scholarly journals Is Tracheostomy Safe?: Common Indications and Early Complications Among Ugandan Patients In A Pre-Covid-19 Era.

2021 ◽  
Author(s):  
Daniel James Nyanzi ◽  
Daniel Atwine ◽  
Ronald Kamoga ◽  
Caroline Birungi ◽  
Caroline A Nansubuga ◽  
...  
Keyword(s):  
Early Complications ◽  
Related Complication ◽  
Chi Square ◽  
Early Tracheostomy ◽  
Prolonged Intubation ◽  
Tube Obstruction ◽  
Life Saving ◽  
Baseline Information ◽  
Adults And Children ◽  
Analysis Models

Abstract Background: Tracheostomy is a life-saving procedure whose outcomes may vary between hospitals based on disparities in their existing expertise. We aimed at establishing the indications, early tracheostomy-related complications and their associated factors in Uganda. Methods: In a prospective cohort study, we consecutively enrolled one-hundred patients, both adults and children 2 hours post-tracheostomy procedure. At baseline, information on patients’ socio-demographics, tracheostomy indications, pre- and post-procedural characteristics was collected through researcher administered questionnaires and from medical records. Clinical examination was performed at baseline but also at either day 7 or whenever a tracheostomy-related complication was suspected during the 7days follow-up. Comparison of patients’ baseline characteristics, tracheostomy indications and complications across two hospitals was done using Pearson’s chi-square. For predictors of early tracheostomy complications, bivariate and multivariate analysis models were fitted using binomial regression in STATA 13.0 software. Results: Majority of patients were adults (84%) and males (70%). The commonest tracheostomy indications were; pulmonary toilet (58%) and anticipated prolonged intubation (42%). Overall, 53% (95% CI: 43.0 – 62.7) had early complications with the commonest being tube obstruction (52.6%). Independent predictors of early tracheostomy-related complications were; anticipated having prolonged intubation as an indication (RR=1.8, 95%CI: 1.19 – 2.76), Bjork flap tracheal incision (RR=1.6, 95%CI: 1.09 – 2.43), vertical tracheal incision (RR=1.53, 95%CI: 1.02 – 2.27), and age below 18 years (RR=1.22, 95%CI: 1.00 – 1.47).Conclusion: Within a pre-COVID-19 context, pulmonary toilet is the commonest tracheostomy indication at major hospitals in Uganda. The incidence of early tracheostomy complications is high and majorly related to post-procedure tracheostomy tube management. Having anticipated prolonged intubation as an indication for tracheostomy, a Bjork flap or vertical tracheal incisions and being a child increases the risk of complications. Emphasis on surgical training and post-procedural management for both clinicians and nurses should be made. New data will be needed within the COVID-19 era.

scholarly journals Early complications of tracheostomy: a study on 100 patients at a single tertiary care centre

2017 ◽  
Vol 4 (1) ◽  
pp. 217
Author(s):  
Pooja Pal ◽  
Arvinder Singh Sood ◽  
Sumant Singla
Keyword(s):  
Tertiary Care ◽  
Care Centre ◽  
Early Complications ◽  
Tertiary Care Centre ◽  
Intraoperative Bleeding ◽  
Tube Obstruction ◽  
Emergency Procedures ◽  
Early Postoperative Complications ◽  
Life Saving ◽  
Fatal Complications

<p class="abstract"><strong>Background:</strong> Tracheostomy is a life saving procedure, which when performed correctly greatly impacts the final outcome of the patient. Although uncommon, fatal complications have been known to occur. The present study was conducted to observe the incidence of early complications of tracheostomy in a tertiary care centre.</p><p class="abstract"><strong>Methods:</strong> 100 consecutive patients subjected to tracheostomy were enrolled, and data pertaining to the indication, and intraoperative and early postoperative complications was collected.  </p><p class="abstract"><strong>Results:</strong> The overall incidence of complications was 77%, with 53% cases of intraoperative bleeding and 13% tube obstruction. A higher incidence of complications was noted in emergency procedures and pediatric tracheostomies. No mortality was seen in the present series.</p><p><strong>Conclusions:</strong> Serious complications may be associated with tracheostomies, many of which can be avoided by meticulous surgical technique and postoperative care.</p>

scholarly journals CURRENT CONCEPTS IN THE MANAGEMENT OF TETANUS

2020 ◽  
Vol 8 (3) ◽  
pp. 242-248
Author(s):  
Y. Tkachenko ◽  
Y. Shkatula ◽  
Y. Badion ◽  
S. Lekishvili ◽  
Y. Khizhnya
Keyword(s):  
Botulinum Toxin A ◽  
Supportive Therapy ◽  
Intrathecal Administration ◽  
Early Tracheostomy ◽  
Prolonged Intubation ◽  
Vaccination Rates ◽  
Adults And Children ◽  
High Doses ◽  
Main Components ◽  
Treatment Of Wounds

