Posterior glottic stenosis following prolonged intubation for COVID-19

Abstract Background Tracheal stenosis following prolonged intubation is a relatively rare but serious problem. This condition is usually managed by surgical or endoscopic interventions. Bronchoscopic balloon dilatation for tracheal stenosis is considered a valuable tool used for the management of tracheal stenosis. In this article, we try to evaluate the role of balloon tracheoplasty in the management of tracheal stenosis and to assess the number of dilatation sessions usually needed as well as the short to midterm outcome. Results This study involved 40 patients with tracheal stenosis diagnosed by computed tomography (neck and chest) and bronchoscopy at the Security Force Hospital in Riyadh, KSA, between January 2013 and August 2018. Patients’ data were retrospectively reviewed and analyzed. Patients’ age ranged between 18 and 60 years. Thirty patients were males (75%); those patients underwent balloon tracheoplasty via dilatation of areas of narrowing using catheter balloon insufflation guided by fiber-optic bronchoscope. Ninety-five percent of the patients had initial success with acceptable dilatation of the stenotic area and improvement of the symptoms. There were no technical or major problems which resulted from the procedure, and no patient complained of severe pain or severe discomfort after the procedure. From the total of 81 BBD sessions, no in-hospital mortality is related to the procedure itself, and ICU stay ranged between 1 and 5 days post-procedure. Among those 40 patients, 16 patients (40%) needed one session, 10 patients (25%) needed two sessions, 8 patients (20%) needed three sessions, and 6 patients (15%) needed more than three sessions of balloon dilatation. Conclusion Balloon tracheoplasty is a simple, safe method and could be a promising and effective approach that offers immediate symptomatic relief for tracheal stenosis in cases with a history of prolonged intubation. It is worth mentioning that BBD is considered as a temporary measure, and most of the cases will need definitive or additional treatment either resection or stent placement.

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Tracheal Injury Following Prolonged Intubation

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.1976.tb03186.x ◽

1976 ◽

Vol 46 (1) ◽

pp. 18-25 ◽

Cited By ~ 16

Author(s):

Harry M. Windsor ◽

Mark X. Shanahan ◽

K. Cherian ◽

Victor P. Chang

Keyword(s):

Tracheal Injury ◽

Prolonged Intubation

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PROLONGED INTUBATION

Survey of Anesthesiology ◽

10.1097/00132586-196408000-00040 ◽

1964 ◽

Vol 8 (4) ◽

pp. 355 ◽

Cited By ~ 1

Author(s):

B. BRANDSTATER

Keyword(s):

Prolonged Intubation

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Tracheotomy in comparison with tracheopathia for prolonged intubation of the lungs in surgical patients

Hirurg (Surgeon) ◽

10.33920/med-15-2006-06 ◽

2020 ◽

pp. 79-86

Author(s):

A. A. Teuvov ◽

A. M. Baziev ◽

Z. N. Lovpache ◽

T. G. Tlupova ◽

A. I. Sardiyanov

Keyword(s):

Critically Ill ◽

Randomized Clinical Trials ◽

Patient Survival ◽

Surgical Patients ◽

Surgical Wound ◽

Prolonged Intubation ◽

Clinically Significant ◽

Critically Ill Adults ◽

Ill Adults

A comparative analysis of the MEDLINE, EMBASE, CINAHL and Cochrane Registry databases was carried out to identify the advantages of puncture-dilatation tracheostomy methods over standard tracheotomy in critically ill patients. In addition, bibliographies and selected conference proceedings were reviewed; included randomized clinical trials comparing puncture-dilatation techniques with standard tracheotomy in critically ill adults, which reported clinically significant outcomes. The extracted data are focused on the criteria for the validity of the studies and the results relevant to practice. Puncture methods are less traumatic and can reduce the likelihood of infection of the surgical wound. Compared to the traditional method, a puncture tracheostomy can be applied in just 2 minutes,which can play a significant role in the prognosis of patient survival. The role of the experience of the operators performing the procedures has a significant impact on the results, which cannot be formally and quantitatively assessed in our analysis.

