Risk Factors for Posttracheostomy Tracheal Stenosis

Yiu, Yin; Merrill, Tyler; Yıldız, Vedat; deSilva, Brad W.; Matrka, Laura

doi:10.1177/0194599818794456

Cited by 72 publications

(96 citation statements)

References 21 publications

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“…18,[22][23][24] Rates have been reported to vary between 1.5% and 1.7% depending on various factors, such as obesity, the need for a wide diameter tracheostomy and long-term mechanical ventilation. 25 In a series of 88 percutaneous tracheostomy cases, Wagner et al reported the development of TS in eight (9.1%) patients. 24 The results of the current study were consistent with the literature in respect to TS.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the efficacy of surgical tracheostomy and percutaneous dilatational tracheostomy with flexible lightwand and ultrasonography in geriatric intensive care patients

Boran

Bilal

et al. 2020

Geriatrics Gerontology Int

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Aim To compare the applicability, technical difficulties and postoperative complications of surgical tracheostomy and percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography method applied because of prolonged intubation to geriatric patients in the intensive care unit. Methods A retrospective evaluation was made of 76 patients who received surgical tracheostomy (group 1) and 78 patients who received percutaneous dilatational tracheostomy (group 2). The patients were evaluated in respect of demographic data, duration of intubation, length of stay in the intensive care unit and discharge status, and after the intervention, the development of tube‐related complications, early stage local complications and late‐stage complications. Results The time from intubation to tracheostomy was determined as 22.73 ± 15.23 days in group 1 and 12.65 ± 7.64 days in group 2. The mortality rate of patients in group 1 was determined to be statistically significantly higher than that of group 2 (P = 0.048). When evaluated in respect to early and late complications, nine early‐ and seven late‐stage complications developed in group 1, and three early‐ and three late‐stage complications developed in group 2 (P = 0.05). In the evaluation of factors related to mortality, the time from intubation to tracheostomy (r = 0.249, P = 0.01) and the presence of a comorbidity (r = 0.325, P = 0.004) were determined to have a positive correlation with the development of mortality. Conclusion Percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography technique is a safe, rapid and effective method with the advantage of management in respect to early complications, such as bleeding, and can be used safely in the geriatric patient population in intensive care conditions. Geriatr Gerontol Int 2020; ••: ••–••.

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Section: Discussionmentioning

confidence: 99%

“…TS is the narrowing of the tracheal lumen by fibrosis or granulation tissue . Rates have been reported to vary between 1.5% and 1.7% depending on various factors, such as obesity, the need for a wide diameter tracheostomy and long‐term mechanical ventilation . In a series of 88 percutaneous tracheostomy cases, Wagner et al .…”

Section: Discussionmentioning

confidence: 99%

Comparison of the efficacy of surgical tracheostomy and percutaneous dilatational tracheostomy with flexible lightwand and ultrasonography in geriatric intensive care patients

Boran

Bilal

et al. 2020

Geriatrics Gerontology Int

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“…Idiopathic subglottic stenosis, which can extend into the upper trachea, plays a role. However, data suggests that the risk associated with intubation is the most common cause of tracheal stenosis, and intubation risk may excessively affect women . Another consideration is that women in this sample may be more symptomatic or relatively healthier than men with tracheal stenosis and therefore were more likely to undergo tracheoplasty.…”

Section: Discussionmentioning

confidence: 94%

“…There is good evidence that the risk of tracheal stenosis after tracheostomy is increased among obese patients . The etiology may be multifactorial.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative outcomes after tracheoplasty: A NSQIP analysis 2014–2016

