Tracheostomy Tube Research Articles

A Case of Posterior Tracheal Wall Rupture During Tracheostomy Treated With Sternocleidomastoid Muscle Reinforcement

A posterior tracheal wall rupture is a rare but life-threatening complication of tracheostomy. Several flaps based on the sternocleidomastoid (SCM) muscle, which has sufficient length and abundant blood supply, are utilized for the reconstruction of tracheal defects. We discuss here a case of a 71-year-old male with multiple organ failure and mental retardation, with posterior tracheal wall damage that had occurred during tracheostomy tube insertion. When planning the repair of the wound, additional reinforcement was necessary due to saliva leakage secondary to decreased consciousness. Direct suturing was followed by the reinforcement of SCM muscle transposition, which was conducted through cervical and endoscopic approach.

Multi-Layered Implant Approach for Hemilaryngectomy Reconstruction in a Porcine Model.

Partial laryngectomies result in voice, swallowing, and airway impairment for thousands of patients in the United States each year. Treatment options for dynamic restoration of laryngeal function are limited. Thus, there is a need for new reconstructive approaches. Here, we evaluated early (4 week) outcomes of multi-layered mucosal-myochondral (MMC) implants when used to restore laryngeal form and function after hemilaryngectomy in a porcine model. Six Yucatan minipigs underwent transmural hemilaryngectomies followed by reconstruction with customized MMC implants aiming to provide site-appropriate localization of regenerated laryngeal tissues, while supporting laryngeal function. All implants were fabricated from polymeric collagen, with a subset of muscle and cartilage implants containing motor endplate-expressing muscle progenitor cells or cartilage-like cells differentiated from adipose stem cells, respectively. Vocalization and laryngeal electromyography (L-EMG) measurements with nerve conduction studies were performed post-operatively and compared with baseline along with gross and histological analyses of the healing response. All animals (n = 6) survived and maintained airway patency, safe swallowing, and phonation, without the use of tracheostomy and/or gastrostomy tubes. Histological evaluation indicated no adverse tissue reaction or implant degradation, showing progressive regenerative remodeling with mucosa reformation and ingrowth of new muscle and cartilage. Preliminary L-EMG suggested weak but detectable motor unit action potentials. Although vocalization duration, frequency, and intensity decreased post-operatively, all animals retained vocal capacity and parameter recovery was evident over the study duration. Engineered collagen polymeric implants in the presence or absence of autologous cell populations may serve as a feasible reconstructive option to restore dynamic function after hemilaryngectomy. Long-term follow-up is needed to further assess functional outcomes. NA Laryngoscope, 2024.

Individual approach to the treatment of patients with stage III–IV laryngeal and laryngopharyngeal cancer in the Altai territory

Laryngeal and laryngopharyngeal cancer is the most common malignancy within the head and neck. Although there are many treatments for laryngeal and laryngopharyngeal cancer, the treatment still faces great challenging.The aim of the study was to evaluate the effectiveness of personalized treatment and one-year recurrence-free survival in patients with stage III–IV laryngeal and laryngopharyngeal, including postoperative complications (VTE, bleeding) within a year.Material and Methods. From July 2022 to October 2023, 100 patients with stage III–IV laryngeal and laryngopharyngeal cancer were treated in the Department of Head and Neck Tumors at the Altai Regional Oncology Center (AROC), Barnaul. There were 95 men (95 %) and 5 women (5 %). Patients were divided into two groups. Group I patients (n=50) with locally advanced laryngeal cancer underwent laryngectomy followed by radiation therapy with a total dose of 54 Gy delivered to the bed of the removed tumor and lymph node drainage region. Group II patients (n=50) received 3 courses of chemotherapy followed by radiation therapy at a dose of 70–74 Gy.Results. In group I patients, clinically insignifcant bleeding from the upper third of the trachea (in the area of contact with the tracheostomy tube) was observed in 3 patients (6.0 %) 3–4 days after surgery. No VTE during hospital stay and within 6–12 months after completion of treatment was observed. The 1-year cumulative survival rate in this group of patients was 90.0 %. In group II patients receiving chemotherapy, bleeding from a pharyngeal tumor was detected in 4 (8.0 %) patients. There were no signs of VTEO in this group. The 1-year cumulative survival rate of these patients was 70 %.Conclusion. Patients with laryngeal/laryngopharyngeal cancer require an individual approach not only in determining therapeutic strategies, but also in the prevention of VTE and hemorrhagic complications.

