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bleeding AND percutaneous tracheostomy

Andreas Schaefer, Yvonne Schneeberger, Daniel Reichart, Alexander M Bernhardt, Mathias Kubik, Markus J Barten, Florian M Wagner, Stefan Kluge, Hermann Reichenspurner, Sebastian A Philipp
Over the last decade the number of heart transplantations declined and the number of implanted left ventricular assist devices (LVAD) markedly increased. Accordingly, common intensive care interventions rise and present their own challenges, especially due to the necessary anticoagulation regimen. One of these procedures is percutaneous dilatation tracheostomy (PDT). We herein report our experience with 34 patients with LVAD and established phrenprocoumon therapy (INR 2.1 ± 0.9, PTT 68.9 ± 19.0 sec...
August 22, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Patrick Brass, Martin Hellmich, Angelika Ladra, Jürgen Ladra, Anna Wrzosek
BACKGROUND: Tracheostomy formation is one of the most commonly performed surgical procedures in critically ill intensive care participants requiring long-term mechanical ventilation. Both surgical tracheostomies (STs) and percutaneous tracheostomies (PTs) are used in current surgical practice; but until now, the optimal method of performing tracheostomies in critically ill participants remains unclear. OBJECTIVES: We evaluated the effectiveness and safety of percutaneous techniques compared to surgical techniques commonly used for elective tracheostomy in critically ill participants (adults and children) to assess whether there was a difference in complication rates between the procedures...
2016: Cochrane Database of Systematic Reviews
Woosuk Chung, Byung Muk Kim, Sang-Il Park
When first introduced, percutaneous dilatational tracheostomy (PDT) was performed using a bronchoscope. The bronchoscope itself, however, has several disadvantages, including interruption of ventilation. Modifications of the standard PDT technique have suggested that PDT can be safely performed without a bronchoscope. However, the safety of these modifications is unclear and many modifications have yet to be widely adopted. This study retrospectively evaluated the safety of a simplified PDT technique using the Cook® Ciaglia Blue Rhino™ in 186 patients...
June 2016: Korean Journal of Anesthesiology
A Ujam, M Perry
PURPOSE: Submental intubation is widely accepted as a safe and effective alternative to nasal intubation or tracheostomy in head and neck surgery patients. Forceful or careless technique can cause significant bleeding and trauma to the soft tissues at this point, increasing the likelihood of troublesome sublingual haematoma. METHODS: We describe the use of a percutaneous tracheostomy horn (Cook Medical Blue Rhino(®)) to allow minimally traumatic submental intubation without the need for serial dilations...
April 30, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Fei Zhao, Qi Zou, Xiandi He, Huaxue Wang
OBJECTIVE: To describe an improved percutaneous tracheostomy combined with conventional tracheostomy technique with result of less trauma and fewer complications, and to explore its application in the patients for whom conventional tracheostomy is difficult to perform. METHODS: A prospective study was conducted. Fifty-seven hospitalized patients, in whom ordinal tracheostomy was difficult to perform, and admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Bengbu Medical College from January 2013 to December 2014 were enrolled...
November 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Stephanie Johnson-Obaseki, Andrea Veljkovic, Hedyeh Javidnia
BACKGROUND: In the setting of critical care, the most common indications for tracheostomy include: prolonged intubation, to facilitate weaning from mechanical ventilation, and for pulmonary toileting. In this setting, tracheostomy can be performed either via open surgical or percutaneous technique. Advantages for percutaneous dilatational tracheostomy (PDT) include: simplicity, smaller incision, less tissue trauma, lower incidence of wound infection, lower incidence of peristomal bleeding, decreased morbidity from patient transfer, and cost-effectiveness...
April 14, 2016: Laryngoscope
Paul Sooby, Laura Pocock, Trevor King, George Manjaly
A 50-year-old woman was admitted to the intensive care unit (ICU) for a life-threatening exacerbation of asthma requiring intubation and ventilation for 7 days. On day 8, she was stepped down from the ventilator via the insertion of a tracheostomy to aid weaning. It was initially decided that a percutaneous tracheostomy would be attempted on ICU, however, following further consideration, it was decided that due to anatomical factors (short neck) a surgical tracheostomy would be performed by the ear, nose and throat (ENT) team...
