Fine Governance of Difficult Tracheostomy in Difficult Airway with Stridor and Respiratory Distress

Soni, Smita; Chacko, Aneena; Poorey, V. K.

doi:10.1007/s12070-020-01971-1

Cited by 2 publications

(3 citation statements)

References 19 publications

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“…7 However, cases of morbid obesity and a short neck make the landmark difficult; even with the proper positioning, it fails to elevate the larynx and expose the upper trachea. 8 While maximising neck extension might bring the trachea closer to the skin, it might also bring up major blood vessels from the upper superior mediastinum into the pretracheal region, putting them at risk for injury. 9 An adequate exposure of trachea is important before making the incision by retracting the thyroid isthmus superiorly if it is located above the 3rd tracheal ring and small incision or complete dissection of the isthmus is located between the 2nd and 3rd tracheal rings.…”

Section: Discussionmentioning

confidence: 99%

“…11 Soni et al reported 3 cases of difficult tracheostomies, one of which was short neck; with proper planning and imaging prior to the operation, the tracheostomy was successfully completed without complications. 8 Ultrasound neck before operation and using the combination of an ultrasound and a fibre optic video bronchoscope may improve the outcomes of percutaneous tracheotomy procedures in short-neck patients. 12 There have been a few case reports of early or late tracheostomy tube usage complications involving bleeding from the tracheoinnominate artery fistula, with the earliest date of presentation on 11th day after the operation.…”

Section: Discussionmentioning

confidence: 99%

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Massive immediate post-tracheostomy bleeding from the innominate artery

Mohd Zakir,

Mohamad,

Shen-Han

et al. 2023

Pol. Ann. Med.

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IntroductionTracheostomy is a surgical airway management procedure that involves making an incision on the anterior neck and opening a direct airway through an incision in the trachea.AimWe report a case of a difficult tracheostomy complicated by massive immediate bleeding from the innominate artery that required a median sternotomy for vascular access and control.Case studyA 26-year-old lady with a short neck underwent a tracheostomy in a semi-emergency setting in view of prolonged intubation and frequent intubation prior. The tracheal incision was performed in between the 3rd and 4th tracheal rings and was complicated by massive bleeding from the innominate artery tear that was located below the sternum and necessitated a midline sternotomy procedure to access the artery. The artery was then repaired primarily and covered with a strap muscle that was swung over to the right and sutured to the periosteum of the right clavicle. She lost 6 L of blood, prompting a massive blood transfusion. Postoperatively, there was no bleeding from the wound, but she had an infected sternotomy wound that was managed with antibiotics and dressings. The tracheostomy tube care was uneventful.Results and discussionThe short-neck hyperextension during trachea exposure can cause major thoracic vessels and tracheal rings to move upward, leading to tracheal incisions being made lower than intended and risking major vessel injury.ConclusionsImaging before surgery is recommended to delineate the anatomy and detect any major vessels present in the case of anticipated difficult tracheostomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Massive immediate post-tracheostomy bleeding from the innominate artery

Mohd Zakir,

Mohamad,

Shen-Han

et al. 2023

Pol. Ann. Med.

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show abstract

“… 9 High frequency jet ventilation, surgical or needle cricothyrotomy, supraglottic airways, and cardiopulmonary bypass are the initial rescue measures in difficult airway conditions. 10 Emergency cricothyrotomy is the final step in the “Can't intubate, can't oxygenate” (CICO) algorithm and is performed to prevent the patient's death. Complication rates vary by study, depending on the level of training, clinical scenario, or location of the procedure, and can range from 0 to 54%.…”

Section: Introductionmentioning

confidence: 99%

Cricothyrotomy - In Unanticipated Difficult Intubation Cases with Respiratory Compromise

Sathiyabama

2024

Int Arch Otorhinolaryngol

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Introduction Cricothyrotomy, percutaneous dilation tracheostomy, and tracheostomy are all cost-effective and safe techniques used in the management of critically ill patients who need an artificial airway other than endotracheal tube ventilation. The present study focused on enlightening on elective and emergency procedures performed on conditions present with difficult airways and also attempts to shed light on the aspects of securing an airway in anticipated and unanticipated difficult intubation. Objective The objective of the study was to compare the three procedures conducted during difficult airway/failed intubation situations. Methods The present retrospective observational study was conducted collecting data from patient files obtained at a tertiary healthcare center from 2013 to 2018. The difficult intubation cases were managed by ear, nose, and throat (ENT) surgeons. The study compared three methods: Cricothyrotomy, percutaneous dilation tracheostomy, and tracheostomy based on factors such as procedure duration, complications, and the instruments required for each procedure. Results The study enrolled 85 patients, 61 males and 24 females, aged between 30 and 70 years old. To perform cricothyrotomy, only a simple blade was required. Cricothyrotomy had the shortest operating time (4.1±3.1 minutes) and the shortest time of full oxygen saturation (3 min). Percutaneous tracheostomy had the least amount of bleeding (1%). Cricothyrotomy significantly showed the least intraoperative bleeding than percutaneous dilation, tracheostomy, and tracheostomy (p = 0.001). Conclusion Cricothyrotomy is preferable as it takes less time to perform, causes less bleeding, and takes the least time for full oxygen saturation than tracheostomy and percutaneous dilatational tracheostomy in “can't intubate, can't oxygenate” patients.

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Fine Governance of Difficult Tracheostomy in Difficult Airway with Stridor and Respiratory Distress

Cited by 2 publications

References 19 publications

Massive immediate post-tracheostomy bleeding from the innominate artery

Massive immediate post-tracheostomy bleeding from the innominate artery

Cricothyrotomy - In Unanticipated Difficult Intubation Cases with Respiratory Compromise

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