<strong>Introduction: </strong>Tracheotomy is a commonly performed procedure, but with very large disparities according to the teams, both in terms of frequency and modality (percutaneous or surgical), tra...<strong>Introduction: </strong>Tracheotomy is a commonly performed procedure, but with very large disparities according to the teams, both in terms of frequency and modality (percutaneous or surgical), tracheotomy has been evolved with medical advances. The objective of this study was to clarify the indications and complications of emergency tracheotomies at the National hospital center (CHN) in Nouakchott Mauritania. <strong>Materials and Methods: </strong>It is a retrospective study of tracheotomies performed in the ENT department of the CHN during the period from January 1, 2010 to December 31, 2018. The indications and complications were noted, as well as the modalities and time of decannulation. <strong>Results:</strong> Tracheotomy was motivated by upper airway obstruction (UAO) in 139 (94%) cases (mean age 32.5 years), or the need for prolonged ventilation in 8 patients (median age 46 years). Sixteen (7%) early complications were noted with 5 untimely decannulations including one fatal and 5 obstructive plug responsible for another death. Six pneumothorax was observed. Fifteen (26%) late complications required additional surgery;7% (n = 11) of patients were decannulated with a mean duration of tracheotomy 26 months. In 19 (28%) cases of decannulations, the persistence of a tracheocutaneous fistula required surgery. <strong>Conclusion:</strong> Emergency tracheotomy is a survival gesture that is sure to be effective. A tracheotomy is not deprived of complications. Familiarity with the technique, the right choice of equipment, perfect knowledge of the anatomical relationships of the trachea, rigorous monitoring and postoperative care represent the main conditions for minimizing the risk of complications.展开更多
<strong>Background:</strong> known since more than 5000 years, tracheotomy is indicated in severe obstructions of the upper airways or in improvement of ventilation in cases of problematic tracheal intubat...<strong>Background:</strong> known since more than 5000 years, tracheotomy is indicated in severe obstructions of the upper airways or in improvement of ventilation in cases of problematic tracheal intubation. Its usefulness and efficiency are certain, but it needs regular assessments. <strong>Aim:</strong> to determine the frequency of tracheotomies in ENT at CNHU of Cotonou, identify the indications, surgical technics and the postoperative course. <strong>Materials and methods:</strong> the study was retrospective, based on files of patients who have had tracheotomies for ten years since 2010. <strong>Results:</strong> in 10 years, 105 tracheotomies were performed for 99 patients, average 10 to 11 per year. Patients were male in 61.9%. Extreme of age where 09 months and 80 years old. Children under15 were concerned in 41.9%, while patients from 45 to 64 years old in 33.3%. Emergency tracheotomy represented 76%. Causes were tumors in 62.8%. Laryngeal papillomatosis was the predominant tumor in children;28 cases or 26.67%. In adults, larynx cancer represented 20%. Skin incisions were horizontal in 94.3%. Tracheal opening was “H-shaped” in 92.4%. Complications occurred in 28.6%. They included granuloma (13.3%) and oeso-tracheal fistula (1.9%). Decanulation was possible in 87.6%, but it was more difficult in children. <strong>Conclusion:</strong> tracheotomy was an act of rescue in our practice.展开更多
Objective To estimate the relative effect of early vs.late tracheotomy on clinical end-points in unselected intensive care unit(ICU)patients undergoing mechanical ventilation.Methods We searched electronic databases(u...Objective To estimate the relative effect of early vs.late tracheotomy on clinical end-points in unselected intensive care unit(ICU)patients undergoing mechanical ventilation.Methods We searched electronic databases(up to February 27,2013)for both randomized control trials and observational studies satisfying the predefined inclusion criteria.Results We retrieved 11 reports of studies including a total of 13 705 patients.Early