The study focuses on the problem of severe tetanus cases, which continue to be reported worldwide. The population of countries with low vaccination rates, including Ukraine, is particularly at risk. Despite the increase in the level of DPT vaccination in our country among adults and children, it remains insufficient, which leads to the registration of new cases of tetanus. The aim of the study was to analyze the main directions in the treatment of tetanus. The authors searched for information in electronic databases such as MEDLINE/Pub Med and Google Scholar for the last 20 years. The search was performed on such terms as tetanus, treatment, benzodiazepines, tetanus immunoglobulin (medical topics). The main components of modern treatment are analyzed in the paper, which include removal of the pathogen by careful surgical treatment of wounds, rational antibiotic therapy. Drugs of choice for the eradication of vegetative forms of the pathogen are benzylpenicillin and metronidazole, but can also be used antibacterial drugs of other groups (macrolides, tetracyclines, cephalosporins). Specific immunotherapy with tetanus immunoglobulin can neutralize the toxin that freely circulates in the blood. Those who do not have vaccination data are also indicated for the introduction of tetanus toxoid. Intrathecal administration of anti-tetanus immunoglobulin remains a debatable issue. In the treatment of convulsions, drugs of the benzodiazepine group are preferred. Infusions of high doses of magnesium, dexmetomedin, baclofen, propofol or their combination can also be used. In the case of severe muscular rigidity, muscle relaxants of nondepolarizing action are used. If the spasms are prolonged, botulinum toxin A may be recommended as an injection into peripheral muscles. B-blockers (esmolol), dexmetomedin, clonidine are used to overcome autonomic dysfunction of the nervous system. Supportive therapy is important. It is aimed at providing the patient with complete nutrition. Adequate ventilation with early tracheostomy helps to avoid complications of prolonged intubation. The above methods can significantly reduce mortality from tetanus from 100% (in the absence of treatment) to 10%–20%. Keywords: tetanus, management, benzodiazepines, magnesium sulfate, tetanus immunoglobin, tracheostomy.

scholarly journals Tips and Pearls for Tracheostomy during the Covid-19 Pandemic

2021 ◽  
Vol 25 (03) ◽  
pp. e459-e462
Author(s):  
Darwin Kaushal ◽  
Shilpa Goyal ◽  
Nithin Prakasan Nair ◽  
Kapil Soni ◽  
Bikram Choudhury ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Present Article ◽  
Critically Ill ◽  
Current Literature ◽  
Literature Search ◽  
Scientific Evidence ◽  
Early Tracheostomy ◽  
Life Saving ◽  
Number Of Patients ◽  
Elective Tracheostomy

AbstractThe number of critically-ill coronavirus disease 2019 (Covid-19) patients requiring mechanical ventilation is on the rise. Most guidelines suggest keeping the patient intubated and delay elective tracheostomy. Although the current literature does not support early tracheostomy, the number of patients undergoing it is increasing. During the pandemic, it is important that surgeons and anesthesiologists know the different aspects of tracheostomy in terms of indication, procedure, tube care and complications. A literature search was performed to identify different guidelines and available evidence on tracheostomy in Covid-19 patients. The purpose of the present article is to generate an essential scientific evidence for life-saving tracheostomy procedures.

scholarly journals Specific immunotherapy using Hymenoptera venom: systematic review

2010 ◽  
Vol 128 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Alexandra Sayuri Watanabe ◽  
Luiz Augusto Marcondes Fonseca ◽  
Clóvis Eduardo Santos Galvão ◽  
Jorge Kalil ◽  
Fabio Fernandes Morato Castro
Keyword(s):  
Randomized Controlled Trials ◽  
Specific Immunotherapy ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Venom Immunotherapy ◽  
Chi Square ◽  
Skin Reactions ◽  
Randomized Controlled ◽  
Chi Square Test ◽  
Adults And Children

