scholarly journals Paediatric paediatric tracheostomy: Changing indications and key complications

2020 ◽  
Vol 8 (6) ◽  
pp. 175-180
Author(s):  
Guilherme Movio ◽  
Ms Shadaba Ahmed
Keyword(s):  
Health Care Professionals ◽  
Survival Rates ◽  
Ventilatory Support ◽  
Upper Airway ◽  
Multidisciplinary Teams ◽  
Vaccination Programs ◽  
Airway Obstructions ◽  
Life Threatening ◽  
Indications And Complications

Background: Paediatric Tracheostomy is a procedure used to ventilate children through a hole in the trachea. Indications for the procedure were once primarily for acute upper airway obstruction due to infections but have now changed. Generally, there is poor knowledge surrounding tracheostomies and a limited knowledge of guidelines amongst health-care professionals. Aim: The aim of this review is to discuss the basis of changes to the indications of paediatric tracheostomy. It  will also investigate the key complications related to the procedure and discuss the importance of multidisciplinary teams being aware of the emergency algorithms for dealing with such complications. Findings: Indications have changed due to advancements in medicine with increased life expectancy and survival rates for children with often life threatening congenital conditions. Tracheostomies can offer these children long term ventilatory support. Upper airway obstructions due to infections are now infrequently indicated for tracheostomy due to successful vaccination programs. Complications today are because of obstructions and decannulations. Intra-operative complications are infrequent, due to refinements in surgical technique. Conclusion: Paediatric Tracheostomy is a rapidly evolving field because of continuous advancements in neonatal and intensive care medicine. The indications and complications have changed together over the last four decades. A greater understanding of tracheostomy complications is requiredfor successful management.

scholarly journals Supporting international networks through platforms for standardised data collection—the European Registries for Rare Endocrine Conditions (EuRRECa) model

Endocrine ◽  
2021 ◽  
Author(s):  
S. R. Ali ◽  
J. Bryce ◽  
C. Smythe ◽  
M. Hytiris ◽  
A. L. Priego ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Knowledge Exchange ◽  
Stakeholder Involvement ◽  
Clinical Activity ◽  
Data Governance ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Life Threatening ◽  
National Boundaries

AbstractRare endocrine pathology is manifested by either a deficiency or excess of one or more hormones. These conditions can be life-threatening and are almost universally associated with long-term morbidity. Understanding the aetiology of these conditions requires multicentre collaboration and expertise, most often across national boundaries, with the capacity for long-term follow-up. The EuRRECa (European Registries for Rare Endocrine Conditions) project (www.eurreca.net), funded by the EU Health Programme, aims to support the needs of the wider endocrine community by maximising the opportunity for collaboration between patients, health care professionals and researchers across Europe and beyond. At the heart of the EuRRECa collaboration is a Core Endocrine Registry that collects a core dataset for all rare endocrine conditions that are covered within Endo-ERN. The registry incorporates patient reported markers of clinical outcome and will signpost participants to high-quality, disease-specific registries. Furthermore, an electronic surveillance programme (e-REC) captures clinical activity and epidemiology for these rare conditions. EuRRECa receives guidance compliant with the highest ethical standards from Expert Working Groups that align with the Main Thematic Groups of Endo-ERN. Security, data quality and data governance are cornerstones of this platform. Clear policies that are acceptable to patients, researchers and industry for data governance coupled with widespread dissemination and knowledge exchange through closely affiliated stakeholders will ensure sustainability beyond the current lifetime of the project. This paper describes the infrastructure that has been developed, stakeholder involvement, the data fields that are captured within the registry and details on the process for using the platform.

scholarly journals Acute Upper Airway Obstruction Secondary to Retained Respiratory Secretions in a Patient with SARS-CoV-2 Respiratory Failure Treated with Prolonged CPAP

2020 ◽  
Vol 6 (3) ◽  
Keyword(s):  
Respiratory Failure ◽  
Airway Obstruction ◽  
Ventilatory Support ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Avoidable Mortality ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Life Threatening ◽  
Novel Coronavirus

