Effect of early tracheostomy on clinical outcomes in critically ill lung transplant recipients

Miyoshi, Ryo; Chen‐Yoshikawa, Toyofumi F.; Hamaji, Masatsugu; Kawaguchi, Atsushı; Kayawake, Hidenao; Hijiya, Kyoko; Motoyama, Hideki; Aoyama, Akihiro; Date, Hiroshi

doi:10.1007/s11748-018-0949-3

Cited by 20 publications

(11 citation statements)

References 23 publications

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“…21,22 The potential etiology of voice and swallowing complications in this patient population is poorly understood and has received little attention in the literature. Cardiothoracic transplant surgery and the post-operative course are inherently complex and can involve (1) compromised respiratory function, (2) prolonged intubation, [23][24][25][26] (3) damage to the recurrent laryngeal nerve (RLN), 10,14,27 (4) intensive care unit acquired weakness, 28 (5) alterations to neurological status 9,28 and (6) chronic gastro-oesophageal reflux. [29][30][31] All these factors are known to have a direct association with swallowing and voice dysfunction.…”

mentioning

confidence: 99%

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Black

Novakovic

Plit

et al. 2021

The Journal of Heart and Lung Transplantation

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mentioning

confidence: 99%

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Black

Novakovic

Plit

et al. 2021

The Journal of Heart and Lung Transplantation

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“…Although these studies did not stratify patients based on tracheostomy timing or technique, these results suggest that patient comorbidities may be one of the more consistent prognosticators for tracheostomy patients, especially given that tracheostomy patients are likely to be in critically ill conditions caused by a wide array of disease processes. [35][36][37] Interestingly, unknown partner status (e.g., not knowing whether a patient is single, married, divorced) was associated with decreased survival. Several studies have demonstrated an association between unpartnered status (single, divorced, separated, widowed) and negative health outcomes-and similarly an association between partnered status (married, significant other) and improved health outcomes-in a variety of patient populations with diverse underlying disease processes.…”

Section: Discussionmentioning

confidence: 99%

Effect of Patient Demographics and Tracheostomy Timing and Technique on Patient Survival

et al. 2020

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Objectives: The ideal timing and technique of tracheostomy vary among patients and may impact outcomes. We aim to examine the association between tracheostomy timing, placement technique, and patient demographics on survival.Study Design: Retrospective cohort study. Methods: A retrospective review was performed for all patients who underwent tracheostomy in 2016 and 2017 at one urban academic tertiary-care hospital. Kaplan-Meier curves were created based on combinations of tracheostomy timing and technique (early percutaneous, early non-percutaneous, late percutaneous, and late non-percutaneous). Cox proportional hazard models were used to determine multivariable effects of timing, technique, and other demographic factors. Primary outcome measures were tracheostomy-related mortality and overall survival. Secondary outcomes were in-hospital, 30-day, and 90-day mortality.Results: Our study included 523 patients. There were six tracheostomy-related deaths, with hemorrhage and tracheoesophageal fistula being the most common causes. Tracheostomy timing and technique combinations were not associated with differences in all-cause mortality or survival following discharge. Cox proportional hazard models showed that Charlson Comorbidity Index (CCI) and unknown partner status were associated with a decrease in survival (P < .01 and P = .05, respectively). Additionally, patient age, gender, race, CCI, and body mass index were not independently associated with changes in survival.Conclusion: Late and non-percutaneous tracheostomies were associated with more tracheostomy-related deaths, but timing and technique were not associated with differences in patient survival. Multiple regression analysis showed that increased patient comorbidities, measured via CCI, and unknown partner status were independently associated with decreased survival. Proceduralists should discuss timing, technique, and patient social factors together with the medical care team when constructing plans for postdischarge management.

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“…Extubation criteria include hemodynamic stability, ability to protect airway, FiO 2 <50%, PEEP of 5 cm H 2 O, Nitric Oxide (NO) <10 ppm, respiratory rate <20/min and minute ventilation <10 mL/kg. For patients who fail to progress, early tracheostomy will facilitate weaning of sedation, pulmonary toilet and ventilator weaning (6).…”

Section: Ventilator Managementmentioning

confidence: 99%

Postoperative management and acute complications after lung transplantation

Haddad¹,

Thomas²

2023

Curr Chall Thorac Surg

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Lung transplantation is an established therapy for select patients with end-stage pulmonary disease, offering prolonged survival and significant improvement in recipient's quality of life. The postoperative care of lung transplant recipients is quite complex and deals with the prevention and management of a wide spectrum of immediate post-operative complications. Since these complications occur frequently and are associated with poor outcomes including increased short and long-term morbidity and mortality, it is extremely important to recognize and manage them early. It is worth noting that the post-operative critical care of lung transplant recipients is multidisciplinary in nature and presents with evolving clinical scenarios that require frequent changes in treatment plans. In addition to the medical and surgical teams, allied health providers like respiratory, physical and nutritional therapists play a pivotal role in the management of patients. Close collaboration and communication between the different teams will eventually translate into a better outcomes and survival. In this review, the first part will highlight the important aspects of the immediate care of the lung transplant recipients following surgery including monitoring, ventilator and hemodynamic management, pain control, immunosuppression and the prevention of infection in addition to other nuances. The second part of the review will discuss the diagnosis and management of acute medical [primary graft dysfunction (PGD), acute allograft rejection] and surgical complications such as those related to the airways, vascular anastomosis or pleural space.

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Effect of early tracheostomy on clinical outcomes in critically ill lung transplant recipients

Cited by 20 publications

References 23 publications

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis

Effect of Patient Demographics and Tracheostomy Timing and Technique on Patient Survival

Postoperative management and acute complications after lung transplantation

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