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tracheostomy decision

Maryam Oskoui, Pamela Ng, Stephen Liben, David Zielinski
BACKGROUND: Increasing numbers of families are requesting active supportive management for their child with spinal muscular atrophy type 1 (SMA1), leading to longer survival and greater prevalence of affected children. Strong opinions exist among physicians for and against the provision of care measures prolonging life. OBJECTIVE: To describe current practice in the care of SMA1 in Canada, and explore the factors underlying inter-physician variability. METHODS: A cross-sectional survey of Canadian hospital-based pediatric neurologists and pediatric respirologists was performed in 2015...
September 29, 2016: Pediatric Pulmonology
Simone Thomas, Wolfgang Sauter, Ulrike Starrost, Marcus Pohl, Jan Mehrholz
BACKGROUND: Treatment of critical illness on intensive-care-units (ICU) results often in persistent invasive endotracheal intubation which might delay rehabilitation and increases the risk of mortality. Recent longitudinal studies have described the recovery of critically ill people, but the detailed time course of decannulation in patients with chronic critical illness with ICU- acquired muscle weakness (ICUAW) is not well known. AIM: The aim of our study was therefore to describe the decannulation times and associated risk factors in patients who are chronic critically ill with ICU acquired weakness...
September 27, 2016: European Journal of Physical and Rehabilitation Medicine
Brian Hutton, Lisa D Burry, Salmaan Kanji, Sangeeta Mehta, Melanie Guenette, Claudio M Martin, Dean A Fergusson, Neill K Adhikari, Ingrid Egerod, David Williamson, Sharon Straus, David Moher, E Wesley Ely, Louise Rose
BACKGROUND: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug pharmacokinetic limitations and minimize oversedation, thereby shortening the duration of mechanical ventilation. At present, it is unclear which strategy is most effective, as few have been directly compared...
2016: Systematic Reviews
L Sakhri, C Saint-Raymond, S Quetant, C Pison, E Lagrange, R Hamidfar Roy, J-P Janssens, C Maindet-Dominici, M Garrouste-Orgeas, M Levy-Soussan, N Terzi, A-C Toffart
The issue of intensive and palliative care in patients with chronic disease frequently arises. This review aims to describe the prognostic factors of chronic respiratory diseases in stable and in acute situations in order to improve the management of these complex situations. The various laws on patients' rights provide a legal framework and define the concept of unreasonable obstinacy. For patients with chronic obstructive pulmonary disease, the most robust decision factors are good knowledge of the respiratory disease, the comorbidities, the history of previous exacerbations and patient preferences...
September 14, 2016: Revue des Maladies Respiratoires
Christa Walgaard, Hester F Lingsma, Pieter A van Doorn, Mathieu van der Jagt, Ewout W Steyerberg, Bart C Jacobs
BACKGROUND: Respiratory insufficiency occurs in 20 % of Guillain-Barré syndrome (GBS) patients, and the duration of mechanical ventilation (MV) ranges widely. We identified predictors of prolonged MV to guide clinical decision-making on tracheostomy. METHODS: We analyzed prospectively collected data from 552 patients with GBS in the context of two clinical trials and three cohort studies in The Netherlands. Potential predictors for prolonged MV, defined as duration of ≥14 days, were considered using crosstabs...
August 18, 2016: Neurocritical Care
Karan Gupta, Dushyant Mandlik, Daxesh Patel, Purvi Patel, Bankim Shah, Devanhalli G Vijay, Jagdish M Kothari, Rajendra B Toprani, Kaustubh D Patel
BACKGROUND: Tracheostomy is a mainstay modality for airway management for patients with head-neck cancer undergoing surgery. This study aims to define factors predicting need of tracheostomy and define an effective objective criterion to predict tracheostomy need. METHODS: 486 patients undergoing composite resections were studied. Factors analyzed were age, previous surgery, extent of surgery, trismus, extent of mandibular resection and reconstruction etc. Factors were divided into major and minor, using the clinical assessment scoring system for tracheostomy (CASST) criterion...
