Child, Preschool ; Humans ; Infant ; Airway Obstruction/complications* ; Laryngostenosis/surgery* ; Tracheostomy

Introduction: Tracheostomy is a surgical procedure that creates a neck opening directly into the trachea, typically performed to establish an alternative airway for individuals who experience difficulty breathing as a result of certain medical conditions. Tracheostomy can be temporary or permanent, and it plays a crucial role in the management of both acute and chronic respiratory issues and can significantly improve the quality of life for those who require it. Objective: This study aims to investigate the incidence, common indications and outcomes of tracheostomy in the Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) department of a tertiary hospital in Manila, Philippines. Methodology: This is a retrospective descriptive study including all admissions and in-patient referrals to the clinical division of the Department of Otorhinolaryngology-Head and Neck Surgery who underwent tracheostomy from January 2016 to December 2020. Data were retrieved by review of medical records and Outcome Based Evaluation (OBE) form of all patients who underwent tracheostomy during the study period. Results: Our study involved 74 patients with a male-to-female ratio of 22:15. The patients' ages ranged from 5 to 89 years. Prolonged intubation was the main reason for tracheostomy, followed by upper airway obstruction due to supraglottic mass for males and vocal cord paralysis for females. Only three patients who had tracheostomy experienced complications and were managed accordingly. Conclusion Tracheostomy is one of the most valuable and reliable surgical procedures for managing airway obstructions. Proper patient and caregiver education as well as constant follow-up are crucial to prevent complications.
Tracheostomy

Objective: To compare outcomes of COVID-19 positive and COVID-19 negative patients who underwent tracheostomy for prolonged intubation in terms of weaning duration, length of ICU and hospital stay, overall and 30-day mortality, and explore risk factors for particular outcomes (mortality, 30-day mortality and weaning duration post tracheostomy). Methods: Design: Retrospective Cohort Study Setting: Tertiary National University Hospital Participants: Of 122 adult patients that underwent tracheotomy between March 30, 2020 and March 30, 2021; 76 adult patients underwent tracheostomy for prolonged intubation were analyzed. Results: Open tracheotomy was performed on 122 adult patients. Seventy six (62.3%) due to prolonged intubation and 46 (37.7%) for airway prophylaxis. Among the former, the mean age was 58.46±16.81 and 54 (71.05%) patients were female, 22 (28.95%) tested COVID-19 positive and 54 (71.05%) tested negative. Mean APACHE II score was 16.62±6.78. Average days of intubation prior to tracheostomy was 29.14±17.66 days. No statistically significant difference in outcomes (weaning days, length of stay, days discharge from ICU and hospital, 30-day mortality, days to death) were noted between COVID19 positive and negative patients who underwent tracheostomy for prolonged intubation. Mortality rates post tracheostomy in this institution appear to be higher than existing literature. On multiple linear regression analysis, days of intubation prior to tracheostomy was associated with increased weaning time post-tracheostomy (OR: 0.35 CI:0.18-0.51 95% p = <.001). This implies that for every additional day of intubation prior to tracheostomy, weaning days increase by 0.35 of a day. Conclusion Outcomes of COVID-19 compared to non-COVID-19 patients undergoing tracheostomy for prolonged intubation do not seem to be significantly different which is consistent with existing literature.
COVID-19 ; tracheostomy

Endoscopy ; Humans ; Retrospective Studies ; Trachea ; Tracheal Stenosis/surgery* ; Tracheostomy/adverse effects*

Objective: To describe the initial outcomes of endoscopic CO2 laser posterior cordectomy and partial arytenoidectomy among patients with bilateral vocal cord paralysis in our institution. Methods: Design: Case Series Setting: Tertiary National University Hospital Participants: 17 Patients Results: Seventeen (17) patients who underwent transoral posterior cordectomy and partial arytenoidectomy using carbon dioxide laser were included in the study consisting of 14 females and 3 males. Iatrogenic injury was the most common cause of bilateral vocal cord paralysis in this subset of patients. Five patients who tolerated decannulation and another six who had no preoperative tracheostomy all reported subjective improvement in breathing. All of them were also observed to have resolution of stridor and increased respiratory comfort compared to their preoperative condition. The most common postoperative complication was granuloma formation at the medial arytenoidectomy site occurring only in 4 patients. None of the patients complained of aspiration episodes or dysphagia during the postoperative period. Conclusion Our initial experience with transoral endoscopic posterior cordectomy and partial arytenoidectomy using carbon dioxide laser has good postoperative outcomes among patients with bilateral vocal cord paralysis.
Human ; Male ; Paralysis ; Vocal Cord Paralysis ; Vocal Cords ; Carbon Dioxide ; Tracheostomy ; Voice Quality

Acute epiglottitis (AE), an inflammation of the epiglottis and adjacent supraglottic structures, can lead to a fatal airway obstruction. We report the case of a 47­year­old male who developed AE after experiencing a sore throat, odynophagia, and high­grade fever for a week. The patient came in with late signs of AE, suggesting a poor prognosis. Laryngoscopy revealed a swollen epiglottis obstructing the patient’s tracheal opening. He had cardiopulmonary arrest due to the airway obstruction. The patient was successfully resuscitated but had several episodes of generalized seizure after the return of spontaneous circulation. He was discharged in a persistent vegetative state. Because AE is unusual in the adult population, a clinician's high index of suspicion for the diagnosis and the emergency team’s prompt intervention are crucial factors in the management approach to AE. Physicians working in the emergency room must be equipped with skills in establishing a definitive airway, especially in securing a surgical airway.
Epiglottitis ; Laryngoscopy ; Tracheostomy ;

