The effect of percutaneous and surgical tracheotomy on thyroid hormones levels

Background: The need for prolonged mechanical ventilation is one of the most serious cases of a disease in patients in intensive care units. Tracheostomy is often considered as a solution when mechanical ventilation is expected to be used for prolonged periods or for improvement of the respiratory state as this approach provides protection of the airways, facilitates access to remove secretions, improves patient convenience and promotes the development of care inside and outside the Intensive Care Unit (ICU).Aim: The aim of the present study was to evaluate the impact of surgical and percutaneous tracheotomy on thyroid hormones and to compare them.Material & Methods: This is a non-randomized clinical trial. The studied sample consisted of 87 patients from the Intensive Care Unit of a General Hospital of Athens who underwent percutaneous or surgical tracheotomy.Results: Thyroid-stimulating hormone levels were increased in surgical group compared to percutaneous group at 2 hours post procedure but the difference was not found statistically significant. The rise in post-operative levels of fT3 compared to preoperative was found statistically significant for surgical tracheostomy group. Elevated fT4 levels were found in both groups.Conclusions: The effect of surgical versus percutaneous tracheostomy on thyroid hormone was analyzed and it was found that both procedures may affect the level of thyroid hormones, being significant in the surgical group.

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

Medicinski pregled ◽

10.2298/mpns18s1077d ◽

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.

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375. COVID 19 infection in a Massachusetts community hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.570 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S257-S258

Author(s):

Raul Davaro ◽

alwyn rapose

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Essential Hypertension ◽

Severe Acute Respiratory Syndrome ◽

High Mortality ◽

Case Series ◽

World Health ◽

Minimal Risk ◽

The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

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Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

Colombia Medica ◽

10.25100/cm.v44i3.1285 ◽

2013 ◽

pp. 184-188 ◽

Cited By ~ 4

Author(s):

Alvaro Sanabria ◽

Ximena Gomez ◽

Valentin Vega ◽

Luis Carlos Dominguez ◽

Camilo Osorio

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cohort Study ◽

Intensive Care ◽

Critically Ill ◽

Medical Condition ◽

Prolonged Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Adult Patients ◽

Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

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Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

Critical Care Research and Practice ◽

10.1155/2020/6688120 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Andrei Karpov ◽

Anish R. Mitra ◽

Sarah Crowe ◽

Gregory Haljan

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Failure ◽

Respiratory Rate ◽

Prolonged Mechanical Ventilation ◽

Case Series ◽

Prone Positioning ◽

Retrospective Case ◽

Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

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The impact of time to tracheostomy on mechanical ventilation duration, length of stay, and mortality in intensive care unit patients

Journal of Critical Care ◽

10.1016/j.jcrc.2008.07.001 ◽

2009 ◽

Vol 24 (3) ◽

pp. 435-440 ◽

Cited By ~ 39

Author(s):

Yaseen M. Arabi ◽

Jamal A. Alhashemi ◽

Hani M. Tamim ◽

Andres Esteban ◽

Samir H. Haddad ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Length Of Stay ◽

Ventilation Duration ◽

Mechanical Ventilation Duration ◽

The Impact

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PREDICTORS OF ABILITY TO WEAN FROM PROLONGED MECHANICAL VENTILATION SIX MONTHS AFTER DISCHARGE FROM A MEDICAL INTENSIVE CARE UNIT

CHEST Journal ◽

10.1378/chest.128.4_meetingabstracts.369s-a ◽

2005 ◽

Vol 128 (4) ◽

pp. 369S

Author(s):

Leslie A. Hoffman ◽

JiYeon Choi ◽

Thomas H. Miller ◽

Keiko Kobayashi ◽

Thomas G. Zullo ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Medical Intensive Care Unit ◽

Prolonged Mechanical Ventilation ◽

Medical Intensive Care

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Use of a Nutrition Support Protocol to Increase Enteral Nutrition Delivery in Critically Ill Patients

American Journal of Critical Care ◽

10.4037/ajcc2014140 ◽

2014 ◽

Vol 23 (5) ◽

pp. 396-403 ◽

Cited By ~ 16

Author(s):