SARS-CoV-2 is a novel coronavirus which can cause respiratory failure requiring ventilatory support. We describe the first documented case of life-threatening upper airway obstruction due to retained secretions around a nasogastric (NG) tube in a patient suffering from this disease who was managed with prolonged continuous positive airways pressure (CPAP). This case highlights the need for awareness around the development of an upper airway mass due to tenacious secretions in SARS-CoV-2 positive patients and the need to develop preventative strategies in order to prevent avoidable mortality. Keywords: Airway obstruction; CPAP; SARS-CoV-2; Coronavirus; Nasogastric tube; Non-invasive ventilation.

scholarly journals Comparison of automatic airway analysis function of Invivo5 and Romexis software

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6319 ◽  
Author(s):  
Noorshaida Kamaruddin ◽  
Firdaus Daud ◽  
Asilah Yusof ◽  
Mohd Ezane Aziz ◽  
Zainul A. Rajion
Keyword(s):  
Airway Resistance ◽  
Intraclass Correlation ◽  
Upper Airway ◽  
Cone Beam ◽  
Intrarater Reliability ◽  
Minimum Area ◽  
Airway Obstructions ◽  
Life Threatening ◽  
The Mean ◽  
Airway Analysis

Background Visualization and calculation of the airway dimensions are important because an increase of airway resistance may lead to life-threatening emergencies. The visualization and calculation of the airway are possible using radiography technique with their advance software. The aim of this study was to compare and to test the reliability of the measurement of the upper airway volume and minimum area using airway analysis function in two software. Methods The sample consisted of 11 cone-beam computed tomography (CBCT) scans data, evaluated using the Invivo5 (Anatomage) and Romexis (version 3.8.2.R, Planmeca) software which afford image reconstruction, and airway analysis. The measurements were done twice with one week gap between the two measurements. The measurement obtained was analyzed with t-tests and intraclass correlation coefficient (ICC), with confidence intervals (CI) was set at 95%. Results From the analysis, the mean reading of volume and minimum area is not significantly different between Invivo5 and Romexis. Excellent intrarater reliability values were found for the both measurement on both software, with ICC values ranging from 0.940 to 0.998. Discussion The results suggested that both software can be used in further studies to investigate upper airway, thereby contributing to the diagnosis of upper airway obstructions.

scholarly journals Natural courses and long-term results of type A acute aortic intramural haematoma and retrograde thrombosed type A acute aortic dissection: a single-centre experience

2019 ◽  
Vol 30 (1) ◽  
pp. 113-120 ◽  
Author(s):  
Yen-Yu Chen ◽  
Hsu-Ting Yen ◽  
Chien-Ming Lo ◽  
Chia-Chen Wu ◽  
David Kwan-Ru Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Medical Therapy ◽  
Acute Aortic Dissection ◽  
Survival Rates ◽  
Type A ◽  
Long Term Results ◽  
Urgent Surgery ◽  
Life Threatening ◽  
Thrombosed Type

Abstract OBJECTIVES Few reports on the outcomes of patients treated for Stanford type A acute aortic intramural haematoma (TAAIMH) and retrograde thrombosed type A acute aortic dissection exist. This study aimed to evaluate their long-term results and predictors of adverse outcomes. METHODS We retrospectively analysed 40 patients with TAAIMH and retrograde thrombosed type A acute aortic dissection. All patients underwent urgent surgery on presentation of life-threatening complications. Before discharge, 18 patients underwent open aortic surgery, and 22 were treated with medical therapy alone. Clinical features of these patients and image appearances were reviewed, and the relationship with overall survival, aortic events, and aortic death was investigated. RESULTS The in-hospital mortality rate was 4.5% (1 patient) with medical therapy alone and 11.1% (2 patients) with surgical intervention. No patient with initial medical therapy required urgent surgery for life-threatening complications beyond 3 days of admission. The overall survival and aortic death-free survival rates at 1, 5 and 10 years were 85.0%, 72.5% and 59.8% and 90.0%, 81.6% and 77.1%, respectively. TAAIMH associated with penetrating aortic ulcer (PAU) was a risk factor of aortic events (P = 0.020) and significantly influenced aortic death-free survival (P = 0.003). CONCLUSIONS Urgent surgery for complicated TAAIMH and retrograde thrombosed type A acute aortic dissection patients and initial medical therapy for uncomplicated patients show favourable long-term survival rates. TAAIMH is frequently associated with PAU; PAU enlargement is common. Although PAU can remain stable for years, it is a strong predictor of poor prognosis. For optimal long-term results, surgical repair is recommended for TAAIMH associated with PAU.

