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Data and Picture Interpretation Stations: Cases 1–45
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
A tracheostomy is a surgical procedure whereby an opening is made in the anterior trachea in order to facilitate ventilation. Emergency tracheostomy is undertaken in the context of acute airway obstruction e.g. foreign body aspiration, Ludwig angina, obstructive laryngeal cancer, or where endotracheal intubation is not possible. Indications for elective tracheostomy include ventilatory wean, as a part of head and neck cancer treatment, subglottic stenosis and chronic aspiration. Early complications include bleeding, infection and pneumothorax. Late complications include subglottic stenosis and tracheoinnominate fistula (a rare but potentially life-threatening complication that presents with significant bleeding).
Congenital Laryngeal Disease
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Treatment is difficult and may involve pressure ventilation – continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) – until there is spontaneous improvement. A tracheostomy may be needed to facilitate ventilation or to bypass a malacic segment. Some cases respond to ‘aortopexy’, where the aorta is hitched forward and anchored to the sternum, thus pulling the mediastinal structures, including the trachea, with it and opening the lumen.
Management of vascular complications during nonvascular operations
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Kush Sharma, M. Ashraf Mansour
Tracheo-innominate artery fistula (TIF) is a potentially life-threating iatrogenic complication that is typically associated with percutaneous or surgical placement of a tracheostomy tube and has also been described in cases of tracheal resection and tracheal stenting (Figure 34.1).11,12 The incidence after surgical tracheostomy has been reported to be 0.1–1% with a peak incidence typically seen 7–14 days after the procedure.12 Risk factors for fistula development include high cuff pressure necrosis, mucosal trauma from mal-positioned cannula, low tracheal incision, excessive neck motion, or radiotherapy.12 This condition is typically fatal unless the problem is immediately recognized and patients have immediate definitive surgical treatment; however, more recently endovascular stent grafts have helped in reducing the morbidity and mortality associated with invasive repair.13
Effect of COVID-19 on the incidence of postintubation laryngeal lesions
Published in Baylor University Medical Center Proceedings, 2023
Madison Buras, Nicole DeSisto, Randall Holdgraf
Increased risk of severe tracheal and laryngeal injury following prolonged intubation due to COVID-19 has also been documented. Fiacchini et al recently evaluated 45 patients following prolonged intubation (>14 days) due to COVID-19. In this group, 47% of patients experienced severe tracheal injury, with 10 having full-thickness tracheal lesions and 4 having formation of a trachea-esophageal fistula. Comparatively, only a single individual in the prolonged intubation group without a diagnosis of COVID-19 experienced a full-thickness tracheal lesion.7 Although COVID-19 infection seems to be lessening because of vaccination, the disease is still occurring globally, and long-term sequelae are still being managed. To our knowledge, no study has investigated the incidence of all laryngeal injuries following intubation in a COVID-19 population. Vocal cord lesions and stenosis have the potential not only to cause quality-of-life issues due to voice or swallowing disorders but also to increase length of tracheostomy requirement due to an unsafe airway. We hypothesized that there was an increase in overall vocal fold injury in patients intubated with COVID-19 as compared to patients intubated for other reasons.
The impact of early surgical treatment of tracheal stenosis on neurorehabilitation outcome in patients with severe acquired brain injury
Published in Brain Injury, 2023
R. Formisano, M. D’Ippolito, M. Giustini, C. Della Vedova, L. Laurenza, M. Matteis, C. Menna, E. A. Rendina
Tracheostomy can be performed through an open surgical or percutaneous technique. Complications related to tracheostomies include: (1) early complications: pneumothorax, pneumomediastinum, bleeding, tracheal wall perforation, blood and/or mucus clots, accidental decannulation: (2) later complications: infections, tracheomalacia, granulation tissue formation, tracheal stenosis, tracheoesophageal fistula, vocal cord dysfunction (injury of recurrent laryngeal nerve), stomal granulation, persistent tracheal fistula, and scarring. The incidence of late complications is estimated to be as high as 65% of patients (7). The incidence of tracheostomy in patients with sABI is reported to be from 50% to 70%, even though the ideal timing for performing tracheostomy in patients with sABI has not been clearly established, and it is still controversial (8,9). In literature, the definition of early tracheostomy ranges from 3 days to < 21 days, depending mainly on patient population (10). However, although the definition of early tracheostomy remains to be agreed upon, there is a growing consensus among researchers that suggests > 21 days are to be considered as late tracheostomy (11).
Effect of tracheostomy timing on outcomes in patients with traumatic brain injury
Published in Baylor University Medical Center Proceedings, 2022
Talha Mubashir, Hongyin Lai, Emmanuella Oduguwa, Rabail Chaudhry, Julius Balogh, George W. Williams, Vahed Maroufy
Demographic information including age, sex, and race were extracted. Tracheostomy-related in-hospital complications, such as tracheal stenosis (519.02) and infection of tracheostomy site (519.01), were recorded. Timing data were unavailable for the aforementioned complications with respect to tracheostomy. The Charlson Comorbidity Index (CCI)13 was calculated based on ICD-9-CM codes and categorized into four comorbidity groups: none, 0; mild, 1–2; moderate, 3–4; and severe, ≥5. Furthermore, the Abbreviated Injury Scale (AIS), which is an anatomical-based coding system that describes a traumatic injury based on injury type, location, and severity,14 was generated based on ICD-9-CM codes and categorized into three groups: mild, 1 or 2; moderate, 3; and severe, 4 or 5. In this study, TBI patients with a AIS head score of 6 were excluded, as they were likely deemed nonsurvivable on admission.