Improving Outcomes for Patients With Tracheostomy Through Implementation of AARC Clinical Practice Guidelines.

The COVID-19 global pandemic dramatically increased our institution's tracheostomy census. Comparing our existing protocols with American Association for Respiratory Care (AARC) January 2021 clinical practice guideline (CPG) relevant to caring for adult patients with tracheostomy in the acute care setting revealed numerous opportunities for improving our care of those patients. We assembled an interdisciplinary tracheostomy team to implement AARC CPG recommendations and manage all patients with tracheostomy in our hospital. We examined the effect our interdisciplinary team approach and implementation of AARC CPG recommendations had on the following metrics: average patient length of stay (LOS); ICU LOS; percentage of ventilator days; percentage of tracheostomy mask days; tracheostomy tube changes; decannulations; average time to decannulation; mortality; 30-d readmissions; and consultations for speech-language pathology (SLP), one-way speaking valves, physical therapy, and occupational therapy. A total of 203 subjects with tracheostomy were followed in a quality improvement study from June 2019-June 2023 (94 in the pre-intervention group, 109 in the post group). There were significant increases between before and after intervention groups in percentage of decannulations in acutely patients with tracheostomy/not present on admission, non-COVID subjects who survived hospitalization (11.8% vs 33.3%, P = .043), percentage of SLP consults (53.2% vs 89.0%, P < .001), and percentage of one-way speaking valve consults (17.0% vs 32.1%, P = .02). Establishment of an interdisciplinary tracheostomy team and implementation of AARC CPG recommendations for care of adult patients with tracheostomy in the acute care setting resulted in positive, statistically significant outcomes.

Clinical Characteristics and Factors Associated with 30-Day Mortality in Patients with Methicillin-resistant Staphylococcal Pneumonia

Objective: We aimed to identify the risk factors associated with 30-day mortality in patients with methicillin-resistant Staphylococcus spp. (MRS) pneumonia.Material and Methods: From March 2021 to March 2023, we conducted a prospective, observational study at Cho Ray Hospital, Viet Nam, in hospitalized patients aged ≥18 years with pneumonia due to MRS. To assess the risk factors for 30-day mortality, we performed univariable and multivariable logistic regression analyses.Results: The 30-day mortality was 39.1% (36 out of 92 patients with MRS pneumonia). The risk factors for death within 30 days in cases with MRS pneumonia were severe pneumonia, being overweight, respiratory failure, shock, or having a medical device (a tracheostomy or endotracheal tube, a central venous catheter, a urinary catheter, or a nasogastric tube). The 30-day mortality increased proportionally with the number of risk factors.Conclusion: Pre-existing factors were associated with the 30-day mortality risk of MRS pneumonia. Therefore, comprehensive therapy, including initial anti-MRS treatment, might be important for improving outcomes in patients with the studied risk factors.

Effective blind bilateral superficial cervical plexus block for tracheostomy tube insertion in a geriatric patient with Ludwig angina with hypertension in resource constrained area: a case report