tracheotomy was associated with significant reductions in mortality[33.3%vs.36.3%;relative risk(RR);0.92;95%confidence interval(CI):0.88,0.97;I2:29%],length of ICU stay(mean difference:6.55 days;95%CI:8.19,4.90;I2:98%)and duration of mechanical ventilation(mean difference:6.53 days;95%CI:11.43,1.63;I2:100%).However,as compared with late tracheotomy,early tracheotomy did not reduce the incidence of hospital pneumonia(21.9%vs.21.0%,RR:0.85;95%CI:0.68,1.06;I2:67%).Conclusions Early tracheotomy can reduce length of ICU stay,duration of mechanical ventilation and mortality but has no influence on hospital pneumonia when compared with late tracheotomy.Once the decision has been made about tracheotomy,clinical physicians should not hesitate to perform the procedure.展开更多
目的 应用高分辨率固态测压技术(HRM)检测Passy-Muir说话瓣膜(PMV)对脑卒中气管切开患者吞咽生物力学的作用,探讨利用咽腔与食管上括约肌(UES)压力参数评估PMV治疗效果的应用价值。方法 2020年1月至2024年1月,新疆维吾尔自治区人民医院...目的 应用高分辨率固态测压技术(HRM)检测Passy-Muir说话瓣膜(PMV)对脑卒中气管切开患者吞咽生物力学的作用,探讨利用咽腔与食管上括约肌(UES)压力参数评估PMV治疗效果的应用价值。方法 2020年1月至2024年1月,新疆维吾尔自治区人民医院100例脑卒中气管切开患者随机分为对照组(n=50)和PMV组(n=50),对照组给予常规吞咽康复,PMV组在此基础上佩戴PMV,共2周。治疗前后,采用改良曼恩吞咽能力评估量表(MMASA)进行临床吞咽功能评估;并进行HRM检查,收集腭咽收缩压力峰值、腭咽收缩时长、UES松弛残余压和UES松弛时间等数据。将PMV组治疗后的MMASA评分与HRM压力参数值进行相关性分析。结果 两组各脱落4例。治疗后,两组UES松弛残余压显著降低(t> 47.403, P <0.001),MMASA评分、腭咽收缩压力峰值、腭咽收缩时长和UES松弛时间均显著增加(t> 19.621, P <0.001);PMV组均优于对照组(t>2.050, P <0.05)。治疗后PMV组腭咽收缩压力峰值(r=0.924, P <0.001)、腭咽收缩时长(r=0.948, P <0.001)和UES松弛残余时间(r=0.954, P <0.001)与MMASA评分呈正相关,UES松弛残余压与MMASA评分呈负相关(r=-0.939, P <0.001)。结论 佩戴PMV治疗能增强脑卒中气管切开患者的吞咽功能,提高咽腔和UES区域的吞咽生物力学水平。利用咽腔和UES区域的压力参数可预测佩戴PMV治疗后患者吞咽功能的改善情况。展开更多
INTRODUCTION Pediatric foreign body aspiration can be a life-threatening emergency requiring immediate intervention.The standard intervention for the vast majority of airway foreign bodies is rigid bronchoscopy,1 whic...INTRODUCTION Pediatric foreign body aspiration can be a life-threatening emergency requiring immediate intervention.The standard intervention for the vast majority of airway foreign bodies is rigid bronchoscopy,1 which was first performed by Gustav Killian in 1897.However,for some large or irregular airway foreign bodies,endoscopic removal remains challenging,even in the most experienced hands.In such cases,open surgery may be preferred to protect the airway and facilitate foreign body removal.We present a unique case of a 9-cm sharp metallic chain lodged in the lower trachea and right main bronchus of a 16-month-old girl,which was removed using combined low tracheotomy and rigid bronchoscopy.This case highlights the treatment options for large and irregular airway foreign bodies in rare locations.展开更多
Background Whether early tracheotomy in patients who require prolonged mechanical ventilation after cardiac surgery can shorten post-operation mechanical ventilation(MV)duration,Intensive Care Unit(ICU)length of stay(...Background Whether early tracheotomy in patients who require prolonged mechanical ventilation after cardiac surgery can shorten post-operation mechanical ventilation(MV)duration,Intensive Care Unit(ICU)length of stay(LOS),hospital LOS after surgery and lower hospital mortality remains controversial. Methods Forty-nine patients who undertook tracheotomy after cardiac surgery,were recruited at Guangdong General Hospital from 1stJanuary 2005 to 31 stDecember 2015. Based on the timing of tracheotomy after cardiac surgery,21cases(0～14 days)and 28 cases(≥15 days)were selected as early tracheotomy group and late tracheotomy group. The hospital mortality,duration of MV,ICU LOS and hospital LOS of these two groups were compared.Results The risks of pneumonia,duration of MV,and ICU LOS(P=0.016,0.034,0.006 respectively)were significantly lower in the early tracheotomy group. Early tracheotomy was also associated with lower risks of stroke and renal replacement therapy(P=0.033,0.01 respectively). Kaplan-Meier curves showed that those who underwent early tracheotomy had shorter duration of MV,ICU LOS,and hospital LOS. Conclusion Early tracheotomy after cardiac surgery might lead to lower risk of pneumonia,shorter duration of MV,and shorter ICU LOS.展开更多
