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Last updated on Monday, April 21, 2014

The latest papers from the medical literature are highlighted below. These come direct from a weekly PubMed search regarding new