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Kumar A, Kohli A, Kachru N, Bhadoria P, Wadhawan S, Kumar D. Fiber-optic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units. Indian J Crit Care Med 2021; 25:1269-1274. [PMID: 34866824 PMCID: PMC8608650 DOI: 10.5005/jp-journals-10071-24021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Percutaneous dilatational tracheostomy (PCDT) using fiber-optic bronchoscope (FOB) is a widely practiced technique, but its availability and cost remain a concern in nations with limited resources. Mini-surgical technique of PCDT incorporating minimal blunt dissection has shown improved results even without the use of FOB. The study is primarily intended to compare these two techniques and establish a safer cost-effective alternative to FOB-guided PCDTs. Patients and methods This randomized comparative study [registered (CTRI/2018/04/013191)] was conducted on 120 mechanically ventilated patients. In 60 patients, mini-surgical PCDT (group-M) was performed with 2 cm longitudinal skin incision and blunt dissection till pretracheal fascia without FOB guidance using Portex-Ultraperc™ sets. In remaining 60 patients, PCDT was performed under FOB vision with similar skin incision (without blunt dissection) using Portex-Ultraperc™ sets (group-F). Two techniques were compared with regard to procedural time and percentage of complications occurred during or after the procedure. Results Procedure time [group-M: 6.30 ± 1.28 minutes; group-F: 14.43 ± 1.84 minutes (p <0.001)] and mean blood loss [group-M: 5.33 ± 1.69 mL; group-F: 6.87 ± 3.11 mL (p = 0.001)] was significantly less in group-M. Higher incidence of desaturation [group-M: 16.7%; group-F: 35% (p = 0.022)] was noted in group-F, whereas arrhythmias [group-M: 21.7%; group-F: 6.7% (p = 0.018)] were higher in group-M. There was no statistical difference in incidence of pneumothorax and subcutaneous emphysema. There was no incidence of posterior tracheal wall perforation in any of the patients. Conclusion Mini-surgical technique is a faster alternative of FOB-guided PCDT with comparable incidence of complications. It can safely be used in intensive care units (ICUs) where FOB is not available. Clinical trial registration number CTRI/2018/05/014307. Name of registry Clinical Trials Registry of India (CTRI), URL-http://ctri.nic.in. How to cite this article Kumar A, Kohli A, Kachru N, Bhadoria P, Wadhawan S, Kumar D. Fiber-optic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units. Indian J Crit Care Med 2021;25(11):1269-1274.
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Affiliation(s)
- Abhijit Kumar
- Department of Anaesthesiology and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Amit Kohli
- Department of Anesthesiology and Intensive Care, Maulana Azad Medical College, Delhi, India
| | - Nishtha Kachru
- Department of Anesthesiology and Intensive Care, Maulana Azad Medical College and Lok Nayak Hospital, Delhi, India
| | - Poonam Bhadoria
- Department of Anaesthesiology and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Sonia Wadhawan
- Department of Anaesthesiology and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Deepak Kumar
- Department of Anaesthesiology and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
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Wen S, Unuma K, Watanabe R, Uemura K. Diagnosis by forensic autopsy of cannula malposition resulting in fatal tension pneumothorax after attempted percutaneous tracheostomy: A short communication. J Forensic Leg Med 2021; 81:102177. [PMID: 34004465 DOI: 10.1016/j.jflm.2021.102177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/15/2021] [Accepted: 04/25/2021] [Indexed: 11/19/2022]
Abstract
Percutaneous tracheostomy is commonly performed in the emergency department or intensive care unit to secure the airways of patients. This procedure is associated with a low incidence of complications; however, some of them, such as iatrogenic pneumothorax, can be fatal. Pneumothorax after percutaneous tracheostomy is most often caused by perforation of the tracheal wall or malposition of the cannula. A woman in her 80s was referred to the emergency department owing to persistent and prolonged coughing. Having speculated that she had acute epiglottitis, and having failed to achieve oral tracheal intubation, the physician performed a percutaneous tracheostomy to secure her airway. However, progressive percutaneous emphysema developed immediately thereafter, and the patient died shortly. Postmortem computed tomography showed bilateral pneumothorax. Forensic autopsy revealed that the tracheostomy cannula had failed to reach the trachea and was erroneously inserted into the right thoracic cavity via peritracheal route. Thus, it was determined that the patient's death was attributable to tension pneumothorax caused by cannula malposition during attempted tracheostomy. To the best of our knowledge, this is the first forensic autopsy case report on fatal tension pneumothorax caused by attempted percutaneous tracheostomy.