IntroductionLudwig angina is a rare, rapidly spreading submaxillary, submandibular, and sublingual necrotizing life-threatening widespread cellulitis of the soft tissue on the floor of the mouth that can cause fatal complications because of airway obstruction. Currently, there are few published studies assessing the efficacy of superficial cervical plexus block for airway surgery and there is no agreement in the literature about airway management. The published recommendations differ and are based on the authors’ own experiences and available resources. This report aimed to provide insight into critical patient management by performing regional anesthesia with fewer complications to the cardiovascular and respiratory systems.Case presentationWe report the case of a 70 year-old hypertensive Black Ethiopian woman with American Society of Anesthesiologist–Physical Status class III and hypertension, who was admitted to the hospital for treatment by her surgeon. The surgeon diagnosed her with Ludwig angina. After adequate physical examination and laboratory investigation, she arrived at the operation room for exploration and drainage of the abscess with a superficial cervical plexus block. She arrived safely at the adult intensive care unit for frequent suctioning. The block was effective until 6 h after the procedure with visual analogue scale (2/10), her vital signs remained stable throughout the postoperative period, and then the tracheostomy tube was removed by the surgeon after 10 days. The patient’s hemodynamic status and breathing effort were satisfactory, and she was discharged 15 days later.Clinical discussionProper airway management is critical for the survival of patients diagnosed with Ludwig angina. According to recent studies, an increasing number of patients with Ludwig angina require intensive care unit admission for tracheal intubation and mechanical breathing. However, it is uncertain whether intensive care reduces the death rate in patients with Ludwig angina. Finally, it is suggested that studies with large sample sizes and strong levels of evidence be conducted to conclude the effectiveness of superficial cervical plexus block for airway emergency surgeries.ConclusionManagement of the airway in patients with Ludwig angina is challenging. Clinicians must take precautions and make sharp decisions on the basis of a variety of circumstances, including the availability of equipment at medical facilities, such as fiberoptic intubation equipment; the anesthetist’s level of experience, such as performing superficial regional block and good mask ventilation; and the patient’s medical status at the time of presentation. As a result, intervention needs to be quick so as to avoid airway obstruction and further complications.

Tracheostomy Cuff Herniation following Cardiac and Pulmonary Arrest

Tracheostomy is a common procedure performed on patients who require long-term airway maintenance and ventilation support. It is preferred over endotracheal intubation due to its reduced airway resistance, lower risk of displacement compared with the endotracheal tube, increased patient comfort, improved weaning from mechanical ventilation, and enhanced suction capabilities. According to the literature, patients needing airway support for fewer than 12 days can undergo translaryngeal intubation, while tracheostomy is indicated for patients requiring ventilatory support for more than 20 days. Although tracheostomy is frequently performed in ICUs and operating rooms, several complications can arise following the procedure. These complications include leakage, obstruction of the tracheal tube, minor or major bleeding or oozing, barotrauma, infections, tracheoesophageal fistula, stenosis, and injury to surrounding peripheral tissues such as arteries, veins, and nerves.1 While herniation of the endotracheal cuff is a more common cause of airway obstruction and hypoxia, tracheostomy tube cuff herniation is a rare complication of this procedure.1-7 In this report, we present a rare case of cardiopulmonary arrest following the implantation of a tracheostomy tube cuff in a female patient and its management.

Development of a Novel Airway-Exchange Broncholaryngoscope.

The purpose of this project was to develop a novel airway-exchange broncholaryngoscope (AEBLScope) to improve the efficiency and accuracy of airway-exchange procedures. The AEBLScope was designed to combine a bronchoscope and airway-exchange catheter (AEC) into a single device and to reduce the blind placement of AECs. The prototype was constructed by modifying an existing distal-chip bronchoscope. A custom AEC was procured to fit concentrically over the flexible portion of the scope. The catheter was connected to the scope handpiece by a customized push-pull locking attachment. The AEBLScope was used to perform airway-exchange procedures with both tracheostomy and endotracheal tubes using two different airway models. Experimental procedures were recorded with still photography to evaluate the exchange of tubes and placement of AECs. In two airway models using the AEBLScope, both tracheostomy and endotracheal tubes were successfully exchanged on first-pass attempt, and AECs were accurately placed under visual guidance. The AEBLScope combines a bronchoscope and AEC into a single tool. Based on these first results, this novel scope has the potential to perform airway-exchange procedures more safely compared with standard procedures by increasing the accuracy of placement, decreasing procedural time, and reducing the morbidity and mortality that can occur from blind placement of AECs. NA Laryngoscope, 134:4488-4493, 2024.

Tissue-Engineered Implant for Hemilaryngectomy Reconstruction with Recurrent Laryngeal Nerve Injury.

