Severe Complications of the Anterior Cricoid Split Operation and Single-Stage Laryngotracheoplasty

1994 ◽  
Vol 103 (9) ◽  
pp. 723-725 ◽  
Author(s):  
Anthony G. Zeitouni ◽  
John Manoukian
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Postoperative Complications ◽  
Postoperative Period ◽  
Intensive Care Unit Setting ◽  
Single Stage ◽  
Successful Outcome ◽  
Increased Risk ◽  
Split Operation

The management of congenital and acquired subglottic stenosis has been considerably facilitated with the introduction of the anterior cricoid split operation and, more recently, the single-stage laryngotracheoplasty. These procedures are followed by a 1- to 2-week period of sedation, during which the patient is paralyzed and completely dependent on mechanical ventilation. Although these procedures have proven very successful at achieving decannulation, the postoperative period can be the source of significant complications. This is illustrated with 4 cases of severe postoperative complications. The possible pathophysiologic causes are discussed, and the literature concerning the postoperative complications of these procedures is reviewed. The avoidance of neuromuscular blockade must be weighed against the possible increased need for narcotics and increased risk of self-extubation. An intensive care unit setting proficient in the care of these patients is necessary for a successful outcome.

scholarly journals Intensive Care Unit Admission, Mechanical Ventilation, and Mortality Among Patients With Type 1 Diabetes Hospitalized for COVID-19 in the U.S.

2021 ◽  
Author(s):  
Catherine E. Barrett ◽  
Joohyun Park ◽  
Lyudmyla Kompaniyets ◽  
James Baggs ◽  
Yiling J. Cheng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Type 1 Diabetes ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Absolute Risk ◽  
Invasive Mechanical Ventilation ◽  
Logistic Models ◽  
Increased Risk

<b>Objective.</b> <p>To assess whether risk of severe outcomes among patients with type 1 diabetes (T1DM) hospitalized for COVID-19 differs from patients without diabetes (DM) or with type 2 diabetes (T2DM). </p> <p><b>Research Design and Methods.</b> </p> <p>Using the Premier Healthcare Special COVID-19 Release Database records of patients discharged after COVID-19 hospitalization from US hospitals from March to November 2020 (N=269,674, after exclusion), we estimated risk differences (RD) and risk ratios (RR) of intensive care unit admission or invasive mechanical ventilation (ICU/MV) and of death among patients with T1DM compared with patients without DM or with T2DM. Logistic models were adjusted for age, sex, and race or ethnicity. Models adjusted for additional demographic and clinical characteristics were used to examine whether other factors account for the associations between T1DM and severe COVID-19 outcomes.</p> <p><b>Results.</b> </p> <p>Compared with patients without DM, T1DM was associated with a 21% higher absolute risk of ICU/MV (RD = 0.21, 95% Confidence Interval [CI]=0.19–0.24; RR=1.49, 95% CI=1.43–1.56) and a 5% higher absolute risk of mortality (RD=0.05, 95% CI=0.03–0.07; RR=1.40, 95% CI=1.24–1.57), adjusting for age, sex, and race or ethnicity. Compared with patients with T2DM, T1DM was associated with a 9% higher absolute risk of ICU/MV (RD=0.09, 95% CI=0.07–0.12; RR=1.17, 95% CI=1.12–1.22), but no difference in mortality (RD=0.00, 95% CI=-0.02–0.02; RR=1.00, 95% CI=0.89–1.13). After adjustment for diabetic ketoacidosis (DKA) occurring before or at COVID-19 diagnosis, patients with T1DM no longer had increased risk of ICU/MV (RD=0.01, 95% CI=-0.01–0.03) and had lower mortality (RD=-0.03, 95% CI=-0.05– -0.01) compared to patients with T2DM.</p> <p><b>Conclusions.</b> </p> Patients with T1DM hospitalized for COVID-19 are at higher risk for severe outcomes than those without DM. Higher ICU/MV risk compared with patients with T2DM was largely accounted for by the presence of DKA. These findings might further guide recommendations related to DM management and the prevention of COVID-19.

Weaning Injured Patients with Prolonged Pulmonary Failure from Mechanical Ventilation in a Non-Intensive Care Unit Setting

2000 ◽  
Vol 49 (2) ◽  
pp. 224-231 ◽  
Author(s):  
Michael W. deBoisblanc ◽  
Robert K. Goldman ◽  
John C. Mayberry ◽  
Dawn M. Brand ◽  
Patrick D. Pangburn ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Unit Setting ◽  
Pulmonary Failure ◽  
Injured Patients

scholarly journals Perfusion Abnormalities Shown On Subtraction CT Angiography In Apparently Normal Lungs And Their Impact On Patient Outcome. A Prospective Cohort Study: What Could We Be Missing?