文摘<strong>Introduction: </strong>Tracheotomy is a commonly performed procedure, but with very large disparities according to the teams, both in terms of frequency and modality (percutaneous or surgical), tracheotomy has been evolved with medical advances. The objective of this study was to clarify the indications and complications of emergency tracheotomies at the National hospital center (CHN) in Nouakchott Mauritania. <strong>Materials and Methods: </strong>It is a retrospective study of tracheotomies performed in the ENT department of the CHN during the period from January 1, 2010 to December 31, 2018. The indications and complications were noted, as well as the modalities and time of decannulation. <strong>Results:</strong> Tracheotomy was motivated by upper airway obstruction (UAO) in 139 (94%) cases (mean age 32.5 years), or the need for prolonged ventilation in 8 patients (median age 46 years). Sixteen (7%) early complications were noted with 5 untimely decannulations including one fatal and 5 obstructive plug responsible for another death. Six pneumothorax was observed. Fifteen (26%) late complications required additional surgery;7% (n = 11) of patients were decannulated with a mean duration of tracheotomy 26 months. In 19 (28%) cases of decannulations, the persistence of a tracheocutaneous fistula required surgery. <strong>Conclusion:</strong> Emergency tracheotomy is a survival gesture that is sure to be effective. A tracheotomy is not deprived of complications. Familiarity with the technique, the right choice of equipment, perfect knowledge of the anatomical relationships of the trachea, rigorous monitoring and postoperative care represent the main conditions for minimizing the risk of complications.
文摘<strong>Background:</strong> known since more than 5000 years, tracheotomy is indicated in severe obstructions of the upper airways or in improvement of ventilation in cases of problematic tracheal intubation. Its usefulness and efficiency are certain, but it needs regular assessments. <strong>Aim:</strong> to determine the frequency of tracheotomies in ENT at CNHU of Cotonou, identify the indications, surgical technics and the postoperative course. <strong>Materials and methods:</strong> the study was retrospective, based on files of patients who have had tracheotomies for ten years since 2010. <strong>Results:</strong> in 10 years, 105 tracheotomies were performed for 99 patients, average 10 to 11 per year. Patients were male in 61.9%. Extreme of age where 09 months and 80 years old. Children under15 were concerned in 41.9%, while patients from 45 to 64 years old in 33.3%. Emergency tracheotomy represented 76%. Causes were tumors in 62.8%. Laryngeal papillomatosis was the predominant tumor in children;28 cases or 26.67%. In adults, larynx cancer represented 20%. Skin incisions were horizontal in 94.3%. Tracheal opening was “H-shaped” in 92.4%. Complications occurred in 28.6%. They included granuloma (13.3%) and oeso-tracheal fistula (1.9%). Decanulation was possible in 87.6%, but it was more difficult in children. <strong>Conclusion:</strong> tracheotomy was an act of rescue in our practice.
文摘Objective To estimate the relative effect of early vs.late tracheotomy on clinical end-points in unselected intensive care unit(ICU)patients undergoing mechanical ventilation.Methods We searched electronic databases(up to February 27,2013)for both randomized control trials and observational studies satisfying the predefined inclusion criteria.Results We retrieved 11 reports of studies including a total of 13 705 patients.Early tracheotomy was associated with significant reductions in mortality[33.3%vs.36.3%;relative risk(RR);0.92;95%confidence interval(CI):0.88,0.97;I2:29%],length of ICU stay(mean difference:6.55 days;95%CI:8.19,4.90;I2:98%)and duration of mechanical ventilation(mean difference:6.53 days;95%CI:11.43,1.63;I2:100%).However,as compared with late tracheotomy,early tracheotomy did not reduce the incidence of hospital pneumonia(21.9%vs.21.0%,RR:0.85;95%CI:0.68,1.06;I2:67%).Conclusions Early tracheotomy can reduce length of ICU stay,duration of mechanical ventilation and mortality but has no influence on hospital pneumonia when compared with late tracheotomy.Once the decision has been made about tracheotomy,clinical physicians should not hesitate to perform the procedure.