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How COVID-19 Patients Were Moved to Speak: A Rehabilitation Interdisciplinary Case Series

HSS Journal ® ◽

10.1007/s11420-020-09778-0 ◽

2020 ◽

Vol 16 (S1) ◽

pp. 56-63

Author(s):

Brianne Mooney ◽

Cecelia Lawrence ◽

Elizabeth Gerosa Johnson ◽

Amanda Slaboden ◽

Karen Ball

Keyword(s):

Physical Therapy ◽

Case Series ◽

Interdisciplinary Cooperation ◽

Patient Specific ◽

Multidisciplinary Teams ◽

Speech Language Pathology ◽

Retrospective Case ◽

Swallowing Function ◽

Prolonged Intubation ◽

Language Pathology

Abstract Background Up to 36% of patients admitted to the ICU for COVID-19 require tracheostomy. While the literature recommends the use of multidisciplinary teams in the management of patients with tracheostomy for other diseases, little is known on the collaborative administration of physical therapy and speech language pathology services in the COVID-19 population. Purpose We sought to determine the outcomes of a collaboration between physical therapy (PT) and speech language pathology (SLP) in the treatment of patients who underwent tracheostomy placement as part of their treatment for COVID-19 at our facility. Methods We conducted a retrospective case series on patients with COVID-19 who had a tracheostomy. We included patients who had undergone mechanical ventilation for 14 days or longer, had a surgical tracheostomy, been discharged from intensive care to a medical unit, and received PT and SLP referrals. We compiled retrospective data from electronic medical records, analyzing days from tracheostomy to achievement of PT and SLP functional milestones, including mobility, communication, and swallowing. Of six critically ill patients with COVID-19 who had tracheostomy placement at our facility, three met inclusion criteria: patient 1, a 33-year-old woman; patient 2, an 84-year-old man; and patient 3, an 81-year-old man. For all patients, PT interventions focused on breathing mechanics, secretion clearance, posture, sitting balance, and upper and lower extremity strengthening. SLP interventions focused on cognitive reorganization, verbal and nonverbal communication, secretion management, and swallowing function. Intensity and duration of the sessions were adapted according to patient response and level of fatigue. Results We found that time to tracheostomy from intubation for the three patients was 23 days, 20 days, and 24 days, respectively. Time from tracheostomy insertion to weaning from ventilator was 9 days for patient 1, and 5 days for patient 2 and patient 3. Regarding time to achieve functional PT and SLP milestones, all patients achieved upright sitting with PT prior to achieving initial SLP milestone of voicing with finger occlusion. Variations in progression to swallowing trials were patient specific and due to respiratory instability, cognitive deficits, and limitations in production of an effortful swallow. Patient participation in therapy sessions improved following establishment of oral verbal communication. Conclusion Interdisciplinary cooperation and synchronized implementation of PT and SLP interventions in three COVID-19 patients following prolonged intubation facilitated participation in treatment and achievement of functional milestones. Further study is warranted.

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Management of Subglottic Stenosis in Children

Otolaryngology ◽

10.1177/019459988509300503 ◽

1985 ◽

Vol 93 (5) ◽

pp. 585-591 ◽

Cited By ~ 8

Author(s):

Francis I. Catlin ◽

Elizabeth M. Spankus

Keyword(s):

Subglottic Stenosis ◽

Prolonged Intubation ◽

Children's Hospital ◽

Children’S Hospital ◽

Lost To Follow Up

We treated 21 children for subglottic stenosis at the Texas Children's Hospital from 1975 to 1983. Ages ranged from newborn to 14 years. Fifteen (71%) were younger than 13 months of age. Prolonged intubation was thought to be a primary contributing factor in 16 of 21 (76%). Nineteen (90%) required tracheotomy. Of these, 11 (58%) were decannulated, four (21%) have not been decannulated, and four (21%) were lost to follow-up. Two of the 11 children who were successfully decannulated required laryngotracheoplasty or thyrotomy. There were three instances of complications and no deaths.

