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Menna C, Fiorelli S, Marinucci BT, Massullo D, D'Andrilli A, Ciccone AM, Andreetti C, Maurizi G, Vanni C, Siciliani A, Tiracorrendo M, Mancini M, Venuta F, Rendina EA, Ibrahim M. New perspectives on tracheal resection for COVID-19-related stenosis: A propensity score matching analysis. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00282-4. [PMID: 38555996 DOI: 10.1016/j.jtcvs.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 03/07/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE The large number of patients with COVID-19 subjected to prolonged invasive mechanical ventilation has been expected to result in a significant increase in tracheal stenosis in the next years. The aim of this study was to evaluate and compare postoperative outcomes of patients who survived COVID-19 critical illness and underwent tracheal resection for postintubation/posttracheostomy tracheal stenosis with those of non-COVID-19 patients. METHODS It was single-center, retrospective study. All consecutive patients with post-intubation/posttracheostomy tracheal stenosis who underwent tracheal resection from February 2020 to March 2022 were enrolled. A total of 147 tracheal resections were performed: 24 were in post-COVID-19 patients and 123 were in non-COVID-19 patients. A 1:1 propensity score matching analysis was performed, considering age, gender, body mass index, and length of stenosis. After matching, 2 groups of 24 patients each were identified: a post-COVID-19 group and a non-COVID group. RESULTS No mortality after surgery was registered. Posttracheostomy etiology of stenosis resulted more frequently in post-COVID-19 patients (n = 20 in the post-COVID-19 group vs n = 11 in the non-COVID-19 group; P = .03), as well as intensive care unit admissions during the postoperative period (16 vs 9 patients; P = .04). Need for postoperative reintubation for glottic edema and respiratory failure was higher in the post-COVID-19 group (7 vs 2 postoperative reintubation procedures; P = .04). Postoperative dysphonia was observed in 11 (46%) patients in the post-COVID-19 group versus 4 (16%) patients in the non-COVID-19 group (P = .03). CONCLUSIONS Tracheal resection continues to be safe and effective in COVID-19-related tracheal stenosis scenarios. Intensive care unit admission rates and postoperative complications seem to be higher in post-COVID-19 patients who underwent tracheal resection compared with non-COVID-19 patients.
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Affiliation(s)
- Cecilia Menna
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
| | - Silvia Fiorelli
- Division of Anesthesiology and Intensive Care, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Domenico Massullo
- Division of Anesthesiology and Intensive Care, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio D'Andrilli
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Ciccone
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudio Andreetti
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giulio Maurizi
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Vanni
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandra Siciliani
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Tiracorrendo
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Mancini
- Morphologic and Molecular Pathology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Federico Venuta
- Division of Thoracic Surgery, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Division of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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2
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Lehnman C, Green T, Booth J. The long-term impact of COVID-19. J Clin Nurs 2024; 33:3-5. [PMID: 38087770 DOI: 10.1111/jocn.16966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024]
Affiliation(s)
| | - Theresa Green
- University of Queensland, Saint Lucia, Queensland, Australia
| | - Jo Booth
- Glasgow Caledonian University, Glasgow, UK
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3
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Duggal R, Davis RJ, Appachi S, Tierney WS, Hopkins BD, Bryson PC. Interdisciplinary assessment of tracheostomy care knowledge: An opportunity for quality improvement. Am J Otolaryngol 2023; 44:103865. [PMID: 37004318 DOI: 10.1016/j.amjoto.2023.103865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE A 2013 AAOHNS consensus statement called for reduced variation in tracheostomy care. Multidisciplinary approaches and standardized protocols have been shown to improve tracheostomy outcomes. This study aims to identify inconsistencies in knowledge in order to design standardized education targeting these areas to improve quality of care. MATERIALS AND METHODS An online, multiple-choice tracheostomy care knowledge assessment was administered to nurses and respiratory therapists in ICUs, stepdown units, and regular nursing floors, as well as residents in otolaryngology, general surgery, and thoracic surgery. The survey was administered and data were recorded using the Select Survey online platform. RESULTS 173 nurses, respiratory therapists, and residents participated in this study. Over 75 % of respondents identified correct answers to questions addressing basic tracheostomy care, such as suctioning and humidification. Significant variation was observed in identification and management of tracheostomy emergencies, and appropriate use of speaking valves. Only 47 % of all respondents identified all potential signs of tracheostomy tube displacement. Respiratory therapists with over 20 years of experience (p = 0.001), were more likely to answer correctly than those with less. Nurses were less likely than respiratory therapists to have received standardized tracheostomy education (p = 0.006) and were less likely than others to choose the appropriate scenario for speaking valve use (p = 0.042), highlighting the need for interdisciplinary education. CONCLUSIONS An interdisciplinary assessment of tracheostomy care knowledge demonstrates variation, especially in identification and management of tracheostomy emergencies and appropriate use of speaking valves. Design of a standardized educational program targeting these areas is underway.