September 2016: Journal of Cranio-maxillo-facial Surgery
Kah Poh Loh, Ankit Kansagra, Meng-Shiou Shieh, Penelope Pekow, Peter Lindenauer, Mihaela Stefan, Tara Lagu
BACKGROUND: In-hospital mortality is high for critically ill patients with metastatic cancer. To help patients, families, and clinicians make an informed decision about invasive medical treatments, we examined predictors of in-hospital mortality among patients with metastatic cancer who received critical care therapies (CCTs). PATIENTS AND METHODS: We used the 2010 California Healthcare Cost and Utilization Project: State Inpatient Databases to identify admissions of patients with metastatic cancer (age ≥18 years) who received CCTs, including invasive mechanical ventilation (IMV), tracheostomy, percutaneous endoscopic gastrostomy (PEG) tube, acute use of dialysis, and total parenteral nutrition (TPN)...
August 2016: Journal of the National Comprehensive Cancer Network: JNCCN
C Carrie Liu, Luke Rudmik
Importance: The timing of tracheostomy in critically ill patients requiring mechanical ventilation is controversial. An important consideration that is currently missing in the literature is an evaluation of the economic impact of an early tracheostomy strategy vs a late tracheostomy strategy. Objective: To evaluate the cost-effectiveness of the early tracheostomy strategy vs the late tracheostomy strategy. Evidence Acquisition: This economic analysis was performed using a decision tree model with a 90-day time horizon...
October 1, 2016: JAMA Otolaryngology—Head & Neck Surgery
Paola Cerutti, Valentina Solara, Silvia Rossi Ferrario
The approach to patients affected by motor neuron disease (MND) and their caregivers requires specific training for the care-team. In fact, the progression of the disease, with the decline of physical--and sometimes cognitive--function, the increasing difficulties in speaking, breathing, and swallowing and the need of invasive choices, as the artificial nutrition and tracheostomy, constitute a challenge for the health professionals, often generating distress. For this reason, their cohesion and sharing abilities are fundamental...
April 2016: Giornale Italiano di Medicina del Lavoro Ed Ergonomia
Marie-Eve Bédard, Douglas A McKim
BACKGROUND: Noninvasive ventilation (NIV) is commonly used to provide ventilatory support for individuals with amyotrophic lateral sclerosis (ALS). Once 24-h ventilation is required, the decision between invasive tracheostomy ventilation and palliation is often faced. This study describes the use and outcomes of daytime mouthpiece ventilation added to nighttime mask ventilation for continuous NIV in subjects with ALS as an effective alternative. METHODS: This was a retrospective study of 39 subjects with ALS using daytime mouthpiece ventilation over a 17-y period...
October 2016: Respiratory Care
Deborah R Liptzin, Elisabeth A Connell, Jennifer Marable, Jill Marks, Jodi Thrasher, Christopher D Baker
INTRODUCTION: Children with chronic respiratory failure and upper airway disorders may require tracheostomy placement and long-term mechanical ventilation, yet many improve to permit ventilator weaning and decannulation. METHODS: As a quality improvement project, we conducted a chart review of patients followed by our Ventilator Care Program who underwent evaluation for weaning nocturnal ventilation (NV) and/or decannulation from 2007-2014. We collected patient demographics and characterized location, monitoring techniques, and outcomes for patients undergoing weaning NV or decannulation...
August 2016: Pediatric Pulmonology
M S Luney, S W English, A Longworth, J Simpson, S Gudibande, B Matta, R M Burnstein, T Veenith
BACKGROUND: To compare the in-hospital mortality and institutional morbidity from medical therapy (MT), external ventricular drainage (EVD) and suboccipital decompressive craniectomy (SDC) following an acute hemorrhagic posterior cranial fossa stroke (PCFH) in patients admitted to the neurosciences critical care unit (NCCU). Retrospective observational single-center cohort study in a tertiary care center. All consecutive patients (n = 104) admitted with PCFH from January 1st 2005-December 31st 2011 were included in the study...
April 12, 2016: Neurocritical Care
Sara B DeMauro, Julie L Wei, Richard J Lin
Neonates and infants may need a tracheostomy for many different reasons, ranging from airway obstruction to a requirement for long term mechanical ventilator support. Here, we present the pathophysiology of the many congenital and acquired conditions that might be managed with a tracheostomy. Decisions about tracheostomy demand consideration of not only the benefits, but also the potential side-effects, which may differ in the short and long term and may be attributable to underlying conditions as well as the tracheostomy...
