Percutaneous Versus Surgical Tracheotomy: An Updated Meta‐Analysis
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Perform an updated meta-analysis investigating differences in complication rates, procedure times, and costs between percutaneous dilational tracheotomy (PDT), operating room surgical tracheotomy (ST), and bedside surgical tracheotomy (BST).Meta-analysis using the Mantel-Haenszel fixed effects model. Prospective and randomized trials comparing ST with PDT from 1999 to present were identified through two independent searches. Outcome measures analyzed included mortality, early complications, late complications, procedure times, and cost.Fourteen studies were identified (1,273 patients) that satisfied the search criteria. Analysis of randomized studies demonstrated significantly more minor early complications with PDT compared with ST (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.01-2.66). Randomized studies comparing PDT with BST demonstrated significantly more early complications with PDT (OR, 4.66; 95% CI, 1.46-14.91). There was no significant difference in late serious complications in studies that randomized patients to ST or PDT (OR, 1.39; 95% CI, 0-16,000). PDT is significantly faster to perform than ST (OR, 0.51; 95% CI, 95% 0.49-0.53). BST and PDT have similar costs, and both are less expensive than ST.Although significantly faster than ST, PDT has more early complications compared with open tracheotomy in the operating room or at the bedside. The long-term complications of the two techniques appear comparable but have not been thoroughly investigated. These findings suggest that a team approach between surgeons and critical care specialists is essential to select the appropriate tracheotomy technique for a given patient.Keywords:
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Objective To observe the effect of clinical application of improved tracheotomy mask.Methods 70 cases of hypertension cerebral hemorrhage patients after tracheotomy were randomly divided into two groups.Group A received airway humidification by improved tracheotomy mask,group B received airway humidification by heat humidifier.Results The effectiveness of humidification in two groups is the same.Conclusion Improved tracheotomy mask can be used for track humidification after tracheotomy.
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As a treatment for respiratory failure in chronic lung disease, an artificial airway is sometimes required for respiratory control. In these circumstances, endotracheal intubation is applied first. However, tracheotomy is sometimes performed when further respiretory care is needed.Twenty three tracheotomies were performed in our department for this purpose during the last 7 years (from April 1998 to March 1995). Twelve patients have survived at present, and most of them were able to break away from mechanical respiration completely within a few days after their tracheotomy. Tracheotomy was more effective as an artificial airway than endotracheal intubation for these patients. On the other hand, seven of the non-surviving 11 patients died soon after tracheotomy. Thus, tracheotomy was not as effective for them as it was for the 12 survivors. It is doubtful whether tracheotomy, an invasive technique, is an appropriate therapy for these poor-prognostic patients. Before making a decision to use tracheotomy, the prognosis for life itself should be evaluated objectively and precisely.
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Objective To compare clinical values of modified tracheotomy and traditional tracheal incision surgery.Methods One hundred and two cases of modified tracheotomy and 118 cases of traditional tracheotomy were discussed by prospective study.And the two groups were compared if there were significant differences in incision length,surgery time and the incidence of complications.Results There were significant differences in incision length,operation time and the incidence of complications between traditional tracheotomy group and modified tracheotomy group(P 0.05).Conclusion Compared with traditional tracheotomy,the modified tracheotomy is more convenient and less invasive and it has fewer complications,so it should be widely promoted in clinic.
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To investigate the causal relationship, if any, between tracheotomy and incidence of aspiration in the acute care setting.Prospective, consecutive.Twenty adult patients evaluated between February 1997 and October 1999 participated. Criteria for inclusion were a dysphagia evaluation before tracheotomy, subsequent tracheotomy and placement of a tracheotomy tube, and then a repeat dysphagia evaluation after tracheotomy prior to decannulation. This permitted the causal relationship between tracheotomy and incidence of aspiration to be investigated. Differences between duration of tracheotomy placement and age were analyzed with the Student t test and for non-parametric nominal data the chi2 test was applied.No causal relationship between tracheotomy and aspiration was exhibited, as 19 of 20 (95%) subjects exhibited the same aspiration status before and after tracheotomy. All 12 (100%) subjects who aspirated before tracheotomy also aspirated after tracheotomy and 7 of 8 (88%) subjects who did not aspirate before tracheotomy also did not aspirate after tracheotomy (P > .05). In addition, no significant differences were observed between aspiration status and days since tracheotomy or age (P > .05).In the acute care setting, no causal relationship between tracheotomy and aspiration status was exhibited.