CONTEXT AND OBJECTIVE: The only effective treatment for patients who have severe reactions after Hymenoptera stings is venom immunotherapy. The aim of this study was to review the literature to assess the effects of venom immunotherapy among patients presenting severe reactions after Hymenoptera stings. DESIGN AND SETTING: Randomized controlled trials in the worldwide literature were reviewed. The manuscript was produced in the Discipline of Allergy and Clinical Immunology, Universidade de São Paulo (USP). METHODS: Randomized controlled trials involving venom immunotherapy versus placebo or only patient follow-up were evaluated. The risk of systemic reactions after specific immunotherapy was evaluated by calculating odds ratios (OR) and their 95% confidence intervals. RESULTS: 2,273 abstracts were identified by the keywords search. Only four studies were included in this review. The chi-square test for heterogeneity showed that two studies were homogeneous and could be included in a meta-analysis. By combining the two studies, the odds ratio became significant: 0.29 (0.10-0.87). However, analysis on the severity of the reactions after immunotherapy showed that the benefits may not be so significant because the reactions were mostly similar to or milder than the original reaction. CONCLUSIONS: Specific immunotherapy should be recommended for adults and children with moderate to severe reactions, but there is no need to prescribe it for children with skin reactions alone, especially if the exposure is very sporadic. On the other hand, the risk-benefit relation should always be assessed in each case.

scholarly journals Tracheostomy in Head and Neck Cancers

2010 ◽  
Vol 2 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Reema Rai ◽  
Parag Watve ◽  
Bachi T Hathiram
Keyword(s):  
Head And Neck ◽  
Simple Procedure ◽  
Fistulous Tract ◽  
Emergency Operation ◽  
Anterior Wall ◽  
Cricothyroid Membrane ◽  
Respiratory Obstruction ◽  
Anterior Aspect ◽  
Life Saving ◽  
Adults And Children

Abstract The term ‘tracheostomy’ or ‘tracheotomy’ refers to the procedure whereby a communication is made between the anterior wall of the trachea and the exterior which bypasses the upper air passages. It results in the formation of a fistulous tract between the anterior aspect of the neck and the trachea allowing air to enter the lower respiratory passages without passing through the nose, pharynx and larynx. It is performed at all ages, however, there are significant differences in the procedure when performed in adults and children. ‘Laryngotomy’ or ‘cricothyrotomy’ is the emergency operation where the airway is opened through the cricothyroid membrane in case of acute respiratory obstruction where there is no time for tracheostomy or inavailability of a competent surgeon to perform the tracheostomy. It is a relatively simple procedure and life-saving.

scholarly journals Comparing the Outcomes of Early and Late Tracheostomy in Severe Traumatic Brain Injury Patient

2021 ◽  
Vol 28 (4) ◽  
pp. 63-70
Author(s):  
Muhammad Ihfaz Ismail ◽  
Zamzuri Idris ◽  
Jafri Malin Abdullah ◽  
Noor Azman A Rahman ◽  
Mazin Nordin
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Early Tracheostomy ◽  
Prolonged Intubation ◽  
High Dependency ◽  
Severe Tbi ◽  
Injury Patient ◽  
The Mean ◽  
Logistic Regression Test

Background: Patients with severe traumatic brain injury (TBI) were expected to have poor Glasgow Coma Scale (GCS) recovery and prolonged intubation. Therefore, an early tracheostomy procedure was indicated for all severe TBI. In view of growing concern regarding the safety and outcome of early tracheostomy on these patients, it was deemed valid and needed to be addressed. Methods: This study was conducted to compare the outcomes of early and late tracheostomies in severe TBI. Only severe TBI patients who were admitted to the Neurosurgery High Dependency Unit (NHDU), Hospital Sultanah Aminah (HSA), Johor Bahru, Johor, Malaysia and who had underwent a tracheostomy were recruited. Three main outcomes noted: duration on ventilation, length of NHDU stay and rate of ventilator associated pneumonia (VAP). Results: Out of 155 patients, 72 (46.5%) were in early tracheostomy group (ETG) and 83 (53.5%) were in late tracheostomy group (LTG). The majority of the participants, 95 (61.3%) were ethnic Malays. The mean duration on ventilator use was 2.65 days (1.57) for ETG and 5.63 days (2.35) for LTG. While, mean NHDU stay was 4.75 days (1.98) for ETG and 9.77 days (2.70) for LTG. Upon independent t-test, early duration of tracheostomies had shown significant outcome in reducing length of NHDU stay, (P < 0.001) and had shortening participants’ time on mechanical ventilator (P < 0.001). Then, based on forward multiple logistic regression test, there were significant association between comorbid (P = 0.003) and tracheostomy (P = 0.020) towards presence of VAP when adjusted for other variables. Conclusion: In this study it was found that early tracheostomy was significant in shortening the duration on ventilator, reducing the length of NHDU stay and reducing the rate of VAP.

scholarly journals Comparative Analysis of Major Incident Triage Tools in Children. A UK population based analysis.