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Endoscopic transcervical odontoidectomy for pediatric basilar invagination and cranial settling

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/4/337 ◽

2008 ◽

Vol 1 (4) ◽

pp. 337-342 ◽

Cited By ~ 42

Author(s):

Matthew J. McGirt ◽

Frank J. Attenello ◽

Daniel M. Sciubba ◽

Ziya L. Gokaslan ◽

Jean-Paul Wolinsky

Keyword(s):

Pediatric Patients ◽

Pediatric Population ◽

Tube Feeding ◽

Basilar Invagination ◽

Craniocervical Junction ◽

Consecutive Series ◽

Initial Experience ◽

Prolonged Intubation ◽

Alternative Approach

✓ Pediatric basilar invagination and cranial settling have traditionally been approached through a transoral–transpharyngeal route with or without extended maxillotomy or mandibulotomy for resection of the anterior portion of C-1 and the odontoid. The authors hypothesize that application of a recently described endoscopic transcervical odontoidectomy (ETO) technique would allow an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients. The authors performed ETO in a consecutive series of pediatric patients presenting with myelopathy or bulbar dysfunction resulting from basilar invagination or cranial settling. All clinical, radiographic, surgical, and follow-up data were prospectively collected. The initial experience with ETO in the pediatric population is analyzed and outcomes are reported. Three patients required ETO for basilar invagination and 1 required ETO with anterior C-1 arch and distal clivus resection for cranial settling. All patients presented with myelopathy. One patient was wheelchair bound with severe quadriparesis. The mean age was 14 ± 3 years (mean ± standard deviation [SD]) in the 2 male and 2 female patients. The ETO and posterior fusion were performed as a 2-stage procedure in 2 (50%) and as a single-stage procedure in 2 (50%) cases. Prolonged intubation or postoperative placement of a gastrostomy tube was not needed in any case. The postoperative hospitalization lasted 9 ± 4 days (mean ± SD). At last follow-up (mean 5 months), head and neck pain had resolved and motor strength had improved or stabilized in all cases. All 4 children were independently functioning and ambulatory at the last follow-up. In the authors' initial experience, ETO has allowed ventral brainstem decompression without the need for prolonged intubation, worsening dysphagia requiring enteral tube feeding, or prolonged hospitalization, and has resulted in cosmetically appealing results. The ETO technique allows an alternative approach for the treatment of ventral pathological entities at the craniocervical junction in pediatric patients.

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Complications Associated With Removal of Airway Devices Under Deep Anesthesia In Children: An Analysis of The Wake Up Safe Database

10.21203/rs.3.rs-1111501/v1 ◽

2021 ◽

Author(s):

Lisa Vitale ◽

Briana Rodriguez ◽

Anne Baetzel ◽

Robert Christensen ◽

Bishr Haydar

Keyword(s):

Adverse Events ◽

Pediatric Anesthesia ◽

National Database ◽

Quality Improvement Initiative ◽

Serious Adverse Events ◽

Screening Criteria ◽

Prolonged Intubation ◽

Respiratory Events ◽

In Series ◽

Airway Devices

Abstract Background: Previous studies examining removal of endotracheal tubes and supraglottic devices under deep anesthesia were underpowered to identify rare complications. This study sought to report all adverse events associated with this practice found in a large national database of pediatric anesthesia adverse events.Methods: An extract of an adverse events database created by the Wake Up Safe database, a multi-institutional pediatric anesthesia quality improvement initiative, was performed for this study. It was screened to identify anesthetics with variables indicating removal of airway devices under deep anesthesia. Three anesthesiologists screened the data to identify events where this practice possibly contributed to the event. Event data was extracted and collated. Results: 102 events met screening criteria and 66 met inclusion criteria. Two cardiac etiology events were identified, one of which resulted in the patient’s demise. The remaining 97% of events were respiratory in nature (64 events), including airway obstruction, laryngospasm, bronchospasm and aspiration. Some respiratory events consisted of multiple distinct events in series. Nineteen respiratory events resulted in cardiac arrest (29.7%) of which 15 (78.9%) were deemed preventable by local anesthesiologists performing independent review. Respiratory events resulted in intensive care unit admission (37.5%), prolonged intubation and temporary neurologic injury but no permanent harm. Provider and patient factors were root causes in most events. Upon investigation, areas for improvement identified included improving patient selection, ensuring monitoring, availability of intravenous access, and access to emergency drugs and equipment until emergence.Conclusions: Serious adverse events have been associated with this practice, but no respiratory events were associated with long-term harm.

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