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Affiliation(s)
- Shuheng Wen
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kana Unuma
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| | - Ryo Watanabe
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Koichi Uemura
- Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Yener N, Üdürgücü M, Alaçam F, Şükrü Paksu M, Sarı İ, Ceyhan Bilgici M. Should pulmonary radiographs be taken routinely following paediatric tracheostomy? Asian Cardiovasc Thorac Ann 2021; 30:245-248. [PMID: 33779303 DOI: 10.1177/02184923211006312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM As the rates of complications related to tracheostomy procedures have fallen in recent years, the routine taking of pulmonary radiographs following tracheostomy has become a matter of debate. The aim of this study was to compare the incidence of complications developing in 120 children who had pulmonary radiographs taken following surgical tracheostomy and to thereby evaluate the necessity of routine pulmonary radiographs after tracheostomy. METHODS The data were retrospectively reviewed of 120 children who had pulmonary radiographs taken following surgical tracheostomy between January 2012 and January 2018. The pulmonary radiographs taken before and immediately after tracheostomy were evaluated independently by two paediatric radiology specialists and the results were recorded. RESULTS The incidence of complications after tracheostomy was determined as 23.3%, and no pneumothorax was determined in any patient. An increase was not seen in the complication incidence in those who had undergone emergency tracheostomy and patients aged < 2 years, which are accepted as high-risk groups. In the evaluation of the pre- and post-tracheostomy radiographs, new findings were determined on the post-tracheostomy radiograph that had not been there previously in eight patients (6.6%). These findings were newly formed infiltration in seven patients (5.8%), and malposition of the tracheostomy tube in one patient (0.8%). No pathology requiring intervention was determined on the radiographs of any patient. CONCLUSION The results of this study support the view that it is not necessary to take pulmonary radiographs routinely following tracheostomy in the paediatric age group, including those at higher risk.
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Affiliation(s)
- Nazik Yener
- Division of Pediatric Critical Care, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Muhammed Üdürgücü
- Division of Pediatric Critical Care, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Fatma Alaçam
- Department of Pediatrics, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Muhammed Şükrü Paksu
- Division of Pediatric Critical Care, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - İrem Sarı
- Division of Pediatric Radiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Meltem Ceyhan Bilgici
- Division of Pediatric Radiology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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Esposito R, Conklin M, McGwin G, Gilbert SR. Do We Need Postoperative Chest Radiographs After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis? Spine Deform 2019; 7:571-576.e2. [PMID: 31202373 DOI: 10.1016/j.jspd.2018.09.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN The question was addressed in three ways: (1) a query of Kids' Inpatient Database (KID) to obtain nationally representative data; (2) retrospective review of cases at a single institution; (3) survey of Scoliosis Research Society (SRS) spine surgeons. OBJECTIVES Evaluate the rate of immediate postoperative pulmonary complications, risk factors, and relevant surgeon practice patterns, to determine the usefulness of routine postoperative chest radiographs after posterior spinal instrumentation and fusion (PSIF) for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Routine postoperative chest radiography after PSIF for AIS is performed in many institutions to evaluate for acute pulmonary complications, particularly pneumothorax (PTX). The incidence of pneumothorax and its effect on management is unknown. METHODS The frequency of PTX and surgical intervention were recorded. We evaluated associations between PTX and patient demographics or comorbidities, as well as survey respondent demographics and their practice patterns. RESULTS In the KID data sets, the risk of PTX after PSIF for AIS patients was 0.3% (30/9,036), with intervention required in 13.3% (4/30) of PTX-positive patients (0.04% of all cases). Review of cases at our institution revealed a PTX rate of 3.3% (8/244) by radiology report. No surgical intervention was required. Patients with PTX had, on average, an increased number of vertebrae fused (p = .012), a proximal thoracic scoliosis curve location (p = .009), and/or an intraoperative blood transfusion (p = .002). SRS respondents reported a PTX risk of 0.8% (87/11,318), and 32.2% (89/276) of respondents indicated routine use of postoperative chest radiographs. Of those, 46.1% (41/89) specified willingness to change practice patterns if provided evidence of low PTX rates. CONCLUSIONS Pneumothorax is uncommon after PSIF for AIS. The need for intervention is even less common. Routine postoperative chest radiographs are of questionable value after PSIF for AIS. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Robert Esposito
- School of Medicine, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL 35294, USA
| | - Michael Conklin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL 35294, USA; Children's of Alabama, 1600 7th Ave. S., Birmingham, AL 35233, USA
| | - Gerald McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL 35294, USA
| | - Shawn R Gilbert
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1720 2nd Ave. South, Birmingham, AL 35294, USA; Children's of Alabama, 1600 7th Ave. S., Birmingham, AL 35233, USA.
