Emergency Tracheostomy: Indications and Technique

Abdelkader, M; Dempster, John

doi:10.1383/surg.21.6.153.15500

Cited by 2 publications

(4 citation statements)

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“…We could not find any study in the literature comparing the success rates of planned decannulation and accidental decannulation in our study. Previous studies show that decannulation time is shorter and decannulation success is higher in upper airway obstructions compared to other indications (10,29,30). Our findings were consistent with the literature.…”

Section: Discussionsupporting

confidence: 92%

“…The literature on pediatric tracheotomy currently contains limited objective data on decannulation outcomes. Various studies report successful decannulation rates between 14.8% and 85.0% (21,(28)(29)(30). In our study, the planned decannulation success rate was found to be 55.6%, but the random decannulation success rate was found to be very low.…”

Section: Discussioncontrasting

confidence: 41%

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Pediatric intensive care unit tracheostomy experiences in Ondokuz Mayıs University Faculty of Medicine

METE¹,

Akça²,

Yener³

2022

J. Exp. Clin. Med.

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In this study; patients who underwent conventional tracheostomy while being followed up on a mechanical ventilator with endotracheal intubation in their pediatric intensive care unit were evaluated retrospectively. It was aimed to share the positive changes observed in clinical-mechanical ventilator parameters with the literature. Study data were obtained from the hospital information management system and recorded in the "Child Patient Evaluation Form with Tracheostomy" as follows: Demographic data, diagnosis of admission to pediatric intensive care unit, indications for mechanical ventilation and tracheostomy, changes in post-procedure mechanical ventilation parameters, tracheostomy complications, decannulation, survival and death rates etc. Post-discharge medical records were created by telephone interviews with parents. IBM SPSS 21 (Statistical Package for Social Sciences) program was used for statistical analysis. In our study; the most common indication (67.0%) for tracheostomy was the need for prolonged mechanical ventilation. Peak inspiratory pressure requirement on mechanical ventilator decreased statistically and tidal volume increased significantly in those who underwent tracheostomy due to prolonged mechanical ventilation requirement (both p<0.001). On the other hand, the mean length of stay in the pediatric intensive care unit after the procedure was statistically significantly shorter (p<0.001). Decannulation success was statistically significantly higher in those who underwent tracheostomy due to upper airway obstruction (p<0.02). In our study; only four (6.2%) patients died due to tracheotomy (cannula occlusion, unplanned decannulation, etc.). Clinicians should consider tracheostomy if extubation cannot be achieved in children and adolescents who have been given mechanical ventilation for a long time (>2-4 weeks) due to progressive primary disease. Tracheotomy should definitely be performed within appropriate medical indications in order to shorten the length of stay in the hospital/Pediatric intensive care unit and to provide medical care outside the hospital (e.g.; a suitable home environment) in order to create general psychosocial-physical well-being in the patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 41%

Pediatric intensive care unit tracheostomy experiences in Ondokuz Mayıs University Faculty of Medicine

METE¹,

Akça²,

Yener³

2022

J. Exp. Clin. Med.

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“…In contrast to what is suggested for elective tracheotomy, emergency OST begins with a midline vertical skin incision, starting from the cricoid and directed towards the jugular incisure of the sternum, to avoid hemorrhagic complications due to injuries of brachiocephalic structures or anterior jugular veins [30,32]. Moreover, vertical-shaped access allows better…”

Section: Methodsmentioning

confidence: 99%

“…In the case of ETI failure, timing is critical and ideal conditions to perform a surgical tracheotomy cannot be always guaranteed [30]. However, efforts should be done to ensure conditions as similar as possible to elective tracheotomy to reduce periprocedural complications and achieve optimal results.…”

Section: Tracheotomy Technique 21 Patient Positioning and Anatomicalmentioning

confidence: 99%

Emergency surgical tracheotomy in the era of COVID-19 pandemic

Muriana¹,

Ciriaco²,

Carretta³

et al. 2021

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At the beginning of 2020 a novel variant of coronavirus, named SARS-CoV-2, was identified as responsible for the development of severe pneumonia and acute respiratory distress syndrome (ARDS) with very high mortality, exceeding 30%. The disease caused by SARS-CoV-2, called Coronavirus Disease 2019 (COVID-19), was declared a pandemic by WHO on March 11th, 2020. Patients affected by COVID-19 may present with subtle, specific symptoms, but the sudden onset of life-threatening acute respiratory failure is not uncommon. The peculiarities of the disease combined with the single patient’s comorbidities, e.g. advanced age and cardiovascular diseases, plus hypoxia and hypotension secondary to ARDS, and multiorgan failure, may lead to unexpected difficulties in the case of tracheal intubation. The occurrence of the ‘Cannot-Intubate-Cannot-Oxygenate’ (CICO) scenario in COVID-19 patients represents a hazard not only for the patients but also for the assisting healthcare workers due to the high risk of aerosol-generating infected particles during conventional rescue airway procedures. While international consensus guidelines on the management of CICO scenario in COVID-19 patients are still lacking, there is evidence that both scalpel cricothyrotomy (CT) and open surgical tracheotomy (OST) represent valid alternatives for the establishment of a front-of-neck emergency airway. Primary CT requires a staged conversion to formal tracheotomy; conversely, OST represents a definitive mastery of the airway in COVID-19 patients in case of prolonged mechanical ventilation dependency, avoiding a second procedure and further exposure to aerosols. Furthermore, in patients with facial trauma and/or head and neck tumors, OST allows obtaining safe airway control. In the context of the current pandemic, emergency OST procedure in SARS-CoV-2 positives (or with unknown status) requires adequate arrangements and the use of proper personal protective equipment to limit risks for clinicians.

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Emergency Tracheostomy: Indications and Technique

Cited by 2 publications

References 0 publications

Pediatric intensive care unit tracheostomy experiences in Ondokuz Mayıs University Faculty of Medicine

Pediatric intensive care unit tracheostomy experiences in Ondokuz Mayıs University Faculty of Medicine

Emergency surgical tracheotomy in the era of COVID-19 pandemic

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