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Affiliation(s)
- Radhika Duggal
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States of America.
| | - Ruth J Davis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Swathi Appachi
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
| | - William S Tierney
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
| | - Brandon D Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
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Sharma PK, Kumar L, Goswami Y, Pujani M, Dikshit M, Tandon R. The aqueous root extract of Withania somnifera ameliorates LPS-induced inflammatory changes in the in vitro cell-based and mice models of inflammation. Front Pharmacol 2023; 14:1139654. [PMID: 37377934 PMCID: PMC10291246 DOI: 10.3389/fphar.2023.1139654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction: Most critically ill COVID-19 patients have bronchitis, pneumonia, and acute respiratory distress syndrome (ARDS) due to excessive inflammatory conditions. Corticosteroids have largely been prescribed for the management of inflammation in these patients. However, long-term use of corticosteroids in patients with comorbidities such as metabolic, cardiovascular, and other inflammatory disorders is ideally not recommended due to safety issues. A potential and safer anti-inflammatory therapy is therefore the need of the hour. Withania somnifera (WS), a well-known herbal medicine used during the pandemic in India to prevent SARS-CoV2 infection, also possesses anti-inflammatory properties. Methods: In the present study, we, therefore, evaluated the effect of the aqueous extract of the roots of W. somnifera in the cell-based assays and in the experimental animal models of LPS-induced inflammation. Results: In the NCI-H460, A549 cells and human peripheral blood mononuclear cells (PBMCs) pre-treatment with W. somnifera reduced the LPS-induced expression of the pro-inflammatory cytokines. In addition, W. somnifera extract also showed potent anti-inflammatory activity in the lung tissues of BALB/c mice challenged intranasally with LPS. We observed a marked reduction in the neutrophil counts in the broncho-alveolar lavage (BAL) fluid, inflammatory cytokines, and fibrosis in the mice lungs pre-treated with W. somnifera. Results obtained thus suggest the potential utility of W. somnifera extract in reducing airway inflammation and recommend the clinical evaluation of W. somnifera extract in COVID-19 patients with a high propensity for lung inflammation.
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Affiliation(s)
| | - Lokesh Kumar
- Translational Health Science and Technology Institute, Faridabad, India
| | - Yamini Goswami
- Translational Health Science and Technology Institute, Faridabad, India
| | - Mukta Pujani
- ESIC Medical College and Hospital, Faridabad, India
| | - Madhu Dikshit
- Translational Health Science and Technology Institute, Faridabad, India
- Pharmacology Division, Central Drug Research Institute, Lucknow, India
| | - Ruchi Tandon
- Translational Health Science and Technology Institute, Faridabad, India
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5
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Hubbell N, Aslam A, Khalil A, Saydain G. Diagnostic Dilemma: A Patient With Pulmonary Fibrosis Who Presented for Severe Tracheal Stenosis After COVID-19 Pneumonia. Cureus 2023; 15:e38060. [PMID: 37234134 PMCID: PMC10208281 DOI: 10.7759/cureus.38060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/27/2023] Open
Abstract
A 44-year-old man with pulmonary fibrosis presented to our pulmonary hypertension clinic with biphasic stridor and dyspnea. He was sent to the emergency department, where he was found to have 90% subglottic tracheal stenosis and was successfully treated with balloon dilation. Seven months prior to the presentation, he required intubation for coronavirus disease 2019 (COVID-19) pneumonia complicated by hemorrhagic stroke. He was discharged after percutaneous dilatational tracheostomy, which was decannulated after three months. Our patient possessed several risk factors for tracheal stenosis, including endotracheal intubation, tracheostomy, and airway infection. Furthermore, our case is of great importance given the developing literature on COVID-19 pneumonia and its subsequent complications. Additionally, his history of interstitial lung disease may have confounded his presentation. Therefore, it is important to understand stridor, as it is an important exam finding that clinically distinguishes upper and lower airway disease. Our patient's biphasic stridor is consistent with the diagnosis of severe tracheal stenosis.