et al. 2019

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Objectives: Tracheoplasty or tracheal resection and are essential components of the care of patients with severe tracheal stenosis. We aimed to study the perioperative outcomes of patients after tracheoplasty or resection using a national surgical registry.Methods: We analyzed the 2014 to 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participant use file for patients who underwent tracheal resection or tracheoplasty (CPT codes 31750, 31760, 31780, and 31781). We analyzed the perioperative outcomes including length of stay (LOS), dehiscence, unplanned reintubations, unplanned surgeries, and 30-day readmission rates. A random 4:1 sample of non-tracheoplasty patients served as the control group.Results: From 2014 to 2016, 126 patients underwent tracheoplasty. The median age was 56 years (IQR = 45-63). There were 93 (74%) females, 88 (70%) white, and 3.2% (4/126) Hispanic. The median LOS was 7 days (IQR = 5-10 days). Of these, 4.8% (6/126) developed wound infections and 3/126 (2.4%) developed wound dehiscence. Five out of 126 required unplanned reintubation (4.0%) and 16/126 (13%) had an unplanned reoperation. The 30-day unplanned readmission rate was 16% (20/126). The wound infection, unplanned intubations, and readmission rates were significantly higher (P < .005) than the control group.Conclusions: The 30-day perioperative outcomes of adult patients undergoing tracheoplasty showed that adverse events are common, but severe adverse events such as death are rare. Continued research into risk mitigation among these patients is warranted.

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Early Outcomes From Early Tracheostomy for Patients With COVID-19

Kwak

Connors

Benedict

et al. 2021

JAMA Otolaryngol Head Neck Surg

111

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IMPORTANCE Decision-making in the timing of tracheostomy in patients with coronavirus disease 2019 has centered on the intersection of long-standing debates on the benefits of early vs late tracheostomy, assumptions about timelines of infectivity of the novel coronavirus, and concern over risk to surgeons performing tracheostomy. Multiple consensus guidelines recommend avoiding or delaying tracheostomy, without evidence to indicate anticipated improvement in outcomes as a result.OBJECTIVE To assess outcomes from early tracheostomy in the airway management of patients with COVID-19 requiring mechanical ventilation. DESIGN, SETTING, AND PARTICIPANTSA retrospective medical record review was completed of 148 patients with reverse transcriptase-polymerase chain reaction-confirmed COVID-19 requiring mechanical ventilation at a single tertiary-care medical center in New York City from March 1 to May 7, 2020. INTERVENTIONS Open or percutaneous tracheostomy.MAIN OUTCOMES AND MEASURES The primary outcomes were time from symptom onset to (1) endotracheal intubation, (2) tracheostomy; time from endotracheal intubation to tracheostomy; time from tracheostomy to (1) tracheostomy tube downsizing, (2) decannulation; total time on mechanical ventilation; and total length of stay. RESULTSParticipants included 148 patients, 120 men and 28 women, with an overall mean (SD) age of 58.1 (15.8) years. Mean (SD; median) time from symptom onset to intubation was 10.57 (6.58; 9) days; from symptom onset to tracheostomy, 22.76 (8.84; 21) days; and from endotracheal intubation to tracheostomy, 12.23 (6.82; 12) days. The mean (SD; median) time to discontinuation of mechanical ventilation was 33.49 (18.82; 27) days; from tracheostomy to first downsize, 23.02 (13.76; 19) days; and from tracheostomy to decannulation, 30.16 (16.00; 26) days. The mean (SD; median) length of stay for all patients was 51. 29 (23.66; 45) days. Timing of tracheostomy was significantly associated with length of stay: median length of stay was 40 days in those who underwent early tracheostomy (within 10 days of endotracheal intubation) and 49 days in those who underwent late tracheostomy (median difference, −8; 95% CI, −15 to −1). In a competing risks model with death as the competing risk, the late tracheostomy group was 16% less likely to discontinue mechanical ventilation (hazard ratio, 0.84; 95% CI, 0.55 to 1.28).CONCLUSIONS AND RELEVANCE This cohort study from the first 2 months of the pandemic in New York City provides an opportunity to reconsider guidelines for tracheostomy for patients with COVID-19. Findings demonstrated noninferiority of early tracheostomy and challenges recommendations to categorically delay or avoid tracheostomy in this patient population. When aligned with emerging evidence about the timeline of infectivity of the novel coronavirus, this approach may optimize outcomes from tracheostomy while keeping clinicians safe.

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Risk Factors for Posttracheostomy Tracheal Stenosis

Cited by 72 publications

References 21 publications

Comparison of the efficacy of surgical tracheostomy and percutaneous dilatational tracheostomy with flexible lightwand and ultrasonography in geriatric intensive care patients

Comparison of the efficacy of surgical tracheostomy and percutaneous dilatational tracheostomy with flexible lightwand and ultrasonography in geriatric intensive care patients

Perioperative outcomes after tracheoplasty: A NSQIP analysis 2014–2016

Early Outcomes From Early Tracheostomy for Patients With COVID-19

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