2021 ◽  
Author(s):  
Mario G. Santamarina ◽  
Felipe Martinez Lomakin ◽  
Ignacio Beddings ◽  
Dominique Boisier Riscal ◽  
Jose Chang Villacís ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Ct Angiography ◽  
Independent Risk Factor ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Increased Risk

Abstract Background: COVID-19 pneumonia seems to affect the regulation of pulmonary perfusion. In this study, through iodine distribution maps obtained with subtraction CT angiography, we quantified and analyzed perfusion abnormalities in patients with COVID-19 pneumonia and correlated them with clinical outcomes.Methods: 205 patients were included in this cohort, from two different tertiary-care hospitals in Chile. All patients had RT-PCR confirmed SARS-CoV-2 infection. CT scans were performed within 24 h of admission, in supine position. Airspace compromise was assessed with CT severity score, and the extension of hypoperfusion in apparently healthy lung parenchyma with perfusion score. CT severity and perfusion scores were then correlated with clinical outcomes. Multivariable analyses using Cox Proportional Hazards regression were used to control for clinical confounders.Results: Fourteen patients were excluded due to uninterpretable images. This left 191 patients, 112 males and 79 females. The mean age was 60.8±16.0 years. The median SOFA score on admission was 2 and average PaFi ratio was 250±118. Patients with severe perfusion abnormalities showed significantly higher SOFA scores and lower Pa/Fi ratios when compared to individuals with mild or moderate anomalies. Severe perfusion abnormalities were associated with an increased risk of intensive care unit (ICU) admission and the requirement of invasive mechanical ventilation (IMV).Conclusion: Patients with severe perfusion anomalies have a higher risk of admission to the ICU and IMV. Perfusion alterations could be considered as an independent risk factor in patients with COVID-19 pneumonia.Summary Statement: Lung perfusion abnormalities in patients with COVID-19 pneumonia were associated with admission to Intensive Care Unit and requirement of invasive mechanical ventilation. Perfusion abnormalities could be considered as an independent risk factor in patients with COVID-19 pneumonia.

scholarly journals Clinical features and the maternal and neonatal outcomes of pregnant women with coronavirus disease 2019

2020 ◽  
Author(s):  
Rui Nie ◽  
Shao-shuai Wang ◽  
Qiong Yang ◽  
Cui-fang Fan ◽  
Yu-ling Liu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pregnant Women ◽  
Clinical Features ◽  
Neonatal Outcomes ◽  
Clinical Severity ◽  
Severe Illness ◽  
Increased Risk ◽  
Maternal And Neonatal Outcomes

ABSTRACTBACKGROUNDThere is little information about the coronavirus disease 2019 (Covid-19) during pregnancy. This study aimed to determine the clinical features and the maternal and neonatal outcomes of pregnant women with Covid-19.METHODSIn this retrospective analysis from five hospitals, we included pregnant women with Covid-19 from January 1 to February 20, 2020. The primary composite endpoints were admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Secondary endpoints included the clinical severity of Covid-19, neonatal mortality, admission to neonatal intensive care unit (NICU), and the incidence of acute respiratory distress syndrome (ARDS) of pregnant women and newborns.RESULTSThirty-three pregnant women with Covid-19 and 28 newborns were identified. One (3%) pregnant woman needed the use of mechanical ventilation. No pregnant women admitted to the ICU. There were no moralities among pregnant women or newborns. The percentages of pregnant women with mild, moderate, and severe symptoms were 13 (39.4%),19(57.6%), and 1(3%). One (3.6%) newborn developed ARDS and was admitted to the NICU. The rate of perinatal transmission of SARS-CoV-2 was 3.6%.CONCLUSIONSThis report suggests that pregnant women are not at increased risk for severe illness or mortality with Covid-19 compared with the general population. The SARS-CoV-2 infection during pregnancy might not be associated with as adverse obstetrical and neonatal outcomes that are seen with the severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) infection during pregnancy. (Funded by the National Key Research and Development Program.)

scholarly journals Dysphagic disorder in a cohort of COVID-19 patients: evaluation and evolution

2021 ◽  
Author(s):  
Andrea Glotta ◽  
Anna Galli ◽  
Maira Biggiogero ◽  
Giovanni Bona ◽  
Andrea Saporito ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critically Ill ◽  
Complete Recovery ◽  
Demographic Characteristics ◽  
Hospital Data ◽  
Multisystem Disease ◽  
Icu Length Of Stay ◽  
Increased Risk