2016: BMJ Case Reports
K Pilarczyk, N Haake, M Dudasova, B Huschens, D Wendt, E Demircioglu, H Jakob, F Dusse
Bleeding complications after percutaneous dilatational tracheostomy (PDT) are infrequent but may have a tremendous impact on a patient's further clinical course. Therefore, it seems necessary to perform risk stratification for patients scheduled for PDT. We retrospectively reviewed the records of 1001 patients (46% male, mean age 68.1 years) undergoing PDT (using the Ciaglia Blue Rhino® technique with direct bronchoscopic guidance) in our cardiothoracic ICU between January 2003 and February 2013. Patients were stratified into two groups: patients suffering acute moderate, severe, or major bleeding (Group A) and patients who had no or only mild bleeding (Group B)...
March 2016: Anaesthesia and Intensive Care
V Razafindranaly, B Lallemant, K Aubry, S Moriniere, S Vergez, E De Mones, O Malard, Ph Ceruse
BACKGROUND: Transoral, minimally invasive, organ preservation surgeries are increasingly used to treat laryngopharyngeal carcinomas to avoid the toxicity associated with combined chemoradiotherapy regimens. This study investigated the efficiency, safety, and functional outcomes of using transoral robotic surgery (TORS) to perform supraglottic laryngectomy (SGL). METHODS: This was a multicenter study using a case series with planned data collection from 2009 to 2012 for patients with supraglottic squamous cell carcinomas (SCC) who underwent SGL using TORS...
2015: B-ENT
A Parchani, R Peralta, A El-Menyar, M Tuma, A Zarour, S Kumar, H Abdulrahman, Y AbdulRahman, H Al-Thani, R Latifi
BACKGROUND: Percutaneous dilatational tracheostomy (PDT) is a routine surgical procedure for critically ill patients who require prolonged ventilatory support. METHODS: We conducted a retrospective cohort study of all PDTs performed at the adult Trauma Intensive Care Unit (TICU) of Hamad Medical Corporation in Doha, Qatar, from January 2009 through September 2012. For all adult patients, we analyzed the demographic characteristics, mean ventilator time before the procedure, injury severity score (ISS), complications, and outcomes...
October 2013: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Kevin Pilarczyk, Henning Carstens, Jens Heckmann, Juri Lubarski, Günter Marggraf, Heinz Jakob, Nikolaus Pizanis, Markus Kamler
BACKGROUND: Percutaneous dilatational tracheostomy (PDT) is the standard airway access in critically ill patients who require prolonged mechanical ventilation. However, the literature lacks reports about the effectiveness and safety of this procedure in thoracic organ transplant recipients, who have increased risks of bleeding and infection. METHODS: We retrospectively reviewed the records of subjects who underwent thoracic organ transplantation at our institution between January 2004 and March 2011 followed by PDT (using the Ciaglia Blue Rhino technique with direct bronchoscopic guidance)...
February 2016: Respiratory Care
Seyed Mohammad-Reza Hashemian, Hadi Digaleh
Although percutaneous dilatational tracheostomy (PDT) is more accessible and less time-demanding compared with surgical tracheostomy (ST), it has its own limitations. We introduced a modified PDT technique and brought some surgical knowledge to the bedside to overcome some standard percutaneous dilatational tracheostomy relative contraindications. PDT uses a blind route of tracheal access that usually requires perioperational imaging guidance to protect accidental injuries. Moreover, there are contraindications in certain cases, limiting widespread PDT application...
November 2015: Medicine (Baltimore)
Ged A Dempsey, Ben Morton, Clare Hammell, Lisa T Williams, Catrin Tudur Smith, Terence Jones
OBJECTIVES: The prevalence and impact of longer-term outcomes following percutaneous tracheostomy, particularly tracheal stenosis, are unclear. Previous meta-analyses addressing this problem have been confounded by the low prevalence of tracheal stenosis and a limited number of studies. DESIGN: Embase, PubMed-Medline, and the Cochrane Central Register of Clinical Trials were searched to identify all prospective studies of tracheostomy insertion in the critically ill...
March 2016: Critical Care Medicine
Yashvir Singh Sangwan, Robert Chasse
BACKGROUND: We describe a modified technique for percutaneous dilatational tracheostomy (PDT) using intermittent bronchoscopy and ultrasound (US). This method requires 1 single physician operator and no special airway adjuncts. Our aim is to reduce the complications associated with the current popular PDT technique, that is, accidental intraprocedural airway loss, intraprocedural bleeding, and hypoventilation associated with use of continuous bronchoscopy. STUDY DESIGN: This is a retrospective review of all PDTs performed on intensive care unit patients at a single nonacademic hospital by a pulmonologist using the modified PDT technique...
