score more than 80%. Moreover, 41 (35%) individuals achieved perfect score.ConclusionThe novel guidelines are well understood and applicable. Remarks that emerged regarding diathermy use should be taken in consideration. Continuous assessment of these guidelines is needed as the pandemic goes on altering its manner and our strategies along with it.

Трахеостомия у пациентов с COVID-19

The COVID-19 pandemic has led to an unprecedented increase in the number of patients who are in critical condition and need artificial ventilation. The need for relatively long periods of ventilation means that many of the patients who receive it are considered candidates for tracheostomy, in order to improve respiratory support. Tracheostomy is a standard procedure in seriously ill patients who require a long-term ventilator. However, tracheostomy in patients with COVID-19 has a number of features. Despite the growing demand, there was not enough time and experience to develop reliable, evidence-based guidance or clinical recommendations on indications, timing, and tracheostomy techniques for patients with COVID-19 patients. Such guidance would be important to ensure a standard of care and improve treatment outcomes. The purpose of this paper is to review our experience, provide evidence and rationale behind our approach, and ultimately formulate our recommendations for managing tracheotomy and optimizing the care of tracheotomized patients with COVID-19.

National questionnaire on skills and techniques in pediatric tracheotomy surgery in Turkey

ObjectiveThe aim of the study was to determine the differences in surgical preferences of ENT Surgeons in Turkey with regard to pediatric tracheotomy. DesignQuestionnaire study. ParticipantsENT Surgeons. Materials and methodsThe national multiple-choice questionnaire study included a total of 16 questions about physicians technical preferences, different methods and complications in pediatric tracheotomy surgery. It was planned and implemented with the support of a professional survey company (www.surveymonkey.com). ResultsThe questionnaire was answered by 591 ENT Surgeons; the percentage of the physicians performing pediatric tracheotomies in the previous year was 59.6%. Forty point four percent (40.4%) of the physicians had not performed tracheotomies in the pediatric age group and 57.9% had not performed tracheotomies in patients under one year old. Seventy point six percent (70.6%) of the physicians who had performed tracheotomies had made vertical skin incisions, 69.5% of them had removed subcutaneous adipose tissue, 81.4% of them had retraction the thyroid isthmus area from their field of view; 83.9% of them had made a vertical incision to the trachea, 82.5% of them had applied a stay suture to the trachea and 4.7% of them had used additional techniques for stoma maturation. The intraoperative mortality, early complication, late complication, and total complication rates were 3.9%, 32.7%, 21.2% and 53.9 respectively. ConclusionsThis is the first large-scale questionnaire study with data on pediatric tracheotomy techniques and the practices of ENT Surgeons at a national level. Common approaches were observed among the.

Percutaneous Dilatational Tracheostomy Using Tube Exchanger.

We describe a modified technique for percutaneous dilatational tracheostomy using a 15F tube exchanger or Eschmann catheter. A retrospective review of 1180 procedures using this modified technique demonstrated it to be effective with a failure rate of only 0.25% (3 patients). Moreover, it provides an additional safeguard with the ability to rapidly reintroduce the endotracheal tube into the trachea guided by the exchange catheter in the event of accidental extubation during the procedure. This technique needs no additional special devices or equipment (eg, a bronchoscope). However, a prospective study is needed to better define its complication rate.

A Modified Translaryngeal Tracheostomy Technique in the Neurointensive Care Unit. Rationale and Single-center Experience on 199 Acute Brain-damaged Patients.

Brain-injured patients frequently require tracheostomy, but no technique has been shown to be the gold standard for these patients. We developed and introduced into standard clinical practice an innovative bedside translaryngeal tracheostomy (TLT) technique aided by suspension laryngoscopy (modified TLT). During this procedure, the endotracheal tube is left in place until the airway is secured with the new tracheostomy. This study assessed the clinical impact of this technique in brain-injured patients. This is a retrospective analysis of prospectively collected data from adult brain-injured patients who had undergone modified TLT during the period spanning from January 2010 to December 2016 at the Neurointensive care unit, San Gerardo Hospital (Monza, Italy). The incidence of intraprocedural complications, including episodes of intracranial hypertension (intracranial pressure [ICP] >20 mm Hg), was documented. Neurological, ventilatory, and hemodynamic parameters were retrieved before, during, and after the procedure. Risk factors for complications and intracranial hypertension were assessed by univariate logistic analysis. Data are presented as n (%) and median (interquartile range) for categorical and continuous variables, respectively. A total of 199 consecutive brain-injured patients receiving modified TLT were included. An overall 52% male individuals who were 66 (54 to 74) years old and who had an admission Glasgow Coma Scale of 7 (6 to 10) were included in the cohort. Intracerebral hemorrhage (30%) was the most frequent diagnosis. Neurointensivists performed 130 (65%) of the procedures. Patients underwent tracheostomy 10 (7 to 13) days after intensive care unit admission. Short (ie, <2 min) and clinically uneventful increases in ICP>20 mm Hg were observed in 11 cases. Overall, the procedure was associated with an increase in ICP from 7 (4 to 10) to 12 (7 to 18) mm Hg (P<0.001). Compared with baseline, cerebral perfusion pressure (CPP), respiratory variables, and hemodynamics were unchanged during the procedure (P-value, not significant). Higher baseline ICP and core temperature were associated with an increased risk of complications and intracranial hypertension. Complication rates were low: 1 procedure had to be converted to a surgical tracheostomy, and 1 (0.5%) episode of minor bleeding and 5 (2.5%) of minor non-neurological complications were recorded. Procedures performed by intensivists did not have a higher risk of complications compared with those performed by ear, nose, and throat specialists. A modified TLT (by means of suspension laryngoscopy) performed by neurointensivists is feasible in brain-injured patients and does not adversely impact ICP and CPP.