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Despite the risk of airway obstruction, tracheotomy has been viewed with trepidation in the management of recurrent respiratory papillomatosis (RRP). The literature suggests that the injury associated with the tracheotomy site may initiate the progression of disease to the distal airway. Alternatively, patients who require tracheotomy for RRP may be predisposed to distal spread because of more aggressive disease. In an effort to clarify this issue, we reviewed the Children's Hospital of Pittsburgh experience with 35 patients with RRP between 1984 and 1994; 13 patients received tracheotomies. Tracheotomy patients presented at a younger age with more widespread disease, often involving the distal airway prior to tracheotomy. Although distal spread occurred in 50% of patients, it was generally limited to the tracheotomy site. Overall, outcome in the tracheotomy group was satisfactory. Complications related to the tracheotomy were rare. We conclude that tracheotomy is an appropriate option for significant airway compromise in patients with RRP.
Recurrent Respiratory Papillomatosis
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This is a case report of a 54-year-old male, who developed a considerable tracheal stenosis after dilatational tracheotomy. Other causes than sequelae after tracheotomy were investigated and excluded. There are two types of tracheotomy: surgical and dilatational tracheotomy. Surgical tracheotomy is the preferred method in complicated cases, while dilational tracheotomy is easier accessible and has become increasingly prevalent. The objective of this case report is to highlight possible complications as well as advantages.
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Objective The aim of this analysis was to perform a meta-analysis evaluating gender difference of delayed healing risk in patients with venous leg ulcers. Methods We searched the PubMed and Web of Knowledge from their inception to 4 July 2015. The meta-analysis of pooled odds ratio and 95% confidence interval for venous leg ulcers healing risk were calculated. Results Twelve studies with 4453 patients were included in the meta-analysis. The pooled odds ratio for healing rate stratified by gender was 1.055 (95% CI 0.955–1.165; Z = 1.05, p = 0.292) by fix-effects model. The Begg's test (z = 2.67, p = 0.007), the Egger's test (t = 4.00, p = 0.003), and asymmetric funnel plot suggested there was significant publication bias. Subgroup analysis showed the pooled odds ratios were 1.048 (95% CI 0.945–1.162; Z = 0.88, p = 0.376) in prospective studies and 1.439 (95% CI 0.757–2.736; Z = 1.11, p = 0.266) in retrospective studies. Sensitivity analyses by only pooled adjusted odds ratios showed the pooled odds ratio was 1.049 (95% CI 0.946–1.163; Z = 0.91, p = 0.365), which indicated the results of meta-analysis were robust. Meta-regression analysis showed the healing rate odds ratio stratified by gender was not related with healing rate (t = 0.73, p = 0.484). Conclusion Our meta-analysis indicates that no gender difference existed for delayed healing in venous leg ulcers. Our results may be also useful in developing a risk score for failure of venous leg ulcers to heal.
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This is a case report of a 54-year-old male, who developed a considerable tracheal stenosis after dilatational tracheotomy. Other causes than sequelae after tracheotomy were investigated and excluded. There are two types of tracheotomy: surgical and dilatational tracheotomy. Surgical tracheotomy is the preferred method in complicated cases, while dilational tracheotomy is easier accessible and has become increasingly prevalent. The objective of this case report is to highlight possible complications as well as advantages.
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Ventilator-associated Pneumonia
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Objective To evaluate comparatively the clinical efficacy of percutaneous dilatational tracheotomy(PDT) and conventional tracheotomy for critically ill patients in ICU.Methods A total of 80 patients in whom tracheotomy was needed were given randomly either PDT or conventional tracheotomy.The mean time used for the operations,complications,and safety were compared between the two methods.Results The mean time to perform PDT was(8±3.1) min and the mean time to conventional tracheotomy was(23.7±11.3) min(P 0.01).The operation-related complications in conventional tracheotomy group were in 13 cases,but 2 in the PDT group.Conclusion PDT is safe,easy to operate,with less time,trauma,and complications,and therefore we espouse its wide application in critical patients who need tracheotomy.
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