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Affiliation(s)
| | - Adam Aslam
- Internal Medicine, Wayne State University, Detroit, USA
| | - Amir Khalil
- Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, USA
| | - Ghulam Saydain
- Internal Medicine, Wayne State University, Detroit Medical Center, Detroit, USA
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6
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Mukai N, Okada M, Konishi S, Okita M, Ogawa S, Nishikawa K, Annen S, Ohshita M, Matsumoto H, Murata S, Harima Y, Kikuchi S, Aibara S, Sei H, Aoishi K, Asayama R, Sato E, Takagi T, Tanaka-Nishikubo K, Teraoka M, Hato N, Takeba J, Sato N. Cricotracheostomy for patients with severe COVID-19: A case control study. Front Surg 2023; 10:1082699. [PMID: 36733889 PMCID: PMC9888534 DOI: 10.3389/fsurg.2023.1082699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Background Tracheostomy is an important procedure for the treatment of severe coronavirus disease-2019 (COVID-19). Older age and obesity have been reported to be associated with the risk of severe COVID-19 and prolonged intubation, and anticoagulants are often administered in patients with severe COVID-19; these factors are also related to a higher risk of tracheostomy. Cricotracheostomy, a modified procedure for opening the airway through intentional partial cricoid cartilage resection, was recently reported to be useful in cases with low-lying larynx, obesity, stiff neck, and bleeding tendency. Here, we investigated the usefulness and safety of cricotracheostomy for severe COVID-19 patients. Materials and methods Fifteen patients with severe COVID-19 who underwent cricotracheostomy between January 2021 and April 2022 with a follow-up period of ≥ 14 days were included in this study. Forty patients with respiratory failure not related to COVID-19 who underwent traditional tracheostomy between January 2015 and April 2022 comprised the control group. Data were collected from medical records and comprised age, sex, body mass index, interval from intubation to tracheostomy, use of anticoagulants, complications of tracheostomy, and decannulation. Results Age, sex, and days from intubation to tracheostomy were not significantly different between the COVID-19/cricotracheostomy and control/traditional tracheostomy groups. Body mass index was significantly higher in the COVID-19 group than that in the control group (P = 0.02). The rate of use of anticoagulants was significantly higher in the COVID-19 group compared with the control group (P < 0.01). Peri-operative bleeding, subcutaneous emphysema, and stomal infection rates were not different between the groups, while stomal granulation was significantly less in the COVID-19 group (P = 0.04). Conclusions These results suggest that cricotracheostomy is a safe procedure in patients with severe COVID-19.
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Affiliation(s)
- Naoki Mukai
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan,Correspondence: Masahiro Okada
| | - Saki Konishi
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Mitsuo Okita
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Siro Ogawa
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kosuke Nishikawa
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan,Department of Bone and Joint Surgery, Ehime University School of Medicine, Toon, Japan
| | - Suguru Annen
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Muneaki Ohshita
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hironori Matsumoto
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Satoru Murata
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yutaka Harima
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Satoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shiori Aibara
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hirofumi Sei
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kunihide Aoishi
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Rie Asayama
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Eriko Sato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Taro Takagi
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kaori Tanaka-Nishikubo
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masato Teraoka
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jun Takeba
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Norio Sato
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
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7
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Zuccatosta L, Zamacona BR, Porcarelli F, Mei F, Gonnelli F, Gasparini S, Di Marco Berardino A. Case Report: Tracheal stenosis due to fibrotic bridges in a post-tracheostomy COVID-19 patient. Front Med (Lausanne) 2022; 9:1025894. [PMID: 36388891 PMCID: PMC9641182 DOI: 10.3389/fmed.2022.1025894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/27/2022] [Indexed: 12/04/2022] Open
Abstract
Tracheal stenosis is a common complication of prolonged endotracheal intubation or tracheostomy, that can be classified as simple (without cartilage involvement) or complex (with cartilaginous support involvement). We report a case of a post-COVID-19 tracheal stenosis with fibrotic bridges between the tracheal walls, creating a net within the lumen and causing significant respiratory distress. The absence of cartilaginous support involvement allowed a definitive bronchoscopic treatment with complete and permanent resolution of stenosis.