scholarly journals Long-term non-invasive ventilation in muscular dystrophy

2016 ◽  
Vol 14 (1) ◽  
pp. 33-36 ◽  
Author(s):  
W Kinnear ◽  
J Colt ◽  
L Watson ◽  
P Smith ◽  
L Johnson ◽  
...  
Keyword(s):  
Muscular Dystrophy ◽  
Survival Rates ◽  
Ventilatory Support ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
The Mean ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

Long-term non-invasive ventilation (NIV) was introduced in the 1980s, initially mainly for patients with poliomyelitis, muscular dystrophy (MD) or scoliosis. The obesity-hypoventilation syndrome has since become the commonest reason for referral to most centres providing home-NIV. Patients with MD are numerically a much smaller part of the workload, but as their disease progresses the need for ventilatory support changes and they require regular comprehensive assessment of their condition. We have examined the trend in MD use of home-NIV in our unit over the last 25 years. The number of new referrals appears to be stabilizing at around 20–25 over a 5-year period, equivalent to approximately 0.5 per 100,000 of population per year. The mean age at commencement of home-NIV is now 37.5 years, with 5-year survival rates of 70–75%. Ten-year survival rates are just over 40%. The distance of usual place of residence from our unit is fairly stable, currently at a mean of 27 km. Excellent survival rates mean that patients with MD, while numerically small, are likely to remain an important part of the workload of centres providing home-NIV. Our data should prove useful in the planning of future services for this group of patients.

scholarly journals Spontaneous Epiglottic Hematoma Secondary to Supratherapeutic Anticoagulation

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Cody A. Koch ◽  
Steven M. Olsen ◽  
Amy M. Saleh ◽  
Laura J. Orvidas
Keyword(s):  
Soft Tissues ◽  
Upper Airway ◽  
Airway Compromise ◽  
Life Threatening ◽  
Anticoagulated Patient ◽  
Life Threatening Complication ◽  
Spontaneous Hematoma

Hemorrhage into the soft tissues of the airway represents a potentially life-threatening complication of long-term anticoagulation. We report the case of a chronically anticoagulated 37-year-old male who developed a spontaneous hematoma of the epiglottis secondary to a supra-therapeutic INR. Epiglottic hematoma should be considered in the differential of any anticoagulated patient presenting with upper airway compromise. The airway should be secured in a controlled fashion, and the coagulopathy should be rapidly corrected.

Aortopexy for the management of paediatric tracheomalacia – the Alder Hey experience

2020 ◽  
Vol 134 (2) ◽  
pp. 174-177
Author(s):  
S P Williams ◽  
P D Losty ◽  
R Dhannapuneni ◽  
A Lotto ◽  
R Guerrero ◽  
...  
Keyword(s):  
Upper Airway ◽  
Vascular Compression ◽  
Limited Data ◽  
Long Term Outcomes ◽  
Retrospective Case ◽  
Life Threatening ◽  
Alder Hey ◽  
Case Note Review

AbstractBackgroundWhilst aortopexy is an accepted and established procedure, there remains considerable heterogeneity within the literature, with inconsistencies in both the approach taken and the technique employed. Furthermore, limited data exist on both patient selection and long-term outcomes. This study aimed to report the experience of managing severe tracheomalacia by way of aortopexy in a large UK paediatric centre.MethodA retrospective case note review was conducted. Mean follow up was five years.ResultsTwenty-five patients underwent aortopexy for severe tracheomalacia caused by external vascular compression. Acute life-threatening events precipitated investigation in 72 per cent of cases. Twenty-one patients initially presented to ENT services for investigation, which comprised upper airway endoscopy and imaging with computed tomography angiography. Post-operatively, the majority of patients demonstrated complete resolution of symptoms and were discharged from all associated services. Only four patients required a tracheostomy.ConclusionAortopexy offers an effective method of treating severe tracheomalacia due to vascular compression.

