scholarly journals A Technique to Minimize Aerosolization During Percutaneous Tracheostomy in COVID-19 Patients

2020 ◽  
Vol 86 (8) ◽  
pp. 904-906
Author(s):  
Alejandro Betancourt-Ramirez ◽  
Jay A. Yelon ◽  
Paul Boland ◽  
Michael Amaturo
Keyword(s):  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Case Series ◽  
Surgical Intensive Care Unit ◽  
Surgical Team ◽  
Surgical Intensive Care ◽  
Level Of Evidence ◽  
Dilatational Tracheostomy ◽  
And Performance

Background The SARS-CoV-2 pandemic has caused respiratory failure in many patients. With no effective treatment or vaccine, prolonged mechanical ventilation is common in survivors. Timing and performance of tracheostomy, for both patient and surgical team safety, remains a question. Here within, we report our experience with percutaneous dilatational tracheostomy with modification to minimize aerosolization. Methods A modified percutaneous dilatational tracheostomy technique is described. The technique was performed on 10 patients in the surgical intensive care unit. Results Ten patients underwent percutaneous dilatational tracheostomy. There were 7 males, and the average age for the group was 60.8 years. The average number of ventilator days before the operation was 26.3. All procedures were successful, and no patient had any procedure-related complications. Conclusions The procedure described was successful in our patient population. We believe that this approach is safe for patients with coronavirus disease 2019 and limits aerosolization during the operation. Level of evidence Level IV, case series.

scholarly journals The percutaneous dilatational tracheostomy in the intensive care unit - our experience

2018 ◽  
Vol 71 (suppl. 1) ◽  
pp. 77-82
Author(s):  
Vladimir Dolinaj ◽  
Sanja Milosev ◽  
Gordana Jovanovic ◽  
Ana Andrijevic ◽  
Nensi Lalic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Prothrombin Time ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Seldinger Technique ◽  
Dilatational Tracheostomy ◽  
Tracheal Cannula

Percutaneous tracheostomy is a commonly carried out procedure in patients in the Intensive Care Unit. Percutaneous dilatational tracheostomy consists of the introduction of a tracheal cannula from the front of the neck, through blunt dissection of the pretracheal tissues, using a guide by Seldinger technique. When percutaneous dilatational tracheostomy procedure was introduced in routine clinical practice in the Clinical Center of Vojvodina, procedural protocol was established. This Protocol includes: 1. indications, contraindications and timing for percutaneous dilatational tracheostomy, 2. assessment of the patient, 3. preparation of the patient and equipment, 4. procedure description, 5. potential complications and complication management. At our institution percutaneous dilatational tracheostomy is performed on an individual patient basis assessment within 5-7 days following translaryngeal intubation. Routinely the platelet count, activated prothrombin time and prothrombin time are checked. The patient?s neck is assessed clinicaly and by the use of fiberoptic bronchoscope and ultrasound. At our institution we use the modified Ciaglia technique of the percutaneous dilatational tracheostomy-Ciaglia Single Dilatator method with the TRACOE? experc Set vario which includes spiral rein?forced tracheal cannula. At the end of procedure fiberoptic evaluation of the tracheobroinchial tree is made and chest X-ray is done. Percutaneous dilatational tracheostomy is a simple, safe, and effective procedure performed in the Intensive Care Unit. It is the preferred technique of airway management in the Intensive Care Units in the patients requiring prolonged mechanical ventilation, tracheobronchial hygiene and weaning from mechanical ventilation.

Acquired Muscle Weakness in the Surgical Intensive Care Unit

2016 ◽  
Vol 124 (1) ◽  
pp. 207-234 ◽  
Author(s):  
Hassan Farhan ◽  
Ingrid Moreno-Duarte ◽  
Nicola Latronico ◽  
Ross Zafonte ◽  
Matthias Eikermann
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Muscle Weakness ◽  
Prolonged Mechanical Ventilation ◽  
Underlying Mechanism ◽  
Time Frame ◽  
Adverse Outcomes ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Drug Induced

Abstract Muscle weakness is common in the surgical intensive care unit (ICU). Low muscle mass at ICU admission is a significant predictor of adverse outcomes. The consequences of ICU-acquired muscle weakness depend on the underlying mechanism. Temporary drug-induced weakness when properly managed may not affect outcome. Severe perioperative acquired weakness that is associated with adverse outcomes (prolonged mechanical ventilation, increases in ICU length of stay, and mortality) occurs with persistent (time frame: days) activation of protein degradation pathways, decreases in the drive to the skeletal muscle, and impaired muscular homeostasis. ICU-acquired muscle weakness can be prevented by early treatment of the underlying disease, goal-directed therapy, restrictive use of immobilizing medications, optimal nutrition, activating ventilatory modes, early rehabilitation, and preventive drug therapy. In this article, the authors review the nosology, epidemiology, diagnosis, and prevention of ICU-acquired weakness in surgical ICU patients.