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Affiliation(s)
- Lina Zuccatosta
- S.O.D. di Pneumologia, Ospedali Riuniti Ancona, Azienda Ospedaliero Universitaria, Ancona, Italy
- *Correspondence: Lina Zuccatosta,
| | - Borja Recalde Zamacona
- S.O.D. di Pneumologia, Ospedali Riuniti Ancona, Azienda Ospedaliero Universitaria, Ancona, Italy
- Interventional Pulmonology Clinica Universidad de Navarra, Pamplona, Spain
| | - Francesco Porcarelli
- S.O.D. di Pneumologia, Ospedali Riuniti Ancona, Azienda Ospedaliero Universitaria, Ancona, Italy
| | - Federico Mei
- S.O.D. di Pneumologia, Ospedali Riuniti Ancona, Azienda Ospedaliero Universitaria, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Francesca Gonnelli
- S.O.D. di Pneumologia, Ospedali Riuniti Ancona, Azienda Ospedaliero Universitaria, Ancona, Italy
| | - Stefano Gasparini
- S.O.D. di Pneumologia, Ospedali Riuniti Ancona, Azienda Ospedaliero Universitaria, Ancona, Italy
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
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Moser CH, Peeler A, Long R, Schoneboom B, Budhathoki C, Pelosi PP, Brenner MJ, Pandian V. Prevention of Endotracheal Tube-Related Pressure Injury: A Systematic Review and Meta-analysis. Am J Crit Care 2022; 31:416-424. [PMID: 36045034 DOI: 10.4037/ajcc2022644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hospital-acquired pressure injuries, including those related to airway devices, are a significant source of morbidity in critically ill patients. OBJECTIVE To determine the incidence of endotracheal tube-related pressure injuries in critically ill patients and to evaluate the effectiveness of interventions designed to prevent injury. METHODS MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for studies of pediatric or adult patients in intensive care units that evaluated interventions to reduce endotracheal tube-related pressure injury. Reviewers extracted data on study and patient characteristics, incidence of pressure injury, type and duration of intervention, and outcomes. Risk of bias assessment followed the Cochrane Collaboration's criteria. RESULTS Twelve studies (5 randomized clinical trials, 3 quasi-experimental, 4 observational) representing 9611 adult and 152 pediatric patients met eligibility criteria. The incidence of pressure injury was 4.2% for orotracheal tubes and 21.1% for nasotracheal tubes. Interventions included anchor devices, serial endotracheal tube assessment or repositioning, and barrier dressings for nasotracheal tubes. Meta-analysis revealed that endotracheal tube stabilization was the most effective individual intervention for preventing pressure injury. Nasal alar barrier dressings decreased the incidence of skin or mucosal injury in patients undergoing nasotracheal intubation, and data on effectiveness of serial assessment and repositioning were inconclusive. CONCLUSIONS Airway device-related pressure injuries are common in critically ill patients, and patients with nasotracheal tubes are particularly susceptible to iatrogenic harm. Fastening devices and barrier dressings decrease the incidence of injury. Evidence regarding interventions is limited by lack of standardized assessments.
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Affiliation(s)
- Chandler H Moser
- Chandler H. Moser is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Anna Peeler
- Anna Peeler is a PhD candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Robert Long
- Robert Long is chief of anesthesia nursing, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Bruce Schoneboom
- Bruce Schoneboom (retired) was associate dean for Practice, Innovation, and Leadership, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Chakra Budhathoki
- Chakra Budhathoki is a biostatistician, School of Nursing and Biostatistics Core, Johns Hopkins University
| | - Paolo P Pelosi
- Paolo P. Pelosi is a chief professor, Anaesthesia and Intensive Care, and director, Specialty School in Anaesthesiology, University of Genoa, and head of the Anaesthesia and Intensive Care Unit at IRCCS San Martino-IST Hospital, Genoa, Italy
| | - Michael J Brenner
- Michael J. Brenner is an associate professor, Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, and President, Global Tracheostomy Collaborative, Raleigh, North Carolina
| | - Vinciya Pandian
- Vinciya Pandian is an associate professor, School of Nursing and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University
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Orozco-Levi M, Reyes C, Quintero N, Tiga-Loza D, Reyes M, Sanabria S, Pizarro C, De Hoyos J, Serrano N, Castillo V, Ramírez-Sarmiento A. Clinical Proof of Concept for Stabilization of Tracheostomy Tubes Using Novel DYNAtraq Device. Med Devices (Auckl) 2022; 15:215-227. [PMID: 35859660 PMCID: PMC9289456 DOI: 10.2147/mder.s366829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022]
Abstract