文摘目的 应用高分辨率固态测压技术(HRM)检测Passy-Muir说话瓣膜(PMV)对脑卒中气管切开患者吞咽生物力学的作用,探讨利用咽腔与食管上括约肌(UES)压力参数评估PMV治疗效果的应用价值。方法 2020年1月至2024年1月,新疆维吾尔自治区人民医院100例脑卒中气管切开患者随机分为对照组(n=50)和PMV组(n=50),对照组给予常规吞咽康复,PMV组在此基础上佩戴PMV,共2周。治疗前后,采用改良曼恩吞咽能力评估量表(MMASA)进行临床吞咽功能评估;并进行HRM检查,收集腭咽收缩压力峰值、腭咽收缩时长、UES松弛残余压和UES松弛时间等数据。将PMV组治疗后的MMASA评分与HRM压力参数值进行相关性分析。结果 两组各脱落4例。治疗后,两组UES松弛残余压显著降低(t> 47.403, P <0.001),MMASA评分、腭咽收缩压力峰值、腭咽收缩时长和UES松弛时间均显著增加(t> 19.621, P <0.001);PMV组均优于对照组(t>2.050, P <0.05)。治疗后PMV组腭咽收缩压力峰值(r=0.924, P <0.001)、腭咽收缩时长(r=0.948, P <0.001)和UES松弛残余时间(r=0.954, P <0.001)与MMASA评分呈正相关,UES松弛残余压与MMASA评分呈负相关(r=-0.939, P <0.001)。结论 佩戴PMV治疗能增强脑卒中气管切开患者的吞咽功能,提高咽腔和UES区域的吞咽生物力学水平。利用咽腔和UES区域的压力参数可预测佩戴PMV治疗后患者吞咽功能的改善情况。
文摘INTRODUCTION Pediatric foreign body aspiration can be a life-threatening emergency requiring immediate intervention.The standard intervention for the vast majority of airway foreign bodies is rigid bronchoscopy,1 which was first performed by Gustav Killian in 1897.However,for some large or irregular airway foreign bodies,endoscopic removal remains challenging,even in the most experienced hands.In such cases,open surgery may be preferred to protect the airway and facilitate foreign body removal.We present a unique case of a 9-cm sharp metallic chain lodged in the lower trachea and right main bronchus of a 16-month-old girl,which was removed using combined low tracheotomy and rigid bronchoscopy.This case highlights the treatment options for large and irregular airway foreign bodies in rare locations.
基金Guangdong Province Medical Scientific Research Foundation (No.A2016120).
文摘Background Whether early tracheotomy in patients who require prolonged mechanical ventilation after cardiac surgery can shorten post-operation mechanical ventilation(MV)duration,Intensive Care Unit(ICU)length of stay(LOS),hospital LOS after surgery and lower hospital mortality remains controversial. Methods Forty-nine patients who undertook tracheotomy after cardiac surgery,were recruited at Guangdong General Hospital from 1stJanuary 2005 to 31 stDecember 2015. Based on the timing of tracheotomy after cardiac surgery,21cases(0～14 days)and 28 cases(≥15 days)were selected as early tracheotomy group and late tracheotomy group. The hospital mortality,duration of MV,ICU LOS and hospital LOS of these two groups were compared.Results The risks of pneumonia,duration of MV,and ICU LOS(P=0.016,0.034,0.006 respectively)were significantly lower in the early tracheotomy group. Early tracheotomy was also associated with lower risks of stroke and renal replacement therapy(P=0.033,0.01 respectively). Kaplan-Meier curves showed that those who underwent early tracheotomy had shorter duration of MV,ICU LOS,and hospital LOS. Conclusion Early tracheotomy after cardiac surgery might lead to lower risk of pneumonia,shorter duration of MV,and shorter ICU LOS.