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Takasugi Y, Aoki R, Tsukimoto S. Asymptomatic hemilateral pneumothorax and pneumomediastinum following surgical tracheostomy in a patient with hyponatremia and zolpidem withdrawal delirium. JA Clin Rep 2018; 4:29. [PMID: 32026950 PMCID: PMC6966920 DOI: 10.1186/s40981-018-0166-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
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Lamperti M, Caldiroli D. Tracheal visualization during tracheostomy: the dark side of the moon or just the moon and mars. Br J Anaesth 2017; 118:8-10. [PMID: 28039237 DOI: 10.1093/bja/aew406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Lamperti
- General Anesthesia Department, Cleveland Clinic Lerner College of Medicine, Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi, Po Box 112412, UAE
| | - D Caldiroli
- Neuroanaesthesia and Neuroicu Department, Neurological Institute Besta, Via Celoria 11, Milano, 20136, Italy
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Cipriano A, Mao ML, Hon HH, Vazquez D, Stawicki SP, Sharpe RP, Evans DC. An overview of complications associated with open and percutaneous tracheostomy procedures. Int J Crit Illn Inj Sci 2015; 5:179-88. [PMID: 26557488 PMCID: PMC4613417 DOI: 10.4103/2229-5151.164994] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Tracheostomy, whether open or percutaneous, is a commonly performed procedure and is intended to provide long-term surgical airway for patients who are dependent on mechanical ventilatory support or require (for various reasons) an alternative airway conduit. Due to its invasive and physiologically critical nature, tracheostomy placement can be associated with significant morbidity and even mortality. This article provides a comprehensive overview of commonly encountered complications that may occur during and after the tracheal airway placement, including both short- and long-term postoperative morbidity.
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Affiliation(s)
- Anthony Cipriano
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Melissa L Mao
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Heidi H Hon
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Daniel Vazquez
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States
| | - Stanislaw P Stawicki
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - Richard P Sharpe
- Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States
| | - David C Evans
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States
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Fang CH, Friedman R, White PE, Mady LJ, Kalyoussef E. Emergent Awake tracheostomy-The five-year experience at an urban tertiary care center. Laryngoscope 2015; 125:2476-9. [DOI: 10.1002/lary.25348] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/25/2015] [Accepted: 03/30/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Christina H. Fang
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey
| | - Remy Friedman
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey
| | - Priscilla E. White
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey
| | - Leila J. Mady
- Department of Otolaryngology-Head and Neck Surgery; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
| | - Evelyne Kalyoussef
- Department of Otolaryngology-Head and Neck Surgery; Rutgers New Jersey Medical School; Newark New Jersey
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Stone ML, Tillou J, Guidry C, Rasmussen S, Kane BJ, Mcgahren ED, Rodgers BM. Chest Radiography does not alter the Treatment Course for Children after Rigid Bronchoscopy. Am Surg 2015. [DOI: 10.1177/000313481508100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to evaluate the usefulness of chest radiography in the direction of postbronchoscopy clinical therapy. From 2001 to 2011, 368 rigid bronchoscopies were performed at a single institution in 221 children. Indications for bronchoscopy, concomitant bronchoscopic procedures, and results of postoperative chest radiography were evaluated. Rigid bronchoscopy was performed in children at a median age of 2.21 years (range, two days to 20 years). Chest radiography was performed at the discretion of the primary surgeon after 275 (74.7%) procedures. Malpositioning of the endotracheal or tracheostomy tube occurred in 1.5 per cent (n = three of 203) of ventilated patients postbronchoscopy. Pneumothorax occurred in 0.5 per cent (n = two of 368) of children and followed laser degranulation (n = one of 117 [0.9%]) and removal of an aspirated foreign body (n = one of 80 [1.3%]). Neither child required tube thoracostomy. Three children necessitated intraoperative tube thoracostomy placement for symptomatic pneumothoraces before radiographic assessment. No children sustained postprocedural complications in the absence of postbronchoscopy radiography. Postbronchoscopy chest radiography in the absence of defined symptomatology is not associated with a change in the postprocedural treatment course, suggesting selective application may be appropriate after at-risk bronchoscopic interventions. Such practice will limit the future cost and radiation exposure associated with this common procedure.