August 2016: Seminars in Fetal & Neonatal Medicine
Fumiharu Kimura
BACKGROUND: Invasive and/or non-invasive mechanical ventilation are most important options of respiratory management in amyotrophic lateral sclerosis. METHODS: We evaluated the frequency, clinical characteristics, decision-making factors about ventilation and survival analysis of 190 people with amyotrophic lateral sclerosis patients from 1990 until 2013. RESULTS: Thirty-one percentage of patients underwent tracheostomy invasive ventilation with the rate increasing more than the past 20 years...
April 28, 2016: Rinshō Shinkeigaku, Clinical Neurology
Lorraine A de Trey, Julia Dudley, Hasnaa Ismail-Koch, Andrew Durward, Hannah Bellsham-Revell, Sean Blaney, Ian Hore, Conal B Austin, Gavin A Morrison
INTRODUCTION: Paediatric tracheobronchomalacia is a rare but potentially serious condition. Severe tracheobronchomalacia requires intervention or operation. This is an evaluation of a ten-year experience at an institution. METHODS: In this retrospective study all patients were included that required an intervention for severe tracheobronchomalacia from 2003 to 2012. Symptoms, aetiology, comorbidities, localisation of the malacia, age at diagnosis, therapeutic measures and associated complications were evaluated...
April 2016: International Journal of Pediatric Otorhinolaryngology
Lee N Pryor, Elizabeth C Ward, Petrea L Cornwell, Stephanie N O'Connor, Marianne J Chapman
BACKGROUND: Tracheostomy cuff deflation is a necessary stage of the decannulation pathway, yet the optimal clinical indicators to guide successful cuff deflation are unknown. OBJECTIVES: The study aims were to identify (1) the proportion of patients tolerating continuous cuff deflation at first attempt; (2) the clinical observations associated with cuff deflation success or failure, including volume of above cuff secretions and (3) the predictive capacity of these observations within a heterogeneous cohort...
August 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
A Ioana Cristea, Hasnaa E Jalou, Deborah C Givan, Stephanie D Davis, James E Slaven, Veda L Ackerman
BACKGROUND: Tracheostomy is a lifesaving procedure to secure the airway and provide respiratory support. The decision to decannulate has classically been an individual physician decision without consensus among experts. The objective of this retrospective study was to assess the safety and efficacy of a standard institutional protocol that utilizes the sleep laboratory to assist in the decannulation process. METHODS: Between 2006 and 2013, patients were identified using a clinical database of decannulation studies...
August 2016: Pediatric Pulmonology
Septimiu Dan Murgu, Katarine Egressy, Balaji Laxmanan, Guillermo Doblare, Rosamaria Ortiz-Comino, D Kyle Hogarth
The purpose of this article is to provide an update on methods for palliating symptoms in patients with histologically benign and malignant central airway obstruction. We review the published literature within the past decade on postintubation, posttracheostomy, and TB- and transplant-related airway strictures; tracheobronchomalacia; and malignant airway obstruction. We review terminology, classification systems, and parameters that impact treatment decisions. The focus is on how airway stent insertion fits into the best algorithm of care...
August 2016: Chest
Silvia Schönenberger, Faisal Al-Suwaidan, Meinhard Kieser, Lorenz Uhlmann, Julian Bösel
BACKGROUND AND PURPOSE: Patients with severe stroke who require mechanical ventilation and neurointensive care unit (NICU) management often require a tracheostomy (TT). The optimal time point for TT remains unclear and a controversy in everyday NICU life. Here, we prospectively evaluated a score for prediction of TT need in NICU patients with cerebrovascular disease. METHODS: Seventy-five consecutively ventilated stroke patients were prospectively included in the study and assessed by the stroke-related early tracheostomy score (SETscore) within the first 24 h of admission...
August 2016: Neurocritical Care
Nataliya Tkachenko, Kanwaljit Singh, Nicolas Abreu, Anne Marie Morse, Christy Day, Kathyrn Fitzgerald, Mikhail Kazachkov, Sanjeev Kothare
BACKGROUND: Children with medical complexity have a high prevalence of sleep disorders. However, outpatient polysomnography to evaluate for these conditions may be difficult to perform because of lack of skilled nursing care. The aim of this study was to explore polysomnography indications in hospitalized children and assess its impact on patient care. METHODS: Data from 85 inpatient polysomnographies of 70 children hospitalized between March and December 2014 were retrospectively collected...
April 2016: Pediatric Neurology
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