2021 ◽  
Author(s):  
James Vassallo ◽  
Saisakul Chernbumroong ◽  
Nabeela Malik ◽  
Yuanwei Xu ◽  
Damian Keene ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Population Based ◽  
Major Incident ◽  
Physiological Data ◽  
Primary Analysis ◽  
Life Saving ◽  
Major Incidents ◽  
Secondary Analyses ◽  
Adults And Children ◽  
Sensitivity Specificity

Introduction. Triage is a key principle in the effective management of major incidents. There is currently a paucity of evidence to guide the triage of children. The aim of this study was to perform a comparative analysis of nine adult and paediatric triage tools, including the novel Sheffield Paediatric Triage Tool (SPTT), assessing their ability in identifying patients needing life-saving interventions (LSI). Methods A ten-year retrospective database review of TARN data for paediatric patients (<16years) was performed. Primary outcome was identification of patients receiving one or more LSIs from a previously defined list. Secondary outcomes included mortality and prediction of ISS>15. Primary analysis was conducted on patients with complete pre-hospital physiological data with planned secondary analyses using first recorded physiological data. Performance characteristics were evaluated using sensitivity, specificity, under and over-triage. Results 15133 patients met TARN inclusion criteria. 4962 (32.8%) had complete pre-hospital physiological data and 8255 (54.5%) had complete first recorded data. Male patients predominated (69.5%), sustaining blunt trauma (95.4%) with a median ISS of 9. 875 patients (17.6%) received at least one LSI. The SPTT demonstrated the greatest sensitivity of all triage tools at identifying need for LSI (92.2%) but was associated with the highest rate of over-triage (75.0%). Both the PTT (sensitivity 34.1%) and JumpSTART (sensitivity 45.0%) performed less well at identifying LSI. By contrast, the adult MPTT-24 triage tool had the second highest sensitivity (80.8%) with tolerable rates of over-triage (70.2%). Conclusion The SPTT and MPTT-24 outperform existing paediatric triage tools at identifying those patients requiring LSIs. This may necessitate a change in recommended practice. Further work is needed to determine the optimum method of paediatric major incident triage, but consideration should be given to simplifying major incident triage by the use of one generic tool (the MPTT-24) for adults and children.

scholarly journals Nsambya Community Home-Based Care Complements National HIV and TB Management Efforts and Contributes to Health Systems Strengthening in Uganda: An Observational Study

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
William Massavon ◽  
Levi Mugenyi ◽  
Martin Nsubuga ◽  
Rebecca Lundin ◽  
Martina Penazzato ◽  
...  
Keyword(s):  
Observational Study ◽  
Health Systems Strengthening ◽  
People Living With Hiv ◽  
Chi Square ◽  
Loss To Follow Up ◽  
Resource Limited ◽  
Home Based ◽  
Chi Square Test ◽  
Adults And Children ◽  
Home Based Care

Community Home-Based Care (CHBC) has evolved in resource-limited settings to fill the unmet needs of people living with HIV/AIDS (PLHA). We compare HIV and tuberculosis (TB) outcomes from the Nsambya CHBC with national averages in Kampala, Uganda. This retrospective observational study compared HIV and TB outcomes from adults and children in the Nsambya CHBC to national averages from 2007 to 2011. Outcomes included numbers of HIV and TB patients enrolled into care, retention, loss to follow-up (LTFU), and mortality among patients on antiretroviral therapy (ART) at 12 months from initiation; new smear-positive TB cure and defaulter rates; and proportion of TB patients tested for HIV. Chi-square test and trends analyses were used to compare outcomes from Nsambya CHBC with national averages. By 2011, approximately 14,000 PLHA had been enrolled in the Nsambya CHBC, and about 4,000 new cases of TB were detected and managed over the study period. Overall, retention and LTFU of ART patients 12 months after initiation, proportion of TB patients tested for HIV, and cure rates for new smear-positive TB scored higher in the Nsambya CHBC compared to national averages. The findings show that Nsambya CHBC complements national HIV and TB management and results in more positive outcomes.

scholarly journals 1518. Real-World Comparative Effectiveness of Baloxavir Marboxil versus Oseltamivir on Influenza-Related Complication and Resource Utilization