February 2016: Journal of Critical Care
S Knipping, A Schmidt, S Bartel-Friedrich
OBJECTIVE: The pre- and postoperative airway management during surgery of head and neck cancer is a clinically relevant and challenging task. Usually an epithelialised tracheostomy is used. The significance of percutaneous dilatational tracheostomy (PDT) in combination with tumour surgery of the head neck area has not yet been fully considered. MATERIAL AND METHODS: Within a surgical therapy of head neck tumours, 58 patients were treated with a PDT by Ciaglia or Fantoni at the Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle during the period from December 2002 to October 2007...
January 2016: Laryngo- Rhino- Otologie
S Decker, J Gottlieb, D L Cruz, C W Müller, M Wilhelmi, C Krettek, M Wilhelmi
PURPOSE: Percutaneous dilatational tracheostomy (PDT) is a standard procedure routinely performed on intensive care units. While complication rates and long-term outcomes have been studied in different patient populations, there are few studies known to these authors involving PDT in trauma patients and the complications which may result. METHODS: Between March 2007 and August 2013, all instances and peri-procedural complications during PDT occurring on the trauma intensive care unit, a unit specialized in the care of injured patients and especially polytrauma patients, were documented...
October 5, 2015: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Victor Razafindranaly, Benjamin Lallemant, Karine Aubry, Sylvain Moriniere, Sébastien Vergez, Erwan De Mones, Oliver Malard, Philippe Ceruse
BACKGROUND: Transoral, minimally invasive, organ preservation surgeries are increasingly used to treat laryngopharyngeal carcinomas to avoid the toxicity associated with combined chemoradiotherapy (CRT) regimens. This study investigated the efficiency, safety, and functional outcomes of using transoral robotic surgery (TORS) to perform supraglottic laryngectomy (SGL). METHODS: This was a multicenter study using a case series with planned data collection from 2009 to 2012 for patients with supraglottic squamous cell carcinomas (SCCs) who underwent an SGL using TORS...
April 2016: Head & Neck
Sebastian Fernandez-Bussy, Bob Mahajan, Erik Folch, Ivan Caviedes, Jorge Guerrero, Adnan Majid
Tracheostomy tube placement is a therapeutic procedure that has gained increased favor over the past decade. Upper airway obstructions, failure to liberate from the ventilator, and debilitating neurological conditions are only a few indications for tracheostomy tube placement. Tracheostomy tubes can be placed either surgically or percutaneously. A percutaneous approach offers fewer surgical site infections and postsurgical bleeding than a surgical approach. A surgical placement posses a lower risk of injury to the posterior tracheal wall and spontaneous decannulation is less common...
October 2015: Journal of Bronchology & Interventional Pulmonology
Carlos M Romero, Rodrigo Cornejo, Eduardo Tobar, Ricardo Gálvez, Cecilia Luengo, Nivia Estuardo, Rodolfo Neira, José Luis Navarro, Osvaldo Abarca, Mauricio Ruiz, María Angélica Berasaín, Wilson Neira, Daniel Arellano, Osvaldo Llanos
OBJECTIVE: To evaluate the efficacy and safety of percutaneous tracheostomy by means of single-step dilation with fiber optic bronchoscopy assistance in critical care patients under mechanical ventilation. METHODS: Between the years 2004 and 2014, 512 patients with indication of tracheostomy according to clinical criteria, were prospectively and consecutively included in our study. One-third of them were high-risk patients. Demographic variables, APACHE II score, and days on mechanical ventilation prior to percutaneous tracheostomy were recorded...
April 2015: Revista Brasileira de Terapia Intensiva
Maria Vargas, Yuda Sutherasan, Massimo Antonelli, Iole Brunetti, Antonio Corcione, John G Laffey, Christian Putensen, Giuseppe Servillo, Paolo Pelosi
INTRODUCTION: Percutaneous dilatational tracheostomy (PDT) is one of the most frequent procedures performed in the intensive care unit (ICU). PDT may add potential benefit to clinical management of critically ill patients. Despite this, no clinical guidelines are available. We sought to characterize current practice in this international survey. METHODS: An international survey, endorsed and peer reviewed by European Society of Intensive Care Medicine (ESICM), was carried out from May to October 2013...
2015: Critical Care: the Official Journal of the Critical Care Forum
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