Comparison of Outcomes between Elective Tracheostomy versus Emergency Tracheostomy

Aim: To compare the frequency of early postoperative complications of elective tracheostomy and emergency tracheostomy. Study design: Comparative/observational study Place and duration of study: Department of ENT/Head & Neck Surgery, Mayo Hospital Lahore from 1st July 2012 to 31st December 2012. Methodology: One hundred patients of both genders undergoing tracheostomy were enrolled. All the patients were divided equally in two groups; Group A (elective) comprised 50 patients and group B (emergency) tracheostomies also comprised 50 patients. Early postoperative complications were examined and compare between both groups. Results: There were 28 (56%) and 22 (44%) males and females in group A with mean age 42.45±10.55 years while in group B 30 (60%) and 20 (40%) patients were male and females with mean age 43.06±9.84 years. Patients received emergency tracheostomy had high rate of postoperative complications as compared to elective tracheostomy (36% vs 16%). The difference was statistically significant(P<0.05). Conclusion: Early postoperative complications were high in patients underwent emergency tracheostomy as compared to elective tracheostomy. Keywords: Early complications, Elective tracheostomy, Emergency tracheostomy

Tips and Pearls for Tracheostomy during the Covid-19 Pandemic

The 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.

Perioperative challenges in managing a morbidly obese patient with COVID-19 undergoing an elective tracheostomy

Tracheostomy is an aerosol-generating procedure and performing it in patients with COVID-19 requiring mechanical ventilation raises significant concerns of infection risk to healthcare workers. We herein report a case of tracheostomy in a critically ill patient with severe COVID-19 acute respiratory distress syndrome. This article depicts the use of personal protective equipment, highlighting the common challenges it presents and ways to address them.

A COMPARATIVE STUDY ON COMPLICATIONS OF EMERGENCY AND ELECTIVE TRACHEOSTOMY IN ENT DEPARTMENT OF DMCH, LAHERIASARAI, BIHAR

Background: Both elective and emergency tracheostomy as life saving procedure is frequently performed. Tracheostomy can be associated with numerous (intraoperative and postoperative) complications. Methods: In this study 120 patients were studied age ranged from 9 years to 79 years in the Department of ENT, Darbhanga Medical College & Hospital, Laheriasarai, Bihar from January 2020 to December 2020. Results: Among 120 tracheostomized patients, 75 (62.5%) were patients of emergency tracheostomy group and 45 (37.5%) were patients of elective tracheostomy group. Laryngeal carcinoma and other head-neck malignancy were the common (67.34%) indications for emergency tracheostomy. Maxillofacial and laryngeal surgery (50.1%) was the common indications for elective tracheostomy. Haemmorage was the most common complication. The second most common complication were subcutaneous surgical emphysema and wound infection. Then the tube displacement, perichondritis and stomal stenosis/ granulation tissue formation were the complications. In all stages (intraoperative, immediate postoperative, early postoperative and late postoperative), the frequency of complications was more in emergency tracheostomy and it was statistically signicant (p<0.05). Conclusion: Complications are more in emergency than elective tracheostomy. Reduction of complications should be aim of all types of tracheostomy.

Unsuccessful weaning from mechanical ventilation in children and ways to avoid it

The aim of the work: to determine causes of unsuccessful weaning depending on subglottic edema markers, level of sedation and sedation-agitation, changes in neurological status and bulbar disorders in children with different types of respiratory failure. Materials and Methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children's Clinical Hospital "OHMATDYT". We included 89 patients aged 1 month – 18 years with acute respiratory failure who was mechanically ventilated for more than 3 days. They were randomly divided into 2 groups. Group I included patients who received lung-protective ventilation strategy and assessment central nervous system function and the percentage of leakage of the gas mixture near the endotracheal tube; group II – patients who received diaphragm-protective in addition to lung-protective ventilation strategy and took into account the results of central nervous system assessment and respiratory gas mixture leakage near endotracheal tube during weaning from mechanical ventilation. The primary endpoint was the frequency of reintubations, the secon­dary endpoint was the frequency of complications (tracheostomy). 82 patients were included in the data analysis. Patients were divided into age subgroups: subgroup 1 – children 1 month – 1 year; subgroup – children 1–3 years; subgroup 3 – children 3–6 years; subgroup 4 – children 6–13 years; subgroup 5 – children 13–18 years. Results and Discussion. The frequency of reintubations in patients of the age subgroup 1 was reduced in group II to 5.3 % compared with 22.7 % in group I (p = 0.02), which was accompanied by a higher frequency of elective tracheostomy (before the first attempt of weaning from mechanical ventilation) which was 11 % in comparison with 0 %, p = 0.001). The frequency of reintubations in the age subgroup 2 was reduced to 5.9 % in group II vs 20 % in group I (p = 0.04), and elective tracheostomy was performed in 18 % patients in group II vs 5 % patients in group I (p = 0.05). There were no significant differences in the frequency of reintubations among patients in the age subgroup 3 (14.2 % in group I vs 11.1 % in group II, p = 0.31); in the age subgroup 4 (13 % vs 17 %, p = 0.19); the age subgroup 5 (6 % vs 7 %, p = 0.72).