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Tracheostomy care

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https://www.readbyqxmd.com/read/27922906/patient-outcomes-after-early-versus-late-tracheostomy-in-the-puerto-rico-trauma-hospital
#1
Ana M Romero Vázquez, Omar García Rodríguez, Ediel Ramos Meléndez, Pablo Rodríguez Ortiz
OBJECTIVE: This study aimed to evaluate the impact of early tracheostomy (ET, ≤7 days) versus that of late tracheostomy (LT, >7 days) on outcomes such as hospital length of stay (LOS), intensive care unit (ICU) days, mechanical ventilation (MV) days, and mortality ratio. METHODS: A historical cohort study was undertaken using charts of patients admitted to the Puerto Rico Trauma Hospital who required MV and underwent tracheostomies, from 2000 to 2013. A logistic regression was performed to evaluate the association between timing of tracheostomy and complications and mortality...
December 5, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27920974/a-case-report-of-malignant-obesity-hypoventilation-syndrome-a-weighty-problem-in-our-icus
#2
Michael Tatusov, Joshua J Joseph, Brian M Cuneo
INTRODUCTION: The obesity epidemic is reflected by increasing numbers of morbidly obese patients being admitted to intensive care units (ICUs). These are complicated patients whose care involves many diagnostic and treatment challenges. We are presenting a fatal case of super obesity, hypoventilation, and multi-organ failure known as malignant obesity hypoventilation syndrome (MOHS). CASE PRESENTATION: 35 year old African American gentleman with a body mass index (BMI) of 115 kg/m(2) presented to the hospital with respiratory distress...
2017: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/27918326/anesthetic-considerations-for-patients-with-congenital-central-hypoventilation-syndrome-a-systematic-review-of-the-literature
#3
Saptashree M Basu, Frances F Chung, Shireen F AbdelHakim, Jean Wong
Congenital central hypoventilation syndrome (CCHS) is a form of sleep-disordered breathing characterized by a diminished drive to breathe during sleep, despite progressive hypercapnia and hypoxia. The condition results from mutations in the paired-like homeobox 2B (PHOX2B) gene. The aim of this review was to conduct a systematic search of the current data on CCHS as it relates to perioperative considerations and to discuss the classification, prevalence, pathophysiology, presentation, genetics, and management of the condition...
December 1, 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27916368/prognostic-indicators-for-early-mortality-after-tracheostomy-in-the-intensive-care-unit
#4
Afshin Parsikia, Matthew Goodwin, Zachary Wells, Zoe Gauthier, Molli Bascom, Moon Suh, Beth Meloro, Jorge Ortiz, Amit R T Joshi
BACKGROUND: Tracheostomy is indicated for patients requiring prolonged mechanical ventilation. The aim of this study is to identify prognostic indicators for early mortality after tracheostomy to potentially avoid futility in the intensive care unit. METHODS: Patients who underwent tracheostomy and died within 30 d of admission (futile group) were compared with patients who underwent tracheostomy and survived more than 30 d after admission (nonfutile group). Categorical data were analyzed using chi-square and Fisher's exact tests...
November 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27909277/-complete-transection-of-the-cervical-trachea-caused-by-chest-blunt-trauma
#5
Masahiro Yamada, Masami Abiko
A 52-year-old man was injured when driving through the gate by a motorcycle without noticing the rope between the gateposts. He developed hoarseness, subcutaneous emphysema and dyspnea, and was transferred to our hospital by an ambulance. Chest X-ray and computed tomography showed subcutaneous and mediastinal emphysema, and complete transection of the cervical trachea. Since respiratory distress progressed rapidly, we performed tracheostomy in the intensive care unit, and the patient was carried to the operating room...
December 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/27899532/long-term-management-for-ventilator-assisted-children-in-hong-kong-2-decades-experience
#6
Shuk-Kuen Chau, Ada Wing-Yan Yung, So-Lun Lee
BACKGROUND: The population of children receiving long-term mechanical ventilation is growing worldwide, but only limited data exist in Asian regions. The objective of the study was to review the management of these children in Hong Kong over the past 2 decades. METHODS: This was a retrospective cohort study. Hospital records from subjects receiving mechanical ventilation for >3 months were retrieved. Demographic characteristics and medical information of subjects (≤21 y old) under the care of the ventilator program at the Duchess of Kent Children's Hospital between 1997 and 2015 were reviewed...
November 29, 2016: Respiratory Care
https://www.readbyqxmd.com/read/27893570/nonoperative-treatment-of-a-tracheocutaneous-fistula-in-a-burn-patient
#7
Katherine Marie Huber, Alicia Rose Billington, Loryn J Taylor, Kimberly Brown Maynell, C Wayne Cruse
Tracheocutaneous fistula (TCF) is a complication occurring after decannulation of a long-term tracheostomy and can lead to significant morbidity. We describe a case of a TCF in a burn patient treated without surgery. No previous cases have been described. A 65-year-old woman presented with symptomatic hypertrophic burn scar contractures of the anterior neck 6 months after undergoing excision and grafting of full-thickness burns to the neck and chest. She had a history of tracheostomy placement at the time of burn...