Laryngeal cancer resections often require excision of portions of the larynx along with sacrifice of the ipsilateral recurrent laryngeal nerve (RLN). In such cases, there are no reconstructive options that reliably restore laryngeal function, rendering patients with severe functional impairment. To address this unmet clinical need, we extend our evaluation of a 3-implant mucosal, muscle, cartilage reconstruction approach aimed at promoting functional laryngeal restoration in a porcine hemilaryngectomy model with ipsilateral RLN transection. Six Yucatan mini-pigs underwent full-thickness hemilaryngectomies with RLN transection followed by transmural reconstruction using fabricated collagen polymeric mucosal, muscle, and cartilage replacements. To determine the effect of adding therapeutic cell populations, subsets of animals received collagen muscle implants containing motor-endplate-expressing muscle progenitor cells (MEEs) and/or collagen cartilage implants containing adipose stem cell (ASC)-derived chondrocyte-like cells. Acoustic vocalization and laryngeal electromyography (L-EMG) provided functional assessments and histopathological analysis with immunostaining was used to characterize the tissue response. Five of six animals survived the 4-week postoperative period with weight gain, airway maintenance, and audible phonation. No tracheostomy or feeding tube was required. Gross and histological assessments of all animals revealed implant integration and regenerative remodeling of airway mucosa epithelium, muscle, and cartilage in the absence of a material-mediated foreign body reaction or biodegradation. Early voice and L-EMG data were suggestive of positive functional outcomes. Laryngeal reconstruction with collagen polymeric mucosa, muscle, and cartilage replacements may provide effective restoration of function after hemilaryngectomy with RLN transection. Future preclinical studies should focus on long-term functional outcomes. NA Laryngoscope, 134:4604-4613, 2024.

Preserving Laryngo-Esophageal Function in Patients With Hypopharyngeal Cancer Treated With Radiotherapy: Predictive Factors and Long-Term Outcomes.

Functional outcomes after hypopharyngeal cancer (HPC) treatment have a significant effect on patients' quality of life and prognosis. This study aimed to identify the predictive factors associated with laryngo-esophageal dysfunction in patients with HPC who received definitive radiotherapy. Patients with HPC treated with definitive intensity-modulated radiotherapy between 2007 and 2019 at our institution were retrospectively evaluated. Laryngo-esophageal dysfunction-free survival (LDFS) events were defined as local recurrence, laryngo-esophageal dysfunction (defined as tracheostomy or feeding tube dependence), or death from any cause. The median follow-up period was 61 months for the 80 patients included in the study. The 5-year LDFS rate was 47%. A clinical T4 stage and lower pretreatment prognostic nutritional index (PNI) were independently associated with a lower LDFS. A clinical T4 stage and lower pretreatment PNI were identified as predictors of a lower LDFS after definitive radiotherapy for HPC.

Bilateral multiple ribs and sternum fracture causing central flail chest with respiratory failure

Bilateral thoracic blunt injuries in a patient may present with central Flail chest, and acute respiratory failure which is one of the life-threatening complications. We present a case of central flail chest caused by blunt trauma, successfully managed with operative rib and sternum fixation. A 35-year male with a central flail chest with acute respiratory failure caused by road-traffic accident who was managed initially with bilateral intercostal chest-tube drainage for significant bilateral hemopneumothorax and lung contusions. The patient was intubated and connected to mechanical ventilatory support with positive pressure ventilation for the internal pneumatic stabilization. There were multiple rib fractures anteriorly (first to seventh rib bilaterally) and fracture of the sternum - the flail chest, for which he underwent bilateral rib fixation and fixation of sternum with titanium reconstruction plate and screws on the 9th postinjury day. Tracheostomy was done along with fixation in the same sitting. Post-operatively, after 48 hours of positive pressure mechanical ventilation, the weaning was started and by the 4-5th day, the patient was on room air with a tracheostomy tube. The patient recovered uneventfully and was discharged on the eighth postoperative day.

