Objective: To assess the complication rate of bronchoscopically guided percutaneous dilational tracheostomy (PDT), with tracheal tube suture fixation and no elective tracheostomy tube exchange, after experience had been gained.
Design: Prospective clinical study.
Setting: Anaesthesiological ICU with mixed surgical and medical patients in a university hospital.
Patients: Hundred thirty-three mechanically ventilated patients (mean age: 54.8 years, range: 13-87 years) with indication for PDT, many with thrombocytopenia and/or coagulation deficits.
Interventions: Hundred thirty-six consecutive PDTs performed by residents under bronchoscopic guidance with stepwise dilation ( n=114, Ciaglia's conventional system) or conic dilation ( n=22, "Blue Rhino" approach) and supervision of experienced staff anaesthesiologists. Tracheostomy tubes were fixed to the skin with a suture and no routine exchange of tracheostomy tubes was performed. Complications were categorised and the results were also compared to an earlier prospective study.
Results: The incidence of tracheostomy tube-related complications (hypoxaemia, cannula misplacement, accidental decannulation, cuff rupture and hernia, or posterior tracheal wall lesion) was low (0.7%) and significantly less (6.2%, p=0.01) than in our earlier study. No patient died of PDT-associated complications. We recorded four (2.9%) clinically relevant bleeding episodes. Insertion of tracheal tubes was easy or only moderately difficult in 86.7%.
Conclusion: With experience in performing PDT, fixation of the tracheal cannula, and omission of routine change of tracheostomy tubes complication rate of PDT is low.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s00134-001-1151-z | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Unmasking Subglottic Stenosis in an Asthmatic Emergency Needing Front-of-Neck Access: A Case Report.
Cureus
November 2024
Pain Management, Singapore General Hospital, Singapore, SGP.
Subglottic stenosis poses a rare but life-threatening risk for difficult tracheal intubation. Here, we report a unique case of undiagnosed subglottic stenosis discovered during emergency intubation of an 80-year-old woman with type 2 respiratory failure from infective exacerbation of asthma. A small calibre size 5.
View Article and Find Full Text PDFThe global impact of scoliosis on tracheal abnormalities and ventilation needs in pediatric patients with tracheostomy tubes.
Int J Pediatr Otorhinolaryngol
December 2024
Texas Children's Hospital, 6701 Fannin St, Suite 640, Houston, TX, 77030, USA; Baylor College of Medicine, One Baylor Plaza Suite NA-102, Houston, TX 77030, USA. Electronic address:
Purpose: To describe the effects of scoliosis severity on the trachea in patients with a tracheostomy tube.
Materials And Methods: A retrospective chart review of patients 21 years and younger with a tracheostomy and scoliosis between 2001 and 2019 was conducted at a single tertiary pediatric hospital. Patients with spine curvature from C6 - T3 (tracheal limits) were divided into two groups based on curvatures that were either greater than or equal to 30° (Group A) or less than 30° (Group B).
Jet versus vibrating mesh nebulizer for tobramycin aerosol in spontaneously breathing children with tracheostomies - a simulation study.
Anaesth Crit Care Pain Med
December 2024
Perioperative Care Program, Perioperative Medicine Team, Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Ave, Nedlands WA 6009, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, 35 Stirling Hwy, Crawley WA 6009, Perth, Australia; School of Human Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley WA 6009, Perth, Australia; Institute for Paediatric Perioperative Excellence, The University of Western Australia, 35 Stirling Hwy, Crawley WA 6009, Perth, Australia; Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, 15 Hospital Ave, Nedlands WA 6009, Perth, Australia. Electronic address:
Article Synopsis
- Tracheostomy tubes increase the risk of respiratory infections, and initial treatment often involves nebulized tobramycin, but there’s a lack of standardized treatment guidelines.
- A study used a breathing simulator to test how much tobramycin reaches simulated children with tracheostomies, comparing delivery methods and doses for different child weights.
- Results showed that jet nebulizers delivered significantly more tobramycin than vibrating mesh nebulizers, highlighting the need for better dosing strategies and further research on drug delivery efficiency and higher dosages for this patient group.
Coaching inexperienced clinicians before a high stakes medical procedure: randomized clinical trial.
BMJ
December 2024
Department of Anesthesia, Harvard Medical School, Boston, MA 02115, USA.
Objective: To assess whether training provided to an inexperienced clinician just before performing a high stakes procedure can improve procedural care quality, measuring the first attempt success rate of trainees performing infant orotracheal intubation.
Design: Randomized clinical trial.
Setting: Single center, quaternary children's hospital in Boston, MA, USA.
Use of transpyloric feeds in extremely low birth weight infants at risk of severe bronchopulmonary dysplasia-a single center experience.
Front Pediatr
November 2024
Neonatology, Connecticut Children's Medical Center, Hartford, CT, United States.
Introduction: The incidence of severe BPD (sBPD), defined as needing oxygen or positive pressure at 36 weeks corrected gestational age (CGA), has remained unchanged. These infants are at risk for developing late pulmonary hypertension (LPHN) or needing surgical interventions such as Gastrostomy Tubes (GT) or Tracheostomy Tubes (TT). The finding of pepsin in the lungs of infants who were extremely low birth weight (ELBW) with sBPD has led to the speculation that gastroesophageal reflux (GER) and aspiration could contribute to their lung disease.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!