November 18, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/27884349/endotoxemia-accelerates-diaphragm-dysfunction-in-ventilated-rabbits
#8
Yi Yang, Tao Yu, Chun Pan, Federico Longhini, Ling Liu, Yingzi Huang, Fengmei Guo, Haibo Qiu
BACKGROUND: Ventilators may induce diaphragm dysfunction, and most of the septic population who are admitted to the intensive care unit require mechanical ventilation. However, there is no evidence that sepsis accelerates the onset of ventilator-induced diaphragm dysfunction or affects the microcirculation. Our study investigated whether lipopolysaccharide (LPS)-induced endotoxemia accelerated diaphragm dysfunction in ventilated rabbits by evaluating microcirculation, lipid accumulation, and diaphragm contractility...
December 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27882804/a-comparison-of-high-frequency-chest-wall-oscillation-and-intrapulmonary-percussive-ventilation-for-airway-clearance-in-pediatric-patients-with-tracheostomy
#9
Aneela Bidiwala, Linda Volpe, Claudia Halaby, Melissa Fazzari, Christina Valsamis, Melodi Pirzada
OBJECTIVES: The aim of this study was to compare two modes of airway clearance, the intrapulmonary percussive ventilation system (IPV) to high frequency chest wall oscillation system (HFCWO) in medically complex pediatric patients with tracheostomy requiring long term care. METHODS: This was a single center, retrospective study comparing the number of respiratory illnesses, lower respiratory tract infections (LRTI), utilization of bronchodilator and systemic steroids, and respiratory illnesses requiring acute care hospitalizations...
November 24, 2016: Postgraduate Medicine
https://www.readbyqxmd.com/read/27876258/normal-saline-instillation-before-suctioning-a-meta-analysis-of-randomized-controlled-trials
#10
Chia-Hui Wang, Jui-Chen Tsai, Shu-Fen Chen, Chien-Ling Su, Lawrence Chen, Chao-Chun Lin, Ka-Wai Tam
BACKGROUND: For airway management of intensive care unit (ICU) patients who are intubated, a 5-10-mL bolus of sterile normal saline (NS) solution is commonly instilled into an endotracheal or tracheostomy tube before suctioning. However, NS instillation has been associated with adverse events such as dyspnea, increasing heart rate, decreasing of oxygenation, blood pressure, and other vital parameters. OBJECTIVE: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the necessity of NS instillation before suctioning in ICU patients...
November 18, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/27870576/airway-management-strategies-for-brain-injured-patients-meeting-standard-criteria-to-consider-extubation-a-prospective-cohort-study
#11
Victoria A McCredie, Niall D Ferguson, Ruxandra L Pinto, Neill Kj Adhikari, Robert A Fowler, Martin G Chapman, Althea Burrell, Andrew J Baker, Deborah J Cook, Maureen O Meade, Damon C Scales
RATIONALE: Patients with acute brain injury are frequently capable of breathing spontaneously with minimal ventilatory support despite persistent neurological impairment. OBJECTIVES: We sought to describe factors associated with extubation timing, success and primary tracheostomy in these patients. METHODS: We conducted a prospective multicenter observational cohort study in three academic hospitals in Toronto, Canada. Consecutive brain-injured adults receiving mechanical ventilation for at least 24 hours in 3 ICUs were screened by study personnel daily for extubation consideration criteria...
November 21, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27867132/learning-curve-for-real-time-ultrasound-guided-percutaneous-tracheostomy
#12
Sandra Petiot, Pierre-Grégoire Guinot, Momar Diouf, Elie Zogheib, Hervé Dupont
OBJECTIVES: The objective of this study was to demonstrate and quantify the ultrasound-guided percutaneous tracheostomy (UPDT) learning curve in a single team since the first UPDT. STUDY DESIGN AND PATIENTS: This was a cohort of all consecutive patients undergoing UPDT in the Amiens teaching hospital surgical intensive care unit between 2010 and 2014. METHODS: The learning process was evaluated according to three aspects: duration of the various steps involved in UPDT, incidence of consecutive complications, and procedure difficulty...
November 17, 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27859296/slide-tracheoplasty-outcomes-in-children-with-congenital-pulmonary-malformations
#13
Michael A DeMarcantonio, Catherine K Hart, Christina J Yang, Meredith Tabangin, Michael J Rutter, Roosevelt Bryant, Peter B Manning, Alessandro de Alarcón
OBJECTIVES/HYPOTHESIS: Evaluate and compare surgical outcomes of slide tracheoplasty for the treatment of congenital tracheal stenosis in children with and without pulmonary malformations. STUDY DESIGN: Retrospective chart review at a tertiary care pediatric medical center. METHODS: We identified patients with tracheal stenosis who underwent slide tracheoplasty from 2001 to 2014, and a subset of these patients who were diagnosed with congenital pulmonary malformations...