Physician-led healthcare structures for patients in out-of-hospital intensive care nursing: a cross-sectional survey by the German Society for Out-of-Hospital Ventilation

Patients in out-of-hospital intensive care are usually provided with a tracheal cannula and often additionally receive mechanical ventilation. Less frequently, they receive non-invasive ventilation. Their potential to be weaned from the ventilator and to have their tracheostomy tubes removed must be evaluated twice per year from January 1, 2025 on. If there is a potential for weaning from mechanical ventilation or removal of the tracheostomy tube, referral to a specialized facility is required. The study aimed at characterizing the specialized institutions which can evaluate the potential of patients to be weaned from the ventilator and to have their tracheostomy tubes removed, and which can perform these tasks as well. Under the auspices of the German Interdisciplinary Society for Out-of-Hospital Ventilation (DIGAB) and with support from the Working group early neurological-neurosurgical rehabilitation (ENNR) a crosssectional online survey took place. Of 18 participating institutions, 11 (61.1%) were certified by professional societies representing neurorehabilitation, respiratory medicine, anaesthesiology and intensive care or paraplegiology. Most leading physicians were specialists in neurology, followed by pulmonology, anaesthesiology and paediatrics. Many professions with a variety of qualifications worked in these institutions. According to n=10 (55.6%) of the participating instituions, regional treatment capacities for patients from out-of-hospital intensive care, who need hospital admission for weaning from mechanical ventilation or a tracheal cannula, were not sufficient. About one third of the institutions offered televisits. Patients in out-of-hospital intensive care need interdisciplinary care, interconnecting out- and inpatient care structures due to medical complexity and participation restrictions. While interdisciplinary teams and a wide spectrum of diagnostic and therapeutic methods were provided in the participating institutions, their structure differed considerably. Quality criteria should be established for centres evaluating the patients' potential to be weaned from the ventilator and to have their tracheostomy tubes removed and performing weaning from mechanical ventilation and tracheal cannulas. Further research is needed to specify those criteria, to quantify inpatient treatment capacities for patients from out-of-hospital intensive care to be weaned from mechanical ventilation or tracheal cannulas,to evaluate the feasibility of weaning from mechanical ventilation and tracheal cannulas in an out-of-hospital setting and to understand the role of telemedicine in the treatment of patients in out-of-hospital intensive care.

Risk Factors Associated with Unplanned Hospitalization Among Long-Term Care Facility Residents: A Retrospective Study in Central Taiwan.

Most residents of long-term care facilities (LTCFs) are patients with chronic diseases requiring long-term care. Unplanned hospitalization of older and frailer residents from LTCFs reduces their mobility and increases the number of infections, complications, and falls that might lead to severe disability or death. This study aimed to identify the critical risk factors associated with unplanned hospitalization among LTCF residents in Taiwan, providing insights that could inform better care practices in similar settings globally. A retrospective study was conducted using inpatient data from a medical center in central Taiwan, covering the period from 2011 to 2019. A total of 1220 LTCF residents were matched with general patients using propensity score matching. Multiple logistic regression analyses were performed to identify factors associated with unplanned hospitalization, controlling for relevant variables. LTCF residents had a significantly higher risk of unplanned hospitalization compared to general patients (OR = 1.44, 95% CI = 1.21-1.73). Key risk factors included advanced age (≥85 years, OR = 1.25, 95% CI = 1.02-1.54), the presence of comorbidities such as diabetes (OR = 1.17, 95% CI = 1.03-1.33) and renal failure (OR = 1.63, 95% CI = 1.42-1.86), high fall risk (OR = 2.67, 95% CI = 2.30-3.10), and being bedridden (OR = 6.55, 95% CI = 5.48-7.85). The presence of a tracheostomy tube also significantly increased hospitalization risk (OR = 1.73, 95% CI = 1.15-2.59). LTCF residents are at a higher risk of unplanned hospitalization, particularly those with specific comorbidities, physical limitations, and indwelling medical devices. These findings underscore the need for targeted interventions to manage these risks, potentially improving care outcomes for LTCF residents globally.

Long-Term Outcomes of Airway Management in 6 Children With Campomelic Dysplasia.

