Awake Tracheostomy: Indications, Complications and Outcome

Sagiv, Doron; Nachalon, Yuval; Mansour, Jobran; Glikson, Eran; Alon, Eran E.; Yakirevitch, Arkadi; Bachar, Gideon; Wolf, Michael; Primov-Fever, Adi

doi:10.1007/s00268-018-4578-x

Cited by 25 publications

(15 citation statements)

References 16 publications

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“…According to Doron Sagiv et al, awake tracheostomies had a slightly higher risk of immediate postoperative complications [11]. In our study, the awake tracheostomy group had slightly more immediate postoperative complications such as pneumothorax, pneumomediastinum, and subcutaneous emphysema complications, which would be expected with the greater number of revision and awake tracheostomies performed.…”

Section: Discussionsupporting

confidence: 60%

Immediate Postoperative Complications in Adult Tracheostomy

Bathula¹,

Srikantha²,

Patrick³

et al. 2020

Cureus

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Objective Tracheostomy is one of the oldest operations for the management of airway obstruction. With time, indications expanded to prolonged mechanical ventilation, and currently, the majority of tracheostomies are done for this reason. There are several techniques used in a tracheostomy procedure, depending on surgeon preference. Immediate complications such as bleeding, pneumothorax, pneumomediastinum, airway fire, and posterior tracheal wall perforation with esophageal injury are rare, although they do occur, and must be managed accordingly. This study aimed to assess differences in types and rates of immediate postoperative complications in patients undergoing tracheostomy when performed under general anesthesia and local anesthesia (awake tracheostomies) at a large academic institution. This is a continuing ongoing literature reporting tracheostomy adverse events. Methods A retrospective chart review was performed to identify patients who underwent tracheostomy placement between January 1, 2013 and December 31, 2019 at the Detroit Medical Center, USA. Postoperative complications such as bleeding, pneumothorax, pneumomediastinum, airway fire, and posterior tracheal perforation were collected along with gender, age, and revision tracheostomy status. IBM SPSS Statistics (IBM Inc., Armonk, USA) was used for statistical analysis with the statical significance defined as a p<0.05. Results A total of 1,469 patient charts were reviewed. Of these, 1,342 met the inclusion and exclusion criteria, of which, males were 57.2% (n=768), and females were 42.8% (n=574). The age range was 18 years to 96 years (mean=58.03; SD= 15.97), and BMI range was 12-83 (mean=28.77; SD=7.885). Multinomial logistic regression was performed to determine whether age, BMI, sex, and revision tracheostomies were represented across both general and awake tracheostomy groups proportionally to their numbers in the total sample. It showed non-significant value for age (χ2=0.776, p=0.378), BMI (χ2=0.004, p=0.947), but significant value for sex (χ2=4.645, p=0.031), revision tracheostomy (χ2=18.282, p<0.001), indicating that males and revision tracheostomies over-represented in awake tracheostomies. Next, Pearson correlation analysis was performed to determine any significant linear relationship between age, sex, and tracheostomy complications. It showed a significant positive correlation between age and tracheal stomal infection [r(1,340)=0.062, p=0.022]. An independent sample t-test showed a statistically significant difference between the mean pneumothorax and pneumomediastinum of general (n=1,277, mean=0.01, SD=0.088) and awake tracheostomies (n=65, mean=0.08, SD=0.269, t=2.069, p=0.043). Pneumothorax pneumomediastinum complications between the general tracheostomy and awake tracheostomy odds ratio (OR)-6.22, indicates the chance of pneumothorax /pneumomediastinum complication is 6.22 times more in awake tracheostomy than general tracheostomy. ...

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Section: Discussionsupporting

confidence: 60%

Immediate Postoperative Complications in Adult Tracheostomy

Bathula¹,

Srikantha²,

Patrick³

et al. 2020

Cureus

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“…Most of the patients were male, in their sixth and seventh decades of life, with a primary or recurrent head and neck malignancy. 6-8 In this study, complications were present in 27.6% of individuals, with 1% tracheotomy-related mortality. These data are comparable with previously reported results presented in the systematic review.…”

Section: Discussionmentioning

confidence: 54%

“…The most common complication was bleeding, whereas pneumonia, pneumothorax, tracheostomy tube obstruction, and subcutaneous emphysema were less common. [6][7][8][9][10][11][12] Reported tracheostomy-related mortality ranged from 0% to 2.7%. [6][7][8][9][10][11]…”

Section: Systematic Reviewmentioning

confidence: 99%

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Predictors of Complications Occurrence Associated With Emergency Surgical Tracheotomy

Jotić

Milovanović

Trivić

et al. 2020

Otolaryngol.--head neck surg.