scholarly journals INFLUENCE OF MAXIMAL ISOMETRIC STRENGTH ON 20-METER SPRINT TIME

2021 ◽  
Vol 27 (1) ◽  
pp. 60-64
Author(s):  
Álvaro Huerta Ojeda ◽  
Daniel Jerez-Mayorga ◽  
Sergio Galdames Maliqueo ◽  
Darío Martínez García ◽  
Ángela Rodríguez-Perea ◽  
...  
Keyword(s):  
Isometric Force ◽  
Pearson Correlation ◽  
Case Series ◽  
Level Of Evidence ◽  
Jump Test ◽  
Wide Range ◽  
Natural Movement ◽  
And Performance ◽  
High Level ◽  
Very High

ABSTRACT Introduction The squat is an exercise that is widely used for the development of strength in sports. However, considering that not all sports gestures are vertical, it is important to investigate the effectiveness of propulsive force stimuli applied in different planes. Objective The main purpose of this study was to determine the influence of maximum isometric force (MIF) exerted on starting blocks over performance in 5, 10 and 20-meter sprints. Methods Seven high-level male sprinters (mean age ± SD = 28 ± 5.77 years) participated in this study. The variables were: a) MIF in squats and on starting blocks (measured using a functional electromechanical dynamometer [FEMD]), b) time in 5, 10 and 20-m sprints and c) jump height (measured by the squat jump test). For data analysis, a Pearson correlation was performed between the different variables. The criteria for interpreting the strength of the r coefficients were as follows: trivial (<0.1), small (0.1−0.3), moderate (0.3−0.5), high (0.5−0.7), very high (0.7−0.9), or practically perfect (>0.9). The level of significance was p < 0.05. Results There was very high correlation between MIF exerted on starting blocks and performance in the first meters of the sprint (5-m: r = -0.84, p = 0.01). However, there was small correlation between MIF in squats and performance in the first meters of the sprint (5-m: r = -0.22, p < 0.62). Conclusion The MIF applied on starting blocks correlates very high with time in the first meters of the sprint in high-level athletes. In addition, the use of the FEMD provides a wide range of possibilities for evaluation and development of strength with a controlled natural movement. Level of evidence IV; Prognostic Studies - Case series.

scholarly journals When the balloon goes up, blood transfusion goes down: a pilot study of REBOA in placenta accreta spectrum disorders

2021 ◽  
Vol 6 (1) ◽  
pp. e000750
Author(s):  
Yevgeniya J M Ioffe ◽  
Sigrid Burruss ◽  
Ruofan Yao ◽  
Beverly Tse ◽  
Alicia Cryer ◽  
...  
Keyword(s):  
Postoperative Ileus ◽  
Placenta Accreta ◽  
Vascular Complication ◽  
Balloon Occlusion ◽  
Surgical Intensive Care Unit ◽  
Retrospective Case ◽  
Surgical Intensive Care ◽  
Level Of Evidence ◽  
Perioperative Morbidity ◽  
Placenta Accreta Spectrum

BackgroundPatients with placenta accreta spectrum (PAS) disorders often suffer massive hemorrhage during cesarean hysterectomies (CHyst). A novel strategy to decrease blood loss and minimize perioperative morbidity associated with PAS is utilization of ER-REBOA Catheter intraoperatively. In this study, we explore the use of ER-REBOA Catheter during CHyst with the goal of minimizing perioperative morbidity and packed red blood cell (PRBC) transfusions.MethodsWe conducted a retrospective case–control study at a regional referral center of consecutive patients with PAS undergoing CHyst. The primary outcomes were PRBC transfusions of ≥4 units. Secondary outcomes included surgical intensive care unit admissions, postoperative length of stay (LOS), postoperative ileus, and vascular complication rate. We also explored utilization of manual palpation and omission of precesarean fluoroscopy for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement verification in distal aortic zone 3.Results90 patients were included in the study. REBOA and non-REBOA cases were similar in clinicodemographic characteristics. 17.7% of REBOA cases received ≥4 units of PRBC compared with 49.3% of non-REBOA cases (p=0.03). Zero REBOA patients developed postoperative ileus, whereas 18 (25%) non-REBOA patients did (p=0.02). LOS was reduced in the REBOA group. Postplacement fluoroscopy was omitted in all REBOA cases. Two postoperative arterial thrombotic events (2 of 19, 11% of REBOA patients) were identified in the REBOA group, one requiring a thrombectomy (1 of 19, 5%).DiscussionDecrease in blood transfusions of ≥4 units of PRBC is demonstrated when ER-REBOA Catheter is placed in distal aortic zone 3 during CHyst performed for severe PAS disorders. The incidence of postoperative ileus and LOS are reduced in the ER-REBOA Catheter group. Placement and utilization of ER-REBOA Catheter during CHyst may be feasible without fluoroscopy when manual placement verification is performed by an experienced operator. Protocol modifications focusing on reducing thrombotic rate are ongoing.Level of evidenceIV.

