Humans ; Tracheostomy ; methods

Dilatation ; Humans ; Tracheostomy ; methods

Infection that progresses to deep areas of the neck requires appropriate assessment of the airway, and securing of the airway is critical in patients with deep neck infection. In the patient in our case report, bilateral pneumothorax occurred while performing tracheostomy to the airways of a patient with deep neck infection, and therefore, this paper details the method used to secure the airway of patients with deep neck infection.
Humans ; Methods ; Neck* ; Pneumothorax* ; Tracheostomy*

Infection that progresses to deep areas of the neck requires appropriate assessment of the airway, and securing of the airway is critical in patients with deep neck infection. In the patient in our case report, bilateral pneumothorax occurred while performing tracheostomy to the airways of a patient with deep neck infection, and therefore, this paper details the method used to secure the airway of patients with deep neck infection.
Humans ; Methods ; Neck* ; Pneumothorax* ; Tracheostomy*

Humans ; Neurosurgical Procedures ; methods ; Obesity ; Tracheostomy ; methods

Tracheostomy is to establish an artificial airway by making an opening at anterior tracheal wall. Due to the blossom of mechanical ventilation and intensive care unit after 1950s, tracheostomy is the most favorable surgical method to access airway at present. In addition to traditional surgical tracheostomy, percutaneous dilational tracheostomy have gained increasing popularity and become an alternative procedure because of its merits such as easier manipulation, shorter operative duration and less complications. This review summarized tracheostomy from definition, history and current status, anatomy and physiology, indications, contraindications, timing, complications and management. We also elaborate our understanding of current contraercy and give some suggestions based on our clinical experience.
Humans ; Intensive Care Units ; Respiration, Artificial ; Trachea ; surgery ; Tracheostomy ; methods

Patients with severe neurological deficit, such as hypoxic ischemic injury, cerebral infarction, and traumatic brain injury, often show comatose mental status and require maintenance of long-term tracheostomy for pulmonary toileting. However, several complications, which are mostly related to the cannula, invariably occur. Permanent tracheostoma is a short, skin-lined, noncollapsing, self-sustaining opening by suturing the denuded skin lining to the margin of the tracheal stoma. This tube-free method is a useful alternative to make long-term airway without tube-related complications in chronic diseases, such as obstructive sleep apnea, and laryngeal cancer, however, it has not yet been reported in chronic brain injured patients. This case report illustrates 3 cases of vegetative patients in our rehabilitation clinic who underwent successful procedure of permanent tracheostoma. Permanent tracheostoma has some benefits associated with the free of tube-related complications, and can be considered as a useful alternative way for chronic brain injured patients with long-term tracheostomy.
Brain Injuries/complications/*rehabilitation ; Humans ; Male ; Middle Aged ; Trachea/*surgery ; Tracheostomy/*methods ; Treatment Outcome

OBJECTIVE: To investigate the impact of tracheostomy tube capping on swallowing physiology in stroke patients with dysphagia via videofluoroscopic swallowing study (VFSS). METHODS: This study was conducted as a prospective study that involved 30 stroke patients. Then, 4 mL semisolid swallowing was conducted with capping of the tracheostomy tube or without capping of the tracheostomy tube. The following five parameters were measured: laryngeal elevation, pharyngeal transit time, post-swallow pharyngeal remnant, upper esophageal sphincter width (UES), and penetration-aspiration scale (PAS) score. RESULTS: On assessment of the differences in swallowing parameters during swallowing between ‘with capping’ and ‘without capping’ statuses, statistically significant differences were found in the post-swallow pharyngeal remnant (without capping, 48.19%±28.70%; with capping, 25.09%±19.23%; p<0.001), normalized residue ratio scale for the valleculae (without capping, 0.17±0.12; with capping, 0.09±0.12; p=0.013), normalized residue ratio scale for the piriform sinus (without capping, 0.16±0.12; with capping, 0.10±0.07; p=0.015), and UES width (without capping, 3.32±1.61 mm; with capping, 4.61±1.95 mm; p=0.003). However, there were no statistically significant differences in laryngeal elevation (x-axis without capping, 2.48±1.45 mm; with capping, 3.26±2.37 mm; y-axis without capping, 11.11±5.24 mm; with capping, 12.64±6.16 mm), pharyngeal transit time (without capping, 9.19± 10.14 s; with capping, 9.09±10.21 s), and PAS score (without capping, 4.94±2.83; with capping, 4.18±2.24). CONCLUSION: Tracheostomy tube capping is a useful way to reduce post-swallow remnants and it can be considered an alternative method for alleviating dysphagia in stroke patients who can tolerate tracheostomy tube capping when post-swallow remnants are observed.
Deglutition ; Deglutition Disorders* ; Esophageal Sphincter, Upper ; Fluoroscopy ; Humans ; Methods ; Physiology ; Prospective Studies ; Pyriform Sinus ; Stroke* ; Tracheostomy*

OBJECTIVETo describe and introduce a new technique for percutaneous dilational tracheostomy without the aid of a bronchoscope.

METHODSTen patients who underwent rotating dilation tracheostomy with percutwist set were prospectively studied. The time needed for the procedure, the grading of the difficulty, the amount of bleeding, and the complications for the procedure were evaluated. All procedures were performed without the aid of a bronchoscope.

RESULTSDuring the operations, blood pressure, ECG parameters were stable. One patient had short period of intraoperative oxygen desaturation. The mean operating time was 6.2 minutes with a range of 3 to 10 minutes. Eight procedures were performed without any difficulty, 2 procedures were performed with some difficulties which could be managed by the surgeon. Six patients had been examined under fibrobronchoscopy within one week postoperatively, no posterior tracheal wall injuries were found. One patient had peristomal bleeding after the operation, one patient had mild infection of the tracheostoma. There were no life threatening complications attributable to this technique.

CONCLUSIONSControlled rotating dilation is a simple, rapid and safe bedside procedure. In the absence of bronchoscopic guidance, the procedure can be safely performed with precautions.

Aged ; Aged, 80 and over ; Dilatation ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Tracheostomy ; methods

OBJECTIVETo present the authors' experience with percutaneous dilatational tracheostomy (PDT), with special attention to early and late complications, outcomes, and primary disease influence.

METHODSBetween November 2000 and May 2001, 22 PDTs were performed with the aid of dilatating forceps in 21 neurosurgical coma patients. A Seldinger wire was introduced through a cannula into the trachea serving as a guide. The guidewire was threaded through the clamped guidewire dilating forceps and the forceps was advanced through the tracheal wall. The trachea was dilated by opening forceps. The guidewire was then threaded through the obturator of the tracheostomy tube and both were advanced into the trachea. Demographic data, patient disease variables and patient anatomical features, as well as perioperative and late complications were recorded prospectively.

RESULTSCompletion of the procedure consumed 4 - 16 minutes (mean, 12 minutes). The procedure caused complications in 3 operations: 2 cases of stomal bleeding, 1 of intratracheal bleeding, but there was no severe tracheal injury or mediastinal emphysema. Furthermore, none of the cases required intervention due to complications. All patients were followed up for 1 to 6 months. Tracheostomy tubes were removed in 16 patients. All cervical incisions were closed with cosmetic demand. Two patients with tracheostomy tubes were retained for primary diseases. Causes of death in 3 others were unrelated to the PDT. No patient developed tracheomalacia or tracheal stenosis as a late complication.

CONCLUSIONSPercutaneous dilatational tracheostomy is a fast, safe and simple procedure for neurosurgical coma patients and can be safely performed by neurosurgeons.

Adult ; Aged ; Coma ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; Tracheostomy ; adverse effects ; methods