Introduction Tracheostomy is one of the most common surgical strategies in intensive care units (ICU) and provides relevant clinical benefit for multiple indications. However, the complications associated with its use range from 5 to 40% according to different series. The risk of these complications could be reduced if fixation strategies and alignment of the tracheostomy tube with respect to the tracheal axis are improved. Aim To build a functional device of technological innovation in respiratory medicine for the fixation and alignment of tracheostomy cannula (acronym DYNAtraq) and to evaluate its feasibility and safety in a pilot study in mechanically ventilated patients. Methods Study carried out in four phases: (1) design engineering and functional prototyping of the device; (2) study of cytotoxicity and tolerance to the force of traction and push; (3) pilot study of feasibility and safety of its use in tracheostomized and mechanically ventilated patients; and (4) health workers satisfaction study. Results The design of the innovative DYNAtraq device included, on the one hand, a connector with very little additional dead space to be inserted between the cannula and the ventilation tubes, and, on the other hand, a shaft with two supports for adhesion to the skin of the thorax with very high tolerance (several kilograms) to pull and push. In patients, the device corrected the malpositioned tracheostomy tubes for the latero-lateral (p < 0.001) and cephalo-caudal angles (p < 0.001). Its effect was maintained throughout the follow-up time (p < 0.001). The use of DYNAtraq did not induce serious adverse events and showed a 70% protective effect for complications (RR = 0.3, p < 0.001) in patients. Conclusion DYNAtraq is a new device for respiratory medicine that allows the stabilization, alignment and fixation of tracheostomy tubes in mechanically ventilated patients. Its use provides additional benefits to traditional forms of support as it corrects misalignment and increases tolerance to habitual or forced movements. DYNAtraq is a safe element and can reduce the complications of tracheostomy tubes.
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Affiliation(s)
- Mauricio Orozco-Levi
- Respiratory Department, Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia.,Group of Research in Muscle, Training and Lung Diseases (EMICON), Ministerio de Ciencia y Tecnología (MINCIENCIAS), Bogotá, Cundinamarca, Colombia.,Department of Medicine, and Facultad de Ciencias Médicas y de la Salud, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia
| | - Carlos Reyes
- Department of Critical Care, Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia
| | - Neikel Quintero
- Respiratory Department, Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia
| | - Diana Tiga-Loza
- Respiratory Department, Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia.,Group of Research in Muscle, Training and Lung Diseases (EMICON), Ministerio de Ciencia y Tecnología (MINCIENCIAS), Bogotá, Cundinamarca, Colombia.,Department of Medicine, and Facultad de Ciencias Médicas y de la Salud, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia
| | - Mabel Reyes
- Respiratory Department, Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia.,Group of Research in Muscle, Training and Lung Diseases (EMICON), Ministerio de Ciencia y Tecnología (MINCIENCIAS), Bogotá, Cundinamarca, Colombia.,Department of Medicine, and Facultad de Ciencias Médicas y de la Salud, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia
| | - Sandra Sanabria
- Bioengineering Research Group, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia
| | - Camilo Pizarro
- Department of Critical Care, Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia
| | - Juan De Hoyos
- Bioengineering Research Group, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia
| | - Norma Serrano
- Research Center, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia
| | - Victor Castillo
- Bioengineering Research Group, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia.,CEO, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia
| | - Alba Ramírez-Sarmiento
- Respiratory Department, Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia.,Group of Research in Muscle, Training and Lung Diseases (EMICON), Ministerio de Ciencia y Tecnología (MINCIENCIAS), Bogotá, Cundinamarca, Colombia.,Department of Medicine, and Facultad de Ciencias Médicas y de la Salud, Universidad de Santander (UDES), Bucaramanga, Santander, Colombia.,Research Center, Fundación Cardiovascular de Colombia (FCV), Floridablanca, Santander, Colombia
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Ershadi R, Rafieian S, Sarbazzadeh J, Vahedi M. Tracheal stenosis following mild-to-moderate COVID-19 infection without history of tracheal intubation: a case report. Gen Thorac Cardiovasc Surg 2021. [PMID: 34813004 DOI: 10.1007/s11748-021-01747-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/14/2021] [Indexed: 11/14/2022]
Abstract
Laryngotracheal stenosis is a major side effect of intubation in patients with Coronavirus 2019 (COVID-19). However, no study has since reported tracheal stenosis in patients with COVID-19 without a history of tracheal intubation. The current study reports a 77-year-old male patient with the COVID-19 infection but without a history of tracheal intubation diagnosed with distal tracheal stenosis. Tracheal stenosis was successfully treated with rigid bronchoscopy. This study reported the first case of tracheal stenosis due to viral tracheitis associated with COVID-19 infection. However, further studies are required to investigate this speculation.
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