scholarly journals Safety of bronchoscopic guided percutaneous dilatational tracheostomy in ICU patients in Tabriz City

2017 ◽  
Vol 36 (3) ◽  
pp. 173
Author(s):  
Mohammad Esmaeil Hejazi ◽  
Mohammadamin Rezazadehsaatlou ◽  
Leila Namvar ◽  
Armin Sadeghi ◽  
Veghar Hejazi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Posterior Wall ◽  
Demographic Variables ◽  
Dilatational Tracheostomy ◽  
Flexible Fiber ◽  
Endoscopic Guidance ◽  
Bronchoscopic Guidance

BACKGROUND<br />Tracheostomy is one of the most frequently performed procedures in intensive care units. The widespread attraction of percutaneous dilatational tracheostomy (PDT) is increasing in modern intensive care units (ICU). Bronchoscopic guidance seems to secure the safety of the technique. Multiple studies done to explain characterize differences in complications and cost-effectiveness of open and percutaneous tracheotomy. The objective of this study was to evaluate the benefits of percutaneous dilatational tracheostomy (PDT) using the Ciaglia technique with bronchoscopic guidance.<br /><br />METHODS<br />A total of 100 elective percutaneous dilatational tracheostomies using the Ciaglia technique with a little modification were performed under flexible fiber optic bronchoscopic guide. The demographic variables were recorded, the underlying cause for patient’s referred to the center for PDT, and intraoperative as well as early postoperative complications. Patients followed for several days after tracheostomy for early complications.<br /><br />RESULTS<br />No severe complications related to percutaneous dilatational tracheostomy were noticed during and after the procedure. Three patients had bleeding during incision and two led to subcutaneus hematoma. There were no other complications such as infection, emphysema and puncture of  posterior wall.<br /><br />CONCLUSIONS<br />We recommended the use of endoscopic guidance bedside percutaneous tracheostomy using the Ciaglia technique with a little modification because it is safe and simple to do without significant complications. PDT with bronchoscopic guidance is a safe and easy procedure that can be done at the bedside setting.

scholarly journals Bronchoscopy Guided V.S Ultrasound Guided Percutaneous Tracheostomy

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H M Elazzazi ◽  
E M Aboseif ◽  
R A Abdelrazik ◽  
A K A Elbardan
Keyword(s):  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Mean Value ◽  
Tube Placement ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
Dilatational Tracheostomy ◽  
Group I ◽  
Endotracheal Tube Placement ◽  
Group Ii

Abstract Introduction Percutaneous dilatational tracheostomy (PDT) is a widely utilized technique in the intensive care unit as it is a safe and cost effective technique. Bronchoscopy guided percutaneous dilatational tracheostomy has traditionally been used as a safety adjunctive tool in order to define the appropriate site for the tracheal puncture, to guide the real-time entrance of the needle into the trachea, avoiding tracheal posterior wall injuries, and confirming the endotracheal tube placement. By contrast, bronchoscopy might not precisely identify the cervical anatomical structures. Ultrasound has emerged as potentially useful tool in assisting percutaneous dilatational tracheostomy when factors that increase the technical difficulty of the procedure (morbid obesity, difficult anatomy & cervical spine precautions) are present. Several studies have demonstrated the value of pre-procedure cervical ultrasound in order to improve the safety of percutaneous dilatational tracheostomy. Objectives This review aimed at comparing bronchoscopy guided versus ultrasound guided percutaneous tracheostomy in terms of the detected complications resulting from each procedure. Design A randomized prospective comparative trial. Setting Critical care department, Ain Shams university hospital. Patients Forty adult patients, requiring elective PDT, and need to maintain a secure airway. Methods They were randomly assigned to 2 groups; fiber optic bronchoscopy PDT group I and Ultrasound guided PDT group II. Both groups used Blue Rhino technique for PDT. Post-operative complications were recorded. Results In group I, males were 11(55%) and females were 9(45%) while in group II, males and females were 14(70%) and 6(30%) respectively. Age in group I ranged from 37-67 with mean value of 52.4±10.89 and in group II ranged from 40-71 with mean value of 54.6±9.81. There was one puncture in 19 cases (95%) in group I, while one puncture in 17 cases (85%) in group II. Total time in group I was ranged from 3-9 with mean value 5.3±1.69 and in group II was ranged from 3-9 with mean value 6.2±1.79. Transient hypoxemia occurs in about 3 cases (15%) in the bronchoscopy guided PDT group in comparison to none in the ultrasound guided PCT group. Bleeding occurred in 2 patients (10%) in bronchoscopy guided PDT group versus one patient (5%) in Ultrasound guided PCT group. Misplacement of the tracheostomy tube was encountered in only two cases (10%) in US guided PDT group and non in the other bronchoscopy guided PDT group, which lead subsequently to pneumothorax in one case (5%). Conclusion Percutaneous dilatational tracheostomy is a bedside safe procedure with low rate of complications. US guided PDT and bronchoscopy guided PDT are effective, safe and associated with similar complication rate and clinical outcome. Bronchoscopy guidance during PDT offers the best vision decreasing the need for multiple punctures and the risk of misdirection or false passage of the tube. Ultrasound is a promising less invasive method to guide the percutaneous tracheostomy procedure.

