Care Status of the ALS Patients With Long-Term Use of Tracheostomy Tube

Park, Yeo Jin; Lee, Jesang; Kim, Sang Hun; Ko, Sung‐Hwa; Shin, Myung Jun; Chang, Jae Hyeok; Shin, Yong Beom

doi:10.5535/arm.2015.39.6.964

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…Ventilation practices and techniques vary from one subject to another with few consequences on TA except the use of cuffed tracheostomy tube that is significantly associated with P. aeruginosa colonization of the respiratory tract. A survey conducted by Park et al in Korea in amyotrophic lateral sclerosis patients with long-term use of tracheostomy tube showed that almost all the patients and caregivers had an erroneous idea about cuff volume and pressure [18]. P. aeruginosa colonization may be due to retention of secretions up to the cuff even though in our study, most of the cuffed tracheostomy tubes are deflated.…”

Section: Discussionmentioning

confidence: 59%

Risk factors for respiratory tract bacterial colonization in adults with neuromuscular or neurological disorders and chronic tracheostomy

Lepainteur

Ogna

Clair

et al. 2019

Respiratory Medicine

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The aim of this study was to describe the endotracheal respiratory flora in a population of adults suffering from neuromuscular or neurological disorders requiring a long-term tracheostomy and to identify risk factors for colonization. We conducted a prospective and single-center observational study among patients with chronic tracheostomy admitted for planned respiratory assessment between February 2015 and December 2016. Data were collected from patient interview and medical charts with a standardized questionnaire. A tracheal aspiration was performed for each patient. Humidifiers were analysed for bacteriological contamination. Overall 77 tracheal aspirates (TA) were obtained from patients included. Pathogenic bacteria were found in 90% of cases (69/77) with a majority of Pseudomonas aeruginosa (32/77, 41%), Staphylococcus aureus (34/77, 44%) and Serratia marcesens. (22/79, 38%) Amoxicillin + Clavulanic-acid and Cefotaxime were adapted for respectively in only 28% and 35% of the subjects due to the natural resistance of organisms. No pathogenic bacteria were isolated from humidifier samples. Risk factors significantly associated with P. aeruginosa colonization were residence in a medical-care home (p = 0.01, OR = 3.8 [1.1; 15.1]) and the presence of a cuff (p = 0.003, OR = 4.4 [1.1; 20.6]). Significant quantities of pathogenic bacteria are frequently isolated from TA of tracheostomised patients in the absence of infection. The frequent resistance of these pathogens to Amoxicillin + Clavulanic-acid precludes the use of this antibiotic in the empiric treatment of pneumonia in this population.

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Section: Discussionmentioning

confidence: 59%

Risk factors for respiratory tract bacterial colonization in adults with neuromuscular or neurological disorders and chronic tracheostomy

Lepainteur

Ogna

Clair

et al. 2019

Respiratory Medicine

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“…ALS leads to weakness and atrophy of the oropharyngeal and respiratory muscles, triggering dysphagia and respiratory failure, the main causes of death in ALS patients. Respiratory failure usually has a late onset, so most patients are assisted by NIV or undergo tracheostomy to improve and prolong life 19 . Dysphagia, in turn, can cause choking, dehydration, malnutrition and weight loss, making gastrostomy one of the main procedures used for the symptomatic treatment of this condition 20 .…”

Section: Variablesmentioning

confidence: 99%

Clinical and epidemiological characteristics of patients with Amyotrophic Lateral Sclerosis (ALS) in central Brazil

Bento¹,

Oliveira

Santos

et al. 2022

Medicina (Ribeirão Preto)

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Objective: This study aimed to evaluate the clinical-epidemiological characteristics of patients with Amyotrophic Lateral Sclerosis (ALS) in the State of Goiás, Brazil. Methods: We conducted a descriptive cross-sectional study to assess medical records of patients with ALS followed-up at the State Rehabilitation and Readaptation Medical Center Dr. Henrique Santillo, Goiânia, GO, Brazil, between 2005 and 2018. In addition, we registered and created a photographic panel with the main clinical findings of ALS cases. Results: From 224 investigated patients, 51.8% were male, and 67.4% manifested the classic form of the disease. Initial symptoms were more frequent in the lower limbs (37.9%), and complications resulted in 45.5% of tracheostomy, 60.3% of gastrostomy, and 49.1% of deaths. Most patients had a five-year survival from the onset of symptoms, and no significant association between the use of non-invasive ventilation and increased survival were found. The analysis of the clinical-epidemiological characteristics showed a more extended time between the first symptoms and the diagnosis of the disease was observed. Conclusion: In this study, the time between the first symptoms and diagnosis was longer than in the literature, resulting in late treatments. In addition, there was no satisfactory result regarding survival with the use of non-invasive ventilation. Therefore, clinical-epidemiological studies of the disease in Brazil, as well as public awareness and training of professionals in recognition of ALS clinical signs will assist in early and more efficient interventions.

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“…Therefore, attempts have been made to obtain a low-pressure, high-volume endotracheal tube cuff for several years. The ideal cuff inflation pressure minimizing the risk of both tracheal wall injury and aspiration has been known to be approximately 20–30 cmH 2 O [ 5 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

What is the Adequate Cuff Volume for Tracheostomy Tube? A Pilot Cadaver Study

et al. 2020

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Objective This study aimed to determine the patterns of tracheostomy cuff pressure changes with various air inflation amounts in different types of tracheostomy tubes to obtain basic data for appropriately managing longterm tracheostomy.Methods We performed tracheostomy on a 46-year-old male cadaver. Three types of tracheostomy tubes (single-cuffed, double-cuffed, and adjustable flange), divided into 8 different subtypes based on internal tube diameters and cuff diameters, were inserted into the cadaver. Air was inflated into the cuff, and starting with 1 mL air, the cuff pressure was subsequently measured using a manometer.Results For the 7.5 mm/14 mm tracheostomy tube, cuff inflation with 3 mL of air yielded a cuff pressure within the recommended range of 20–30 cmH<sub>2</sub>O. The 7.5 mm/24 mm tracheostomy tube showed adequate cuff pressure at 5 mL of air inflation. Similar values were observed for the 8.0 mm/16 mm and 8.0 mm/27 mm tubes. Double-cuffed tracheostomy cuff pressures (7.5 mm/20 mm and 8.0 mm/20 mm tubes) at 3 mL air inflation had cuff pressures of 18–20 cmH<sub>2</sub>O at both the proximal and distal sites. For the adjustable flange tracheostomy tube, cuff pressure at 6 mL of cuff air inflation was within the recommended range. Maximal cuff pressure was achieved at inflation with almost 14 mL of air, unlike other tube types.Conclusion Various types of tracheostomy tubes showed different cuff pressures after inflation. These values might aid in developing guidelines For patients who undergo tracheostomy and are discharged home without cuff pressure manometers, this standard might be helpful to develop guidelines.

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Care Status of the ALS Patients With Long-Term Use of Tracheostomy Tube

Cited by 6 publications

References 13 publications

Risk factors for respiratory tract bacterial colonization in adults with neuromuscular or neurological disorders and chronic tracheostomy

Risk factors for respiratory tract bacterial colonization in adults with neuromuscular or neurological disorders and chronic tracheostomy

Clinical and epidemiological characteristics of patients with Amyotrophic Lateral Sclerosis (ALS) in central Brazil

What is the Adequate Cuff Volume for Tracheostomy Tube? A Pilot Cadaver Study

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