November 15, 2016: Laryngoscope
https://www.readbyqxmd.com/read/27852959/percutaneous-dilatational-tracheostomy-in-ankylosing-spondylitis-bechterew-disease-is-feasible-and-not-associated-with-higher-complication-rates
#14
Uwe Hamsen, Oliver Kamp, Chris Kaczmarek, Mirko Aach, Christian Waydhas, Thomas A Schildhauer, Oliver Jansen
BACKGROUND: Ankylosing spondylitis (AS) is a common disease with an incidence of approximately 0.5% in Europe, causing severe limitations of axial spine mobility and cervical kyphosis. Deformities of the cervical spine and the temporomandibular joints could increase the risk of complications while performing an intubation or tracheostomy. The percutaneous dilatational tracheostomy (PDT) is a standard procedure in intensive care medicine. However, the combination of cervical kyphosis and osteoporosis makes patient positioning challenging...
November 15, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27842947/extracorporeal-support-during-bilateral-sequential-lung-transplantation-in-patients-with-pulmonary-hypertension-risk-factors-and-outcomes
#15
Pranav R Shah, Michael L Boisen, Daniel G Winger, Jose Marquez, Christian A Bermudez, Jay K Bhama, Norihisa Shigemura, Jonathan D'Cuhna, Kathirvel Subramaniam
OBJECTIVE: To identify preoperative predictors of extracorporeal support in patients with pulmonary hypertension (PH) undergoing bilateral sequential lung transplantation (LTx), and to examine outcomes associated with the use of extracorporeal support. DESIGN: Retrospective, observational study. SETTING: Single organ transplantation and tertiary care university medical center. PARTICIPANTS: Adults with PH (preoperative mean pulmonary artery pressure (mPAP)≥25 mmHg) who underwent primary bilateral sequential LTx during 2007 to 2013...
August 18, 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27842753/the-changing-role-for-tracheostomy-in-patients-requiring-mechanical-ventilation
#16
REVIEW
Kamran Mahmood, Momen M Wahidi
Tracheostomy is performed in patients who require prolonged mechanical ventilation or have upper airway instability. Percutaneous tracheostomy with Ciaglia technique is commonly used and rivals the surgical approach. Percutaneous technique is associated with decreased risk of stomal inflammation, infection, and bleeding along with reduction in health resource utilization when performed at bedside. Bronchoscopy and ultrasound guidance improve the safety of percutaneous tracheostomy. Early tracheostomy decreases the need for sedation and intensive care unit stay but may be unnecessary in some patients who can be extubated later successfully...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27808411/characterizing-mortality-in-pediatric-tracheostomy-patients
#17
Jamie L Funamura, Sonia Yuen, Kosuke Kawai, Ozgul Gergin, Eelam Adil, Reza Rahbar, Karen Watters
OBJECTIVES/HYPOTHESIS: To assess the longitudinal risk of death following tracheostomy in the pediatric age group. STUDY DESIGN: Retrospective cohort study. METHODS: Hospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ(2) tests and the Cox proportional hazards model...
November 3, 2016: Laryngoscope
https://www.readbyqxmd.com/read/27806150/patterns-of-care-in-hospitalized-vascular-surgery-patients-at-end-of-life
#18
Dale G Wilson, Sheena K Harris, Heidi Peck, Kyle Hart, Enjae Jung, Amir F Azarbal, Erica L Mitchell, Gregory J Landry, Gregory L Moneta
Importance: There is limited literature reporting circumstances surrounding end-of-life care in vascular surgery patients. Objective: To identify factors driving end-of-life decisions in vascular surgery patients. Design, Setting, and Participants: In this cohort study, medical records were reviewed for all vascular surgery patients at a tertiary care university hospital who died during their hospitalization from 2005 to 2014. Main Outcomes and Measures: Patient, family, and hospitalization variables potentially important to influencing end-of-life decisions...
November 2, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27792804/trismus-as-a-clinical-manifestation-of-tetanus-a-case-report
#19
Ioannis Papadiochos, Sofia Papadiochou, Vassilis Petsinis, Lampros Goutzanis, Charikleia Atsali, Nikolaos Papadogeorgaki
Although the incidence of tetanus disease has radically declined in developed countries, both dental practitioners and oral and maxillofacial surgeons should be knowledgeable about its diagnosis since initial manifestations of the disease, such as trismus and dysphagia, are observed in the orofacial region. This study reports on a case of generalized tetanus diagnosed in a middle-aged man. Before the tetanus diagnosis, the patient had sought medical advice from seven different health care professionals, including a dentist and an oral and maxillofacial surgeon...
October 2016: Journal of Oral & Facial Pain and Headache
https://www.readbyqxmd.com/read/27790273/clinical-practice-guideline-of-acute-respiratory-distress-syndrome
#20
REVIEW
Young-Jae Cho, Jae Young Moon, Ein-Soon Shin, Je Hyeong Kim, Hoon Jung, So Young Park, Ho Cheol Kim, Yun Su Sim, Chin Kook Rhee, Jaemin Lim, Seok Jeong Lee, Won-Yeon Lee, Hyun Jeong Lee, Sang Hyun Kwak, Eun Kyeong Kang, Kyung Soo Chung, Won-Il Choi
There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment...
October 2016: Tuberculosis and Respiratory Diseases
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