Management of Laryngotracheal Stenosis: A 10-Year Study on the Role of Stents

Introduction Laryngotracheal stenosis (LTS) is mostly due to road traffic accidents, prolonged intubation, and tracheostomy. Objectives This study focused on a 10-year experience on the role of stents in the management of LTS in a tertiary referral hospital. The aims of this study were to study the internal dimensions of the subglottis and upper trachea in the Indian adult population; to study the mucosal response to injury to the subglottis and the trachea; and to develop an ideal stent for use in LTS in a rabbit model. Materials and Methods The authors have been treating patients with LTS since 2000. The present study deals with the experience of 82 cases of LTS treated over the past 10 years using stents as well as surgical procedures such as Shiann Yann Lee tracheoplasty and tracheal resection and anastomosis. The work also involved a focused research on LTS using rabbits by inducing injury to the mucosa of the upper trachea and subglottis and histological study of the response to injury. The study led to the development of new indigenous stent for use in rabbits to prevent LTS. This stent has been patented. Statistical Analysis The study of the subglottis and upper tracheal discussion have been analyzed and proved that the dimension in the Indian adult population was smaller than in Caucasians. The mucosal inflammation following injury at the subglottis and upper trachea can be reversed by topical application of triamcinolone, which was better than Mitomycin on statistical analysis. Results The quality of life measured after treatment of LTS using stents and other methods of reconstructive surgery has given an overall benefit of 90% with no mortality. Conclusion LTS is a preventable disease. It can be prevented by proper care of patients in ICU and correct technique of endotracheal intubation and tracheostomy. Further, it can be avoided using medications during extubation and proper decannulation protocol. The silastic “T” tube stents are useful to improve the quality of life in these patients.

Assessment of the percutaneous dilatational tracheostomy technique in experimental manikins and canine cadavers.

To evaluate procedure time, ease of placement, and complication rates of percutaneous dilatational tracheostomy (PDT) compared to surgical tracheostomy (ST) in canine cadavers. Randomized crossover experimental manikin and cadaver study involving 6 novice veterinary students. University teaching hospital. Canine tracheostomy training manikin, 24 canine cadavers. None. For training, each student performed 10 PDT and 10 ST procedures on a training manikin, followed by 2 PDT and 2 ST procedures on a canine cadaver. After each training procedure, feedback from bronchoscopy and observers was provided. Final PDT and ST tube placements using new equipment were performed in unused cadavers. Placements were timed, ease of placement was scored using visual analog scales (VAS, 0-10 cm), and complications were assessed by two independent observers using ordinal scales (0-3). Cadaver tracheas were explanted postprocedure to evaluate anatomical damage scores (0-3). Procedure time and VAS scores for PDT and ST procedures were analyzed using mixed-effects linear models, accounting for student, technique, and procedure number with post hoc pairwise comparisons. Data are presented as median (range). For the final cadaver placement, there were no significant differences in placement time (300 seconds [230-1020] vs 188 seconds [116-414], P = 0.210), ease of placement (3.8 cm [2.1-5.7] vs 1.9 cm [0-4.7], P = 0.132), anatomical damage score (1 [0-2] vs 0 [0-1], P = 0.063), or equipment complications score (0 [0-1] vs 0 [0-0], P = 1.000) between PDT and ST, respectively. These data suggest that PDT can be performed as quickly, as easily, and as safely as ST in a canine cadaver by novice veterinary students following manikin training. Additional studies will be required to determine if these findings can be translated into veterinary clinical practice.

Our Experience with Percutaneous and Surgical Tracheotomy in Intubated Critically Ill Patients.

Open surgical tracheotomy (OST) and percutaneous dilatational tracheotomy (PDT) are commonly used for securing airway in intubated critically ill patients. The purpose of this study was to compare the safety of OST and PDT, particularly in intubated critically ill patients. The medical records of intubated critically ill patients who underwent tracheotomy between August 2006 and July 2017 were analyzed retrospectively. Minor and major complication rates were compared according to the tracheotomy technique. Preoperative intubation time, postoperative decannulation time, reason for hospitalization, and demographic data, including the Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, were evaluated. A total of 332 cases were enrolled into the study. The minor and major complication rates for both techniques were 27.2%, 8.8%, 9.7% and 3.2%, respectively. Minor and major complication rates were higher in the OST group (p=0.01, p=0.03, respectively). The rate of every single complication was also compared on groups' basis. Accidental decannulation (p=0.02) and pneumothorax (p=0.05) were found to be significantly frequent in the OST group. There was no impact of the preoperative intubation time on the minor (p=0.20) and major complication (p=0.29) rates found. There was no statistically significant difference regarding the postoperative decannulation time (p=0.32). Also, there was no statistically significant difference between two groups in terms of the APACHE II (p=0.69) and SOFA (p=0.37) scores. However, a statistically significant difference between the groups in terms of overall survival was found, in favor of PDT (p<0.001). This study revealed that PDT is safer than OST, particularly in intubated critically ill patients.