Friederike Compton ◽

Christian Bojarski ◽

Britta Siegmund ◽

Markus van der Giet

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Enteral Nutrition ◽

Invasive Mechanical Ventilation ◽

Nutrition Support ◽

Early Enteral Nutrition ◽

Feeding Tubes ◽

Enteral Nutrition Support ◽

The Impact

BackgroundEarly enteral nutrition is recommended for patients in intensive care units, but nutrition provision is often hindered by a variety of unit-specific problems.ObjectivesTo evaluate the impact of a nutrition support protocol on nutrition prescription and delivery in the intensive care unit.MethodsNutrition-related data from 73 patients receiving mechanical ventilation who were treated in an adult medical intensive care unit before introduction of an enteral nutrition support protocol were retrospectively compared with data for 87 patients admitted after implementation of the protocol.ResultsAfter implementation of the protocol, enteral nutrition was started significantly earlier (P = .007) and enteral feeding goals were reached significantly faster (6 vs 10 days, P < .001) than before. Prescription of enteral nutrition on the first day of invasive mechanical ventilation increased from 38% before to 54% after (P = .03) implementation of the protocol. Prescribed and delivered nutrition doses on the first 2 days of mechanical ventilation also increased significantly (P < .001) after the protocol was implemented. Nasojejunal feeding tubes were used in 52% of patients before and 56% of patients after protocol implementation P = .63). Jejunal tubes were placed earlier after the protocol was implemented than before (median 5 vs 6.5 days), and when a jejunal tube was in place, feeding goals were reached faster (median 2 vs 3 days, P = .002).ConclusionImplementing an enteral nutrition support protocol shortened the time to reach feeding goals. Jejunal feeding tubes were necessary in more than half of the patients, and with a jejunal feeding tube in place, feeding goals were reached rapidly.

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The Impact of Hyperoxia on Outcome of Patients Treated with Noninvasive Respiratory Support

Canadian Respiratory Journal ◽

10.1155/2020/3953280 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Seyhan Pala Cifci ◽

Yasemin Urcan Tapan ◽

Bengu Turemis Erkul ◽

Yusuf Savran ◽

Bilgin Comert

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Oxygen Therapy ◽

Invasive Mechanical Ventilation ◽

Respiratory Support ◽

High Flow Oxygen ◽

The Impact

Objective. Oxygen therapy is one of the most common treatment modalities for hypoxemic patients, but target goals for normoxemia are not clearly defined. Therefore, iatrogenic hyperoxia is a very common situation. The results from the recent clinical researches about hyperoxia indicate that hyperoxia can be related to worse outcomes than expected in some critically ill patients. According to our literature knowledge, there are not any reports researching the effect of hyperoxia on clinical course of patients who are not treated with invasive mechanical ventilation. In this study, we aimed to determine the effect of hyperoxia on mortality, and length of stay and also possible side effects of hyperoxia on the patients who are treated with oxygen by noninvasive devices. Materials and Methods. One hundred and eighty-seven patients who met inclusion criteria, treated in Dokuz Eylul University Medical Intensive Care Unit between January 1, 2016, and October 31, 2018, were examined retrospectively. These patients’ demographic data, oxygen saturation (SpO2) values for the first 24 hours, APACHE II (Acute Physiology and Chronic Health Evaluation II) scores, whether they needed intubation, if they did how many days they got ventilated, length of stay in intensive care unit and hospital, maximum PaO2 values of the first day, oxygen treatment method of the first 24 hours, and the rates of mortality were recorded. Results. Hyperoxemia was determined in 62 of 187 patients who were not treated with invasive mechanic ventilation in the first 24 hours of admission. Upon further investigation of the relation between comorbid situations and hyperoxia, hyperoxia frequency in patients with COPD was detected to be statistically low (16% vs. 35%, p<0.008). Hospital mortality was significantly high (51.6% vs. 35.2%, p<0.04) in patients with hyperoxia. When the types of oxygen support therapies were investigated, hyperoxia frequency was found higher in patients treated with supplemental oxygen (nasal cannula, oronasal mask, high flow oxygen therapy) than patients treated with NIMV (44.2% vs. 25.5%, p<0.008). After exclusion of 56 patients who were intubated and treated with invasive mechanical ventilation after the first 24 hours, hyperoxemia was determined in 46 of 131 patients. Mortality in patients with hyperoxemia who were not treated with invasive mechanical ventilation during hospital stay was statistically higher when compared to normoxemic patients (41.3% vs 15.3%, p<0.001). Conclusion. We report that hyperoxemia increases the hospital mortality in patients treated with noninvasive respiratory support. At the same time, we determined that hyperoxemia frequency was lower in COPD patients and the ones treated with NIMV. Conservative oxygen therapy strategy can be suggested to decrease the hyperoxia prevalence and mortality rates.

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