Background: COVID-19 is a multisystem disease complicated by respiratory failure requiring sustanined mechanical ventilation (MV). Prolongued oro-tracheal intubation is associated to an increased risk of dysphagia and bronchial aspiration. Purpose of this study was to investigate swallowing disorders in critically ill COVID-19 patients. Methods This was a retrospective study analysing a consecutive cohort of COVID-19 patients admitted to the Intensive Care Unit (ICU) of our Hospital. Data concerning dysphagia were collected according to the Gugging Swallowing Screen (GUSS) and related to demographic characteristics, clinical data, ICU Length-Of-Stay (LOS) and MV parameters. Results From March 2 to April 30 2020, 31 consecutive critically ill COVID-19 patients admitted to ICU were evaluated by speech and language therapists (SLT). Twenty-five of them were on MV (61% through endotracheal tube and 19% through tracheostomy); median MV lenght was 11 days. Seventeen (54.8%) patients presented dysphagia; a correlation was found between first GUSS severity stratification and MV days (p < 0.001), ICU LOS (p < 0.001), age (p = 0.03) and tracheostomy (p = 0.042). No other correlations were found. At 16 days, 90% of patients had fully recovered; a significant improvement was registered especially during the first week (p < 0.001). Conclusion Compared to non-COVID-19 patiens, a higher rate of dysphagia was reported in COVID-19 patients, with a more rapid and complete recovery. A systematic early SLT evaluation of COVID-19 patients on MV may thus be useful to prevent dysphagia-related complications.

One-Stage Operation in Multiple and Concomitent Trauma

2003 ◽  
Vol 10 (3) ◽  
pp. 10-15 ◽  
Author(s):  
E L Litvina ◽  
A V Skoroglyadov ◽  
D I Gordienko ◽  
E A Litvina ◽  
A V Skoroglyadov ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Postoperative Complications ◽  
Postoperative Period ◽  
Surgical Intervention ◽  
Time Sequence ◽  
Point Of View ◽  
Emergency Operations ◽  
One Step ◽  
Period Decrease

The question of the performance of one step operation in patients with concomitant and multiple trauma from the point of view of the choice of surgical intervention time, sequence and type of operation is considered. The advantages of one step operation include: one narcosis, one postoperative period, decrease of the risk of posttraumatic and postoperative complications, easing of treatment and nursing at intensive care unit as well as earlier rehabilitation. Criteria for the detection of the surgery time, sequence and type of operative intervention for individual patient with polytrauma were elaborated. Between 1998 and 2002, 282 one-step operations (71 emergency operations (within 5 hours after trauma), 135 urgent operations (within the first 3 days after trauma) and 76 delayed operations (within 10-14 days after trauma)) were performed at Moscow clinical Hospital #1 named after IV. I. Pirogov.

scholarly journals Outcomes of Patients with COVID-19 in the Setting of Chronic Opioid Use Disorder

2020 ◽  
Author(s):  
PhD Heather F. Thiesset ◽  
MS Michael Newman ◽  
MD Joseph E. Tonna ◽  
PhD Ray M. Merrill
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Retrospective Chart Review ◽  
Opioid Use Disorder ◽  
Hospital Inpatient ◽  
Opioid Use ◽  
Inpatient Hospitalization ◽  
Increased Risk ◽  
Chronic Opioid Use

Abstract Background: There are no known studies regarding the effects of COVID-19 in patients with a concurrent diagnosis of opioid use disorder (OUD). Due to the rapidly developing nature and consequences of this disease, it is important to identify patients at an increased risk for serious illness. The aim of this study was to understand the disease burden of COVID-19 on patients with OUD by looking at their rates of hospitalization, admission to the intensive care unit (ICU), and receipt of mechanical ventilator support.Methods: This retrospective chart review compared clinical parameters from patients with positive COVID-19 status as identified by a positive SARS-CoV-2 PCR test and diagnosed OUD at the University of Utah Health. Descriptive statistics and prevalence ratios (PRs) were generated. Log binomial models generated PRs adjusted by age, sex, race, and comorbidities of asthma, pneumonia, and diabetes.Results: COVID-19 patients with OUD were significantly more likely than patients without OUD to have asthma (p<0.01), diabetes (p<0.01), and chronic pneumonia (p<0.01), to be hospitalized (23% vs 4%; p<0.01), to be admitted to the ICU (11% vs 2%; p<0.01), and to receive mechanical ventilation (7% vs 1%; p<0.01). After adjusting for age, sex, race, asthma, pneumonia, and diabetes, patients with OUD continued to be at increased risk for inpatient hospitalization (aPR=5.65, 95% confidence interval [CI]=2.29-13.92), intensive care unit (ICU) admission (aPR=0.69, 95% CI = 0.19-2.45), and mechanical ventilation (aPR=1.25, 95% CI =0.27-5.75). Patients with OUD averaged longer stays in the hospital than those without OUD (9.53 days vs 0.70 days, p<.001).Conclusion: Patients that have a diagnosis of OUD in the presence of COVID-19 are more likely to be hospitalized, admitted to the ICU, receive mechanical ventilation and have longer hospital inpatient stays compared to patients without OUD.

scholarly journals Intensive Care Unit Admission, Mechanical Ventilation, and Mortality Among Patients With Type 1 Diabetes Hospitalized for COVID-19 in the U.S.