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Affiliation(s)
- Matthew L. Stone
- Department of Surgery, The University of Virginia Health System, Charlottesville, Virginia; and
| | - Johnd Tillou
- The University of Virginia School of Medicine, Charlottesville, Virginia
| | - Christophera Guidry
- Department of Surgery, The University of Virginia Health System, Charlottesville, Virginia; and
| | - Sarak Rasmussen
- Division of Pediatric Surgery and the
- Department of Surgery, The University of Virginia Health System, Charlottesville, Virginia; and
| | - Bartholomew J. Kane
- Division of Pediatric Surgery and the
- Department of Surgery, The University of Virginia Health System, Charlottesville, Virginia; and
| | - Eugene D. Mcgahren
- Division of Pediatric Surgery and the
- Department of Surgery, The University of Virginia Health System, Charlottesville, Virginia; and
| | - Bradley M. Rodgers
- Division of Pediatric Surgery and the
- Department of Surgery, The University of Virginia Health System, Charlottesville, Virginia; and
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Yeo WX, Phua CQ, Lo S. Is routine chest X-ray after surgical and percutaneous tracheostomy necessary in adults: a systemic review of the current literature. Clin Otolaryngol 2014; 39:79-88. [PMID: 24575958 DOI: 10.1111/coa.12233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND For many years, routine post-tracheostomy chest X-ray has been the standard of care for patients in many countries. However, recent evidence suggests that this is unnecessary and cost-ineffective. OBJECTIVE To review the current literature and examine the role of routine post-tracheostomy chest X-ray in adult patients. TYPE OF REVIEW Systemic review. SEARCH STRATEGY Electronic databases (PubMed, EMBASE, Cochrane) were searched using the keywords 'chest X-ray/radiography/radiograph' and 'tracheostomy/tracheotomy' in various permutations. Search period ranged from 1960 to 2012. Inclusion criteria included systematic reviews, meta-analyses, randomised control trials, prospective and retrospective case series. Paediatric and non-English articles were excluded. Abstracts and subsequently full text articles were screened by two of the authors independently. References from obtained articles were also examined. EVALUATION METHOD Specific outcome measures were collated to evaluate the usefulness of post-tracheostomy chest X-ray: Chest X-ray detected (tracheostomy-related) complication rates Proportion of cases requiring significant intervention Potential predictors of complications RESULTS Routine post-tracheostomy chest X-ray is of a low yield, and its findings had limited impact on patient management. Complication detection rates for surgical and percutaneous tracheostomy are 2.2% and 3.2%, respectively. Only 0.7% and 1.8% of chest X-rays performed in surgical and percutaneous tracheostomy cases, respectively, required intervention. Certain groups of patients, however, are at higher risks of complications, and may benefit from post-tracheostomy chest X-ray. For surgical tracheostomy, these groups include those with post-operative signs and symptoms of complications or had emergent or 'difficult' tracheostomies. For percutaneous tracheostomy, high-risk patients include trauma cases (unspecified), patients with post-procedural signs and symptoms of complications, patients who have high ventilatory requirements, difficult tracheostomy cases or tracheostomy cases performed without bronchoscopic guidance. CONCLUSION The practice of routine post-tracheostomy chest X-ray is debatable owing to its low yield and minimal impact on clinical management. However, certain groups of patients appear to be at higher risks of post-tracheostomy complications; currently, there is insufficient evidence to conclude the absolute need for routine chest X-ray in these groups of patients, although it may be prudent to do so based on available evidence in the literature and logical clinical reasoning.
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Affiliation(s)
- W X Yeo
- Ministry of Health Holdings, Singapore, Singapore
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