OBJECTIVE: To discover the factors that may affect the use of selective tracheostomy among patients who have undergone head and neck surgeries with free flap reconstruction, so that the patients will not need tracheostomy nor receive the unnecessary treatment. METHODS: Five hundred and thirty-three patients who had undergone head and neck surgery with free flap reconstruction operated by the same team of surgery at Department of Oral and Maxillofacial Surgery at Peking University School of Stomatology from 2015 to 2016 were reviewed. Three hundred and twenty-one (60.2%) of these patients underwent selective tracheostomy. All the patients' demographic information, operation-related information, prior treatments, comorbidities and complications were recorded and analyzed. RESULTS: The patients with defects of the tongue, mouth floor, oropharynx and bilateral mandible, who underwent neck dissection and with previous radiotherapy and smoking habit were more likely to get selective tracheostomy. Usage of bulky soft tissue flap might also add to the risk of airway obstruction and the need of selective tracheostomy, while other factors were not significantly related to the risk of postoperative airway obstruction and the patients could be kept safe without selective tracheostomy. Most cases without tracheostomy were kept safe except one case, while 8.39% of the patients with tracheostomy suffered from tracheostomy related complications, mainly pneumonia and hemorrhage of the tracheostomy wound, yet none led to serious consequences or even death. CONCLUSION Selective tracheostomy is not necessary for patients who have undergone head and neck surgeries with free flap reconstruction except that there are defects at the tongue, oropharynx and mandible. Neck dissection, bulky soft tissue flap reconstruction, previous radiotherapy and smoking habit may also add to the risk of postoperative airway obstruction, while a favorable decision would involve a combination of all the above factors to assure the safety of the postoperative airway for the patients undergone head and neck surgeries with free flap reconstruction.
Airway Obstruction/surgery* ; Free Tissue Flaps ; Head and Neck Neoplasms/surgery* ; Humans ; Postoperative Complications/surgery* ; Reconstructive Surgical Procedures/adverse effects* ; Retrospective Studies ; Tracheostomy

COVID-19/transmission* ; COVID-19 Testing ; Humans ; Infection Control ; Infectious Disease Transmission, Patient-to-Professional/prevention & control* ; Intraoperative Care ; Pandemics ; Personal Protective Equipment ; Postoperative Care ; Preoperative Care ; Tracheostomy/methods*

Objective: To discuss the complications and postoperative outcomes of tracheotomy with different etiology in children. Methods: One hundred and eighty-six patients underwent tracheotomy were retrospectively analyzed from January 2016 to December 2018,including 117 males and 69 females. The children aged from 4 days to 14 years (median age 31.5months). One case was operated under local anesthesia in emergency room, 2 cases were operated under local anesthesia in pediatric intensive care unit, the rest 183 cases were operated under general anesthesia in operation room. The 186 children were divided into four groups according to their direct causes of tracheotomy. Group A(90 cases): Neuromuscular disease and severe infection,Group B(26 cases): Head and neck tumor,Group C(57 cases): Congenital malformation and upper airway obstruction,Group D(13 cases): Accidental injury. The basic information, surgical complications and postoperative outcomes were recorded and analyzed. All patients were followed up by clinic or by telephone. Spss 19.0 software was used for statistical analysis. Results: One hundred and eighty-six patients were followed up for one to four years. 33 children lost the follow-up and 46 died. Among the 186 patients, 23 cases had emergency tracheotomy (12.4%). The rate of emergency tracheotomy in group C(16 cases, 28.1%) was higher than that in the other three groups(χ2=28.08,P<0.05). The average age of patients and hospital stay in group C were significantly lower than those in the other three groups (F=33.76,P<0.05; F=14.95,P<0.05). Incision bleeding occurred in 11 cases, Subcutaneous emphysema occurred in 6 cases and accidental decannulation occurred in 10 cases (4 cases within 2 weeks and 6 after 2 weeks). Six patients underwent tracheocutaneous fistula closure operation after decannulation and the stoma healed spontaneously in other extubated children. Two patients underwent secondary tracheotomy due to accidental decannulation, and three patients underwent secondary tracheotomy for dyspnea after decannulation. In 107 cases of survival children, decannulation was successful in 65 patients and failed in 42 patients. The average duration of wearing tracheal tube was 8.8 months. The decannulation rates in the four groups were 55.6%, 45%, 69% and 77.8%, with no significant difference. Conclusions: The complications after tracheotomy in children are rare, and no severe complications occurred in long-term tracheotomy patients. The duration of wearing tracheal tube is related to the treatment of their primary disease.
Adolescent ; Anesthesia, General ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Postoperative Complications/etiology* ; Retrospective Studies ; Tracheostomy ; Tracheotomy/adverse effects*

Humans ; Mediastinitis ; Tracheostomy ; Tracheotomy