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S761-S762
Author(s):  
Eddie Neuberger ◽  
Chris Wallick ◽  
Devika Chawla ◽  
Rita de Cassia Castro
Keyword(s):  
Real World ◽  
Comparative Effectiveness ◽  
Treated Group ◽  
Administrative Claims ◽  
Related Complication ◽  
Chi Square ◽  
Outpatient Visits ◽  
Signed Rank ◽  
The Us ◽  
Ed Visits

Abstract Background In the 2018-19 season, there were an estimated 490,500 hospitalizations and 24,000 deaths from influenza in the US. Understanding how antiviral use affects rates and severity of complications is crucial to inform clinical practice. The objective of this study was to compare the frequency and costs of complications in influenza patients treated with baloxavir compared with oseltamivir-treated patients. This is one of the first analyses to examine comparative effectiveness of baloxavir in a real-world setting. Methods This retrospective cohort study used IBM MarketScan US administrative claims data from the 2018–19 influenza season. Patients were required to have an outpatient visit for influenza followed by a prescription for baloxavir or oseltamivir within 2 days. Baloxavir- and oseltamivir-treated patients were propensity score matched based on key baseline clinical and demographic characteristics. All-cause, all respiratory-related, and select respiratory-related (infection, asthma, and COPD) HRU in the 15 and 30 days following prescription fill were assessed using chi-square and Fisher’s exact tests for categorical measures and Wilcoxon signed-rank tests for counts and costs. Results We included 5,080 baloxavir-treated patients and 10,160 matched oseltamivir-treated patients in the analysis. Statistically significantly lower HRU was associated with baloxavir compared with oseltamivir therapy (15-day: respiratory-related ED visits, select respiratory-related ED visits and outpatient visits; 30-day: all-cause hospitalization, respiratory-related ED visits, select respiratory-related ED visits and outpatient visits (Table 1). Similarly, associated costs were generally lower in the baloxavir-treated group. Baloxavir-treated patients had lower mean per-patient all-cause 15-day costs (ED visits: $30 [95% CI: $21–$39] vs $42 [95% CI: $32–$51]; hospitalizations: $31 [95% CI: $6–$55] vs $74 [95% CI: $43–$104]) and 30-day costs (ED visits: $46 [95% CI: $35–$57] vs $67 [95% CI: $55–$79]; hospitalizations: $47 [95% CI: $15–$80] vs $119 [95% CI: $78–$161]). Table 1. Proportion of patients with at least one event Conclusion These findings suggest that treatment of influenza with baloxavir may improve outcomes and lower HRU costs compared with oseltamivir treatment. Disclosures Eddie Neuberger, PharmD, Genentech, Inc. (Employee) Chris Wallick, PharmD, MS, Genentech, Inc. (Employee) Devika Chawla, PhD MSPH, Genentech, Inc. (Employee) Rita de Cassia Castro, MD, Genentech, Inc. (Employee)

scholarly journals Novel Expandable Architected Breathing Tube for Improving Airway Securement in Emergency Care

2020 ◽  
Author(s):  
David Berard ◽  
Juan David Navarro ◽  
Gregg Bascos ◽  
Angel Harb ◽  
Yusheng Feng ◽  
...  
Keyword(s):  
Gold Standard ◽  
Healthcare Providers ◽  
Standard Of Care ◽  
Contact Forces ◽  
Prolonged Intubation ◽  
Air Volume ◽  
Life Saving ◽  
Potential Benefits ◽  
Tracheal Tissue ◽  
Health Complications

Abstract Life-saving interventions utilize endotracheal intubation to secure a patient’s airway, but performance of the clinical standard of care endotracheal tube (ETT) is inadequate. For instance, in the current COVID-19 crisis, patients can expect prolonged intubation. This protracted intubation may produce health complications such as tracheal stenosis, pneumonia, and necrosis of tracheal tissue, as current ETTs are not designed for extended use. In this work, we propose an improved ETT design that seeks to overcome these limitations by utilizing unique geometries which enable a novel expanding cylinder. The mechanism provides a better distribution of the contact forces between the ETT and the trachea, which should enhance patient tolerability. Results show that at full expansion, our new ETT exerts pressures in a silicone tracheal phantom well within the recommended standard of care. Also, preliminary manikin tests demonstrated that the new ETT can deliver similar performance in terms of air pressure and air volume when compared with the current gold standard ETT. The potential benefits of this new architected ETT are threefold, by limiting exposure of healthcare providers to patient pathogens through streamlining the intubation process, reducing downstream complications, and eliminating the need of multiple size ETT as one architected ETT fits all

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