2021 ◽  
Author(s):  
Catherine E. Barrett ◽  
Joohyun Park ◽  
Lyudmyla Kompaniyets ◽  
James Baggs ◽  
Yiling J. Cheng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Type 1 Diabetes ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Absolute Risk ◽  
Invasive Mechanical Ventilation ◽  
Logistic Models ◽  
Increased Risk

<b>Objective.</b> <p>To assess whether risk of severe outcomes among patients with type 1 diabetes (T1DM) hospitalized for COVID-19 differs from patients without diabetes (DM) or with type 2 diabetes (T2DM). </p> <p><b>Research Design and Methods.</b> </p> <p>Using the Premier Healthcare Special COVID-19 Release Database records of patients discharged after COVID-19 hospitalization from US hospitals from March to November 2020 (N=269,674, after exclusion), we estimated risk differences (RD) and risk ratios (RR) of intensive care unit admission or invasive mechanical ventilation (ICU/MV) and of death among patients with T1DM compared with patients without DM or with T2DM. Logistic models were adjusted for age, sex, and race or ethnicity. Models adjusted for additional demographic and clinical characteristics were used to examine whether other factors account for the associations between T1DM and severe COVID-19 outcomes.</p> <p><b>Results.</b> </p> <p>Compared with patients without DM, T1DM was associated with a 21% higher absolute risk of ICU/MV (RD = 0.21, 95% Confidence Interval [CI]=0.19–0.24; RR=1.49, 95% CI=1.43–1.56) and a 5% higher absolute risk of mortality (RD=0.05, 95% CI=0.03–0.07; RR=1.40, 95% CI=1.24–1.57), adjusting for age, sex, and race or ethnicity. Compared with patients with T2DM, T1DM was associated with a 9% higher absolute risk of ICU/MV (RD=0.09, 95% CI=0.07–0.12; RR=1.17, 95% CI=1.12–1.22), but no difference in mortality (RD=0.00, 95% CI=-0.02–0.02; RR=1.00, 95% CI=0.89–1.13). After adjustment for diabetic ketoacidosis (DKA) occurring before or at COVID-19 diagnosis, patients with T1DM no longer had increased risk of ICU/MV (RD=0.01, 95% CI=-0.01–0.03) and had lower mortality (RD=-0.03, 95% CI=-0.05– -0.01) compared to patients with T2DM.</p> <p><b>Conclusions.</b> </p> Patients with T1DM hospitalized for COVID-19 are at higher risk for severe outcomes than those without DM. Higher ICU/MV risk compared with patients with T2DM was largely accounted for by the presence of DKA. These findings might further guide recommendations related to DM management and the prevention of COVID-19.

scholarly journals Evaluation of the Safety of Percutaneous Dilational Tracheostomy Compared with Surgical Tracheostomy in the Intensive Care Unit

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Yuta Suzuki ◽  
Takeshi Suzuki ◽  
Yuko Yamamoto ◽  
Ayano Teshigawara ◽  
Jun Okuda ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Skin Incision ◽  
Percutaneous Dilational Tracheostomy ◽  
Surgical Tracheostomy ◽  
Mechanical Ventilation Support ◽  
Secondary Outcomes

Background. Tracheostomy is a necessary procedure for patients who require long-term mechanical ventilation support. There are two methods for tracheostomy in current use: surgical tracheostomy (ST) and percutaneous dilational tracheostomy (PDT). In the current study, we retrospectively compared the safety of both procedures performed in our intensive care unit (ICU). Methods. In this study, we enrolled subjects who underwent tracheostomy in our ICU between January 2012 and March 2016. We excluded subjects who were <20 years old and underwent tracheostomy in the operating room. As a primary outcome, we evaluated the rate of complications between ST and PDT groups. The length of ICU stay, time to tracheostomy from intubation, and the rate of mechanical ventilation and mortality at 28 postoperative days were also examined as secondary outcomes. Results. Compared with the ST group, the rate of all complications was lower in the PDT group (13.4% vs. 38.8%, p=0.007). Although the rate of intraoperative complications did not differ between the two groups (3.8% vs. 8.1%, p=0.62), relative to the ST procedure, the PDT procedure was associated with fewer postoperative complications (34.6% vs. 9.6%, p=0.003). Among postoperative complications, accidental removal of the tracheostomy tube and an air leak from the tracheostomy fistula were less frequent in the PDT group than the ST group. Between the two groups, there were no significant differences in their secondary outcomes. Conclusion. This retrospective study indicates that relative to ST, PDT is a safer procedure to be performed in the ICU. Fewer postoperative complications following PDT might be attributed to the small skin incision made during this procedure.

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