This case series describes the outcomes of airway management, including airway reconstruction, in 6 patients with campomelic dysplasia and tracheostomy/ventilator dependence secondary to multilevel airway obstruction. Case series and clinical guidelines are provided for the airway management of patients with campomelic dysplasia. Average age of individuals is 19.4 years. Mean follow-up was 12.2 years. Four individuals underwent open airway reconstruction and achieved decannulation. One patient underwent airway reconstruction with improvement of a complete subglottic stenosis but remains ventilator dependent due to severe scoliosis. The remaining 2 patients did not require additional airway reconstruction, have been liberated from ventilator support, and are under evaluation for tracheostomy tube decannulation. Although campomelic dysplasia was historically considered a lethal form of congenital skeletal dysplasia, with many patients succumbing to respiratory failure due to tracheobronchomalacia in the neonatal period, airway reconstruction and long-term survivorship is feasible in children with campomelic dysplasia and significant airway disease.

Rehabilitation and functional outcomes of COVID-19 patients in a rehabilitation hospital in Qatar.

Patients recovering from severe COVID-19 infections have experienced prolonged cognitive, physical, and psychological sequelae, including cardiorespiratory and motor deconditioning, neurological deterioration, anxiety, and depression. The impact of rehabilitation post-acute COVID-19 infection was recognized in the literature, but studies assessing and quantifying specific functional outcomes were lacking. This study aims to describe the characteristics and quantify the changes in functional outcomes of patients admitted to Qatar Rehabilitation Institute (QRI) for inpatient rehabilitation (IPR) post-COVID-19 infection during a 10-month period in 2021. This is a retrospective observational cohort study, which included individuals over 18 years of age with a documented COVID-19-positive diagnosis who were admitted to QRI for IPR due to COVID-19 complications. Data was collected by the investigators from January 1, 2021, until October 30, 2021. A total of 243 patients were included in this study. The changes in functional rehabilitation outcomes were assessed and quantified at both the patient's baseline (on admission to QRI) and after completion of IPR (on discharge). The duration of the IPR program varied based on each patient's baseline assessment. Patients were given a total of 8-12 weeks to achieve their rehabilitation goals and were discharged once those goals were met. Several validated tools were utilized in this study including Functional Independence Measure (FIM), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Modified Medical Research Council (mMRC) Dyspnea Scale, Mini-Mental State Examination (MMSE), and Right- and left-Hand Grip Strength. In addition, patients' diet, the need for respiratory support, and the presence of a tracheostomy tube before and after IPR were also recorded. In total, 84.4% of the included patients were males (n = 205); with a mean age of 52.44 ± 12.99 years. The most commonly reported comorbidities were type 2 diabetes (62.1%) and hypertension (49.8%) with 83.5% of patients experiencing critical illness neuromyopathy. The average patients' length of stay in QRI was 33.92 ± 27.72 days. A statistically significant improvement in all functional outcome scales was noted following the completion of the IPR program (p = 0.001). The number of patients requiring modification to their diet or feeding via nasogastric tube (NGT) significantly decreased by 35% and 93%, respectively (p = 0.001). Patients requiring respiratory support decreased by 98% (p = 0.001) and the need for a tracheostomy tube among patients was reduced by 95% (p = 0.001). IPR following COVID-19 infection was associated with significant functional, motor, and cardiorespiratory improvement. Dedicating clinics for post-COVID-19 rehabilitation would ensure improved patient outcomes and enhanced recovery.

Wide exposure VS. stab surgical incisions in necrotizing fasciitis of the head and neck: a retrospective analysis of 22 cases.