Comparison of Ciaglia and Griggs Percutaneous Tracheostomy Techniques - A Biomechanical Animal Study.

ABSTRACTBackground and aimsThe two most common commercial percutaneous dilation tracheotomy (PDT) sets apply different techniques. Our aim was to investigate the biomechanical properties of these two techniques on an animal model, that simulate a human trachea.Materials and methodsBiomechanical properties of the different steps of the Ciaglia Blue Rhino® and Griggs Portex® techniques were measured on 20 pig cadavers.ResultsWe found that the use of the two different devices created equal sized openings in the trachea (p >0.05). The force needed to insert the Griggs forceps was 1.8 kg average compared to 2.51 kg using the Ciaglia dilator (p <0.00001). The calculated total energy expenditure in the Ciaglia Blue Rhino® kit was 1.46 times greater than the Griggs Portex® kit (p <0.0001). This was mainly due to the amount of energy required during the final dilator stage, which was 4 times more using the Ciaglia Blue Rhino® dilator than the Portex® Griggs-dilator forceps.ConclusionWe conducted a series of biomechanical properties experiments on an animal model of PDT using two popular commercial kits – Griggs Portex® guidewire dilating forceps by Smiths Medical and Ciaglia Blue-Rhino® by Cook Medical. The Ciaglia technique required almost 50% more energy to perform a PDT (p <0.0001), mainly because of the force exerted during the final dilator insertion stage compared to the Griggs forceps. Further research is needed to examine if these properties are related to some of the PDT complications.How to cite this articleRonen O, Rosin I, Taitelman UZ, Altman E. Comparison of Ciaglia and Griggs Percutaneous Tracheostomy Techniques – A Biomechanical Animal Study. Indian J Crit Care Med 2019;23(6):247–250.

Pediatric tracheostomy technique and complications—From the standpoint of children’s Hospital-to avoid complications—

Pediatric tracheostomy technique and complications—From the standpoint of children’s Hospital-to avoid complications—

Consideration of pediatric tracheostomy techniques at a university hospital and a laryngeal hospital

Consideration of pediatric tracheostomy techniques at a university hospital and a laryngeal hospital

Seasonal distribution of the incidence of bell's palsy

The aim of this study was to investigate the tissue damage created by the two commonly used percutaneous tracheostomy methods of multiple dilatational tracheostomy and the controlled rotating dilation technique. A total of 21 sheep trachea samples were obtained from the slaughterhouse. The tracheas were separated into 3 groups of 7 samples in each. In Group 1, only an incision was made. In Group 2, the multiple dilatational tracheostomy method was applied, and in Group 3, the controlled rotating dilation technique. The tissue samples taken were separated into 2 equal pieces. One piece was used for histopathological examination and the other was examined under electron microscope. When the hematoxylin-eosin staining results and the electron microscope images of the sheep trachea slices were evaluated, cartilage integrity was observed to have been preserved in Groups 1 and 2. In Group 3, there was seen to be epithelial injury and disruption of the cartilage integrity. To reduce the complications of percutaneous tracheostomy techniques to a minimum, the protection of tissue integrity is important. The multiple dilatational tracheostomy method was seen to be superior to the controlled rotating dilation technique in respect of protecting tissue integrity.

Paediatric tracheostomy: A modified technique and its outcomes, results from a South Indian tertiary care

Study objectivesTo review the key parameters related to the proposed modified pediatric tracheostomy technique with to determine the efficacy, safety and outcomes in a tertiary hospital in south India. Patients and Methods A retrospective chart review of all children aged below 16 years who underwent tracheostomy at a tertiary hospital in south India during the period of August 2014 to August 2016. Data on age, gender, indication for tracheostomy, primary disease condition, duration of intubation, complications and decannulation rate were recorded. ResultsFifty children aged below 16 years underwent tracheostomy between August 2014 and August 2016. The average of the children was 5.35 years. (Range14 days to 14 years). The male female ratio was 1.6:1. In our study prolonged intubation was the most common indication (62%). None of the children had early post-operative complications such as bleeding, pneumothorax, surgical emphysema or accidental decannulation. Peristomal granulations (24%) was the most common complication although none was severe to warrant operative intervention. One child had a lifethreatening tube block requiring cardiopulmonary resuscitation. None of the children had accidental decannulation during the period of the study. Tracheocutaneous fistula was seen in 2 children (4%) and was the only long-term complication. These children required surgical decannulation. There was no clinical evidence of tracheal stenosis or tracheomalacia in any child. ConclusionPediatric tracheostomy is challenging for both the surgeon and the care-giver specially in the early post-operative period. Our proposed modified technique addresses these concerns and without any significant complications.