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Objective In emergency airway management, the occurrence of surgical tracheotomy complications is increased and may be fatal for the patient. However, the factors that play a role in complication occurrence and lead to lethal outcome are not known. The objective of this study was to determine predictors associated with the occurrence of complications and mortality after emergency surgical tracheostomy. Study Design Retrospective study with a systematic review of the literature. Setting Tertiary medical academic center. Subjects and Methods We included 402 adult patients who underwent emergency surgical tracheostomy under local anesthesia due to upper airway obstruction. Demographic, clinical, complication occurrence, and mortality data were collected. For statistical analysis, univariable and multivariable logistic regression methods were used. Results In multivariable analysis, significant positive predictors of complication occurrence were previously performed tracheotomy (odds ratio [OR] 3.67, 95% confidence interval [CI], 0.75–17.88), neck pathology (OR 2.05, 95% CI 1.1–1.77), and tracheotomy performed outside the operating room (OR 5.88, 95% CI, 1.58–20). General in-hospital mortality was 4%, but lethal outcome as a direct result of tracheotomy complications occurred in only 4 patients (1%) because of intraoperative and postoperative complications. Conclusion The existence of neck pathology and situations in which tracheotomy was performed outside the operating room in uncontrolled conditions were significant prognostic factors for complication occurrence. Tracheotomy-related mortality was greater in patients with intraoperative and early postoperative complications. Clinicians should be aware of the increased risk in specific cases, to prepare, prevent, or manage unwanted outcomes in further treatment and care.

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“…Em um estudo retrospectvo de Sagiv et al, 2018, foi observado que das 37 traqueostomias realizadas 70, 3% eram de causa oncológica (Sagiv et al, 2018). Já em um estudo de LEE et al, 2016 Research, Society and Development, v. 9, n. 12, e16991210963, 2020 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v9i12.10963 5 a principal complicação pela traqueostomia foi obstrução traqueal (41%), seguida de outras complicações em menores proporções.…”

Section: Introductionunclassified

Ação educacional na rotina de cuidados aos pacientes oncológicos com cânula metálica de traqueostomia

Oliveira

Filho

Martins

et al. 2020

RSD

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Introdução: A traqueostomia é um procedimento cirúrgico realizado com freqüência em pacientes oncológicos, havendo necessidade de cuidados especiais por parte dos profissionais de saúde, familiares e cuidadores. Objetivo: Analisar a rotina de cuidados com a higienização da cânula metálica aos pacientes oncológicos traqueostomizados. Método: Após aprovação do Comitê de Ética em Pesquisa, o estudo foi de intervenção preventiva com abordagem qualitativa realizado com os profissionais de saúde do Hospital Ophir Loyola (HOL) – Belém-PA, no período de Abril a Setembro/ 2019, com a realização de um questionário de 9 questões abertas, repassado aos profissionais. Para a análise dos dados foi utilizada a técnica de análise de conteúdo de Bardin, e o software Iramuteq, realizou a codificação das falas. Resultados: A população foi composta de 25 participantes: 8 enfermeiros, 9 técnicos de enfermagem e 8 fisioterapeutas, sendo que 8 profissionais foram representados pelos residentes de enfermagem e fisioterapia; e 17 eram profissionais e 8 eram profissionais residentes. O Iramuteq gerou a nuvem de palavras em que palavras mais evocadas são visualizadas graficamente e a Classificação Hierárquica Descendente, que gerou um corpus com 76,44% de aproveitamento, e 6 classes de segmentos de textos diferentes entre si. Conclusão: Foi possível a análise rotineira de como os profissionais de saúde realizam os cuidados com a cânula metálica, um percentual significativo de profissionais demonstraram possuir um conhecimento incompatível com a literatura, um vídeo educacional foi criada para o profissional de saúde para facilitar na transmissão dos cuidados de higienização da traqueostomia em benéfico ao paciente.

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Awake Tracheostomy: Indications, Complications and Outcome

Cited by 25 publications

References 16 publications

Immediate Postoperative Complications in Adult Tracheostomy

Immediate Postoperative Complications in Adult Tracheostomy

Predictors of Complications Occurrence Associated With Emergency Surgical Tracheotomy

Ação educacional na rotina de cuidados aos pacientes oncológicos com cânula metálica de traqueostomia

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