Necrotizing fasciitis of the head and neck is a rare, rapidly progressing bacterial infection with high mortality. Traditional surgical management involves wide exposure incisions, but minimally invasive stab incisions have emerged as a potential alternative. This study aimed to compare outcomes between wide exposure and stab surgical incisions in the management of head and neck necrotizing fasciitis. A retrospective analysis was conducted on 22 patients treated for necrotizing fasciitis of the head and neck between January 2006 and January 2023. Patients were divided into two groups based on the surgical approach: wide exposure incisions (N = 15) and stab surgical incisions (N = 7). Data on mortality, hospital stay, hypertrophic scarring, neck contractures, and tracheostomy tube dependence were collected. The overall mortality rate was 9.1%, with 6.7% in the wide exposure group and 14.3% in the stab surgical incision group (p > 0.05). Hypertrophic scarring occurred in 59.1% of patients, all of whom underwent wide exposure incisions. Neck contractures were observed in 9.1% of cases, also in the wide exposure group. Tracheostomy was performed in 63.6% of patients, with successful decannulation achieved in 91.7%. The median hospital stay was longer in the stab surgical incision group (p < 0.05), partly due to the need for revision surgeries. Wide exposure incisions remain the standard treatment for necrotizing fasciitis of the head and neck due to their effectiveness in managing extensive tissue necrosis. However, stab surgical incisions offer the advantage of reduced morbidity and functional impairment. These benefits are offset by a slightly higher mortality rate and the potential need for additional interventions. Stab incisions may be a viable option in carefully selected patients, particularly those without extensive comorbidities or advanced disease.

Stenting of the trachea with cicatricial stenosis, immediate and long-term results

The aim of study Evaluation of the results of stenting in the treatment of cicatricial stenosis of the trachea. Materials and methods During the period from 1995 to 2023, 154 patients with cicatricial stenosis of the trachea were treated (men - 109 (70.77%), women - 45 (29.22%). The age of the patients ranged from 15 to 83 years. Patients of working age (from 20 to 50 years old) were 102 (66, 23%). The causes of stenosis were: tracheostomy and / or prolonged mechanical lung ventilation through a tracheostomy tube (106-68.83%), mechanical ventilation through the orotracheal tube (38-24.67%), in 6 (3.89%) after circular resection of the trachea, in 3 (1.94%) recurrence of stenosis after tracheolaryngoplasty, in 1 (0.64%) after radiation therapy for primary tracheal cancer in the area of tumor stenosis. Results. In 69 (44.80%) patients, tracheal stenting was performed. Indications for stenting: the impossibility of performing circular resection of the trachea due to the severity of the condition (64-92.75%), preoperative preparation (2-2.89%), cicatricial narrowing of the tracheal anastomosis after circular resection of the trachea (2-2.89%), stenosis of the trachea after long-term treatment of staged treatment (tracheolaryngoplasty with the introduction of a T-shaped tube) (1-1.44%). In 67 patients silicone stents of the Dumont type were inserted, in 2 - stents made of an endotracheal tube and fixed to the neck tissues with a non-absorbable ligature. Complications in the postoperative period occurred in 22 (31,88%) patients. There were no lethal outcomes. It was possible to form a lumen sufficient for breathing in 46 (66.66%) patients. Conclusions. Tracheal stenting in patients with cicatricial tracheal stenosis is a safe and highly effective method that can be used both independently and for preoperative preparation. Restenosis that occurs after the stent removing can be corrected by stent reinsertion by circular resection of the trachea performing, if the patient’s condition allows it.

Mapping health-related quality of life of children and families receiving pediatric invasive home mechanical ventilation: a scoping review protocol

BackgroundChildren utilizing invasive home mechanical ventilation (administered via tracheostomy tube) receive intensive care at home without the support of trained staff typically present in an intensive care unit; within the context of worsening home nursing shortages, much of the 24/7 care burden falls to families which are likely under supported. Prior reviews have explored the quality of life of children receiving various forms of mechanical ventilation, without addressing the impact on the family. Additionally, the literature inconsistently differentiates the unique experience of families with children using invasive home mechanical ventilation from non-invasive, which has lower morbidity and mortality and requires less nursing care in the home. Therefore, our study aims to explore and map the existing literature regarding the impact of invasive home mechanical ventilation on the child and family’s quality of life. Identified gaps will inform future research focused on improving the family quality of life of children with invasive home mechanical ventilation.MethodsFive databases will be searched using keywords and controlled vocabulary to identify relevant studies: Ovid Medline, Embase, Scopus, and Cochrane Library. English language studies will meet inclusion criteria if they include primary research studies of children or families of children utilizing invasive home mechanical ventilation at home and assess quality of life. Children and young adults aged 0–25 years will be included. We exclude studies of hospitalized children, studies focused solely on healthcare professional experiences or clinical outcomes, and those focused on the period surrounding discharge from admission for tracheostomy placement. Two independent reviewers will screen studies at the title/abstract and full-text levels. Two independent reviewers will extract data from relevant studies. Disagreements will be resolved by an independent third reviewer. A targeted grey literature search will be performed utilizing ProQuest, clinicaltrials.gov, WHO trial registry, Google Scholar, and professional societies. Findings will be presented in tables and figures along with a narrative summary.DiscussionThis scoping review seeks to map the literature and provide a descriptive report of the health-related quality of life of children using invasive home mechanical ventilation and their families.RegistrationOpen Science Framework https://doi.org/10.17605/OSF.IO/6GB84Date of Registration: November 29, 2023.