Comparison of Percutaneous Dilatational Tracheostomy with Open Tracheostomy in Intensive Care Unit

2019 ◽  
Vol 41 (1) ◽  
pp. 1-7
Author(s):  
Pramesh S Shrestha ◽  
Moda N Marhatta ◽  
Subhash P Acharya ◽  
Ninadini Shrestha
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Hospital Length Of Stay ◽  
Apache Ii Score ◽  
Time Duration ◽  
Surgical Tracheostomy ◽  
Dilatational Tracheostomy ◽  
Emergency Procedures

Introduction: Tracheostomy is one of the frequent surgical procedure carried out in intensive care unit. Percutaneous tracheostomy is becoming increasingly popular compared to conventional open surgical tracheostomy in ICU. Methods: A prospective randomized trial with twenty patients in each group was conducted to compare the outcomes of percutaneous and surgical tracheostomy. Percutaneous tracheostomy was performed using Ciaglia Blue Rhino technique and surgical tracheostomy was performed using established technique. The outcomes were compared in relation to randomization to tracheostomy, completion of procedure, intra operative and post-operative complications, hospital length of stay and cost. Results: There were no major complications in either group. Most variables studied were not statistically significant. The two groups did not differ in terms of basic demographics or APACHE II score. The only variables to reach statistical significance were time duration from tracheostomy randomization to start of procedure and time taken for completion of procedure. It was mean 31.85±15.35 hours in Percutaneous Tracheostomy group and in Surgical Tracheostomy group it was mean 49.10±23.61 hours respectively (p<0.009). Time taken to perform percutaneous tracheostomy was mean 15.50±3.22 minutes and for surgical tracheostomy it was mean 20.30±3.38 minutes. (p<0.001). Conclusion: Percutaneous dilatational tracheostomy is simple, faster to perform and can be done at bedside to avoid considerable delay in the performance of open tracheostomy where there is high demand for elective and emergency procedures in operating room.  

Weaning Readiness and Fluid Balance in Older Critically Ill Surgical Patients

2006 ◽  
Vol 15 (1) ◽  
pp. 54-64 ◽  
Author(s):  
Carol Diane Epstein ◽  
Joel R. Peerless
Keyword(s):  
Mechanical Ventilation ◽  
Fluid Balance ◽  
Older Patients ◽  
Prolonged Mechanical Ventilation ◽  
Venous Pressure ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
In The Beginning

• BackgroundFew studies address predictors for successful weaning of older adults from mechanical ventilation. • ObjectiveTo develop a clinical profile of older patients who are successfully weaned from long-term mechanical ventilation. • MethodsForty patients in the trauma and surgical intensive care unit who were at least 60 years old were enrolled in the study after 3 days of active weaning and were monitored daily until successfully weaned or until the end of the 14-day study. Hemodynamic and gas exchange variables, fluid balance, oxygen cost of breathing, and scores on the Burns Weaning Assessment Program were analyzed. • ResultsCompared with patients who were not weaned, successfully weaned patients required mechanical ventilation for 5.3 days, started active weaning earlier (mean 10.7 vs 14.5 days, P = .04), had lower mean negative daily fluid balances in the beginning (−0.394 vs 1.107 L, P = .004), and had lower mean net cumulative fluid balances (6.856 vs 16.212 L) at the time of enrollment. They also maintained both a lower mean net cumulative fluid balance (10.753 vs 25.049 L, P= .02) and a negative daily fluid balance (−0.389 vs 1.904 L, P = .03) throughout. Their mean central venous pressure decreased over time and was significantly lower (P&lt;.001). • ConclusionPersistent positive fluid balance in older surgical patients is associated with prolonged mechanical ventilation. Estimates of fluid balance might be useful in weaning older patients from long-term mechanical ventilation.

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