scholarly journals Omphalocele and Gastroschisis in Newborns: Over 16 Years of Experience from a Single Clinic

2017 ◽  
Vol 6 (2) ◽  
pp. 27 ◽  
Author(s):  
Shunusuke Watanabe ◽  
Tatuya Suzuki ◽  
Fujio Hara ◽  
Toshihiro Yasui ◽  
Naoko Uga ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Congenital Heart ◽  
Survival Rates ◽  
Abdominal Wall Defects ◽  
Associated Anomalies ◽  
Average Hospital Stay ◽  
Average Hospital ◽  
Limb Deformities ◽  
Life Threatening

Infants born with potentially life-threatening conditions of omphalocele and gastroschisis may require long-term hospitalization. We aimed to compare the outcomes of these two conditions occurring over a 16-year period (2001-16). It is a retrospective study of 19 newborns undergoing surgery for these two abdominal wall defects (8 patients with omphalocele and 11 cases of gastroschisis). The average birth weights for the newborns with omphaloceles and gastroschisis were 2554.5 g and 2248.6 g respectively. Associated anomalies included trisomy 18, Beckwith-Wiedemann syndrome, congenital heart disease, Meckel’s diverticulum, inguinal hernias, renal deformities, limb deformities, cryptorchidism, body stalk anomalies, and closed gastroschisis. The average hospital stay for the newborns with omphaloceles and gastroschisis were 42.6 days 50.2 days respectively. The time to the start of postoperative nutritional supplementation for the newborns with omphaloceles and gastroschisis were 4.3 days for the infants with omphaloceles and 7.3 days for respectively. The survival rates for the newborns with omphaloceles and gastroschisis were similar, 87.5% and 81.8% respectively. Survival rates in omphalocele correlated negatively with associated anomalies. In gastroschisis cases, strict care is necessary when intestinal dilation is observed via fetal sonography.

Periodic monitoring of vampire bats and rabies: a new framework for animal restoration projects in the Neotropics

2020 ◽  
Author(s):  
Fernando Gonçalves ◽  
Daniel G. Streicker ◽  
Mauro Galetti
Keyword(s):  
Disease Transmission ◽  
Lessons Learned ◽  
Multidisciplinary Teams ◽  
Risk Area ◽  
Food Web Structure ◽  
Land Bridge ◽  
High Risk Area ◽  
Restoration Project ◽  
Vampire Bats

Nowadays, restoration project might lead to increased public engagement and enthusiasm for biodiversity and is receiving increased media attention in major newspapers, TED talks and the scientific literature. However, empirical research on restoration project is rare, fragmented, and geographically biased and long-term studies that monitor indirect and unexpected effects are needed to support future management decisions especially in the Neotropical area. Changes in animal population dynamics and community composition following species (re)introduction may have unanticipated consequences for a variety of downstream ecosystem processes, including food web structure, predator-prey systems and infectious disease transmission. Recently, an unprecedented study in Brazil showed changes in vampire bat feeding following a rewilding project and further transformed the land-bridge island into a high-risk area for rabies transmission. Due the lessons learned from ongoing project, we present a novel approach on how to anticipate, monitor, and mitigate the vampire bats and rabies in rewilding projects. We pinpoint a series of precautions and the need for long-term monitoring of vampire bats and rabies responses to rewilding projects and highlighted the importance of multidisciplinary teams of scientist and managers focusing on prevention educational program of rabies risk transmitted by bats. In addition, monitoring the relative abundance of vampire bats, considering reproductive control by sterilization and oral vaccines that autonomously transfer among bats would reduce the probability, size and duration of rabies outbreaks. The rewilding assessment framework presented here responds to calls to better integrate the science and practice of rewilding and also could be used for long-term studying of bat-transmitted pathogen in the Neotropical area as the region is considered a geographic hotspots of “missing bat zoonoses”.

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