Epidemiology and Regional Variation in Additional Surgical Interventions for Children with Congenital Diaphragmatic Hernia: A Multi-institutional Analysis.

To determine practice variation in surgical management of co-morbidities in pediatric patients with Congenital Diaphragmatic Hernia (CDH). A higher percentage of CDH patients are surviving to discharge, accompanied by an increase in morbidity requiring surgical interventions such as tracheostomy and gastrostomy tube insertion. The frequency, trends, and regional variations in operative management of these co-morbidities in this population are unclear. Neonates who underwent CDH repair between 2012-2022 in the United States Pediatric Health Information System database were identified. Multivariable regression identified predictive factors for additional surgical morbidity after CDH repair, defined by an additional surgical intervention during index hospitalization or within one year after discharge. To narrow the spectrum of severity of disease, only patients with an intensive care unit admission on index hospitalization were included. Secondary analysis compared frequency of operations and hospital resource utilization by region. 4003 patients underwent CDH repair and were discharged from their index hospitalization. 1939 (48%) underwent at least one additional surgical procedure after the index CDH repair. Most performed surgeries were gastrostomy tube (28%), fundoplication (13%), and tracheostomy (5%). Covariates associated with additional surgical morbidity included: prematurity (OR 1.38; 95% CI: 1.20-1.59), cardiac co-morbidity (OR 1.31; 95% CI: 1.14-1.49), and chromosomal anomalies (OR 1.76, 95% CI: 1.30-2.40). Northeast (OR: 2.43; CI 1.42-3.52), Midwest (OR 2.11; 95% CI: 1.45-3.07), and South (OR 1.45, 95% CI 1.02-2.12) regions were associated with additional surgical morbidity. Patients who required additional surgical procedures had longer initial inpatient length of stays (71 versus 31d) and higher associated costs ($357,000 versus $161,000). Surgical morbidity exists in CDH patients after initial CDH repair. Counseling families on these outcomes is important in establishing expectations for management. Establishing guidelines for optimal surgical management will require continued reporting from multi-institutional studies.

Epidermolysis Bullosa with Pyloric Atresia in a Premature Infant

Introduction: Epidermolysis bullosa with pyloric atresia (EB-PA) is a rare subtype of the broader bullous disorder known as epidermolysis bullosa resulting from mutations in basal keratinocyte proteins, most notably plectin or α6β4 integrin. Objective: Our case aims to highlight both the cutaneous and extracutaneous manifestations of this entity that lead to a diagnosis and guide management. Case: We report a case of EB-PA in a newborn born with skin fragility and respiratory distress, later found to have mutations in both PLEC genes on chromosome 8. In addition to forming bullae and erosions requiring diligent wound care, she developed pyloric atresia and hypoxia from respiratory secretions necessitating a pyloromyotomy and proximal duodenal resection, tracheostomy tube, gastrostomy tube, and antibiotics for intermittent sepsis. Conclusion: EB-PA is characterized by instability in all plectin-containing tissues, particularly the skin, but the prevalence of plectin throughout the body can lead to wide-ranging and serious complications, including gastrointestinal and tracheoesophageal strictures, protein-losing enteropathy, and renal anomalies. EB is readily recognizable clinically when presenting with classic bullae but given the serious nature of the extracutaneous manifestations of EB-PA, prompt diagnosis with genetic testing and surveillance for systemic involvement is essential to promote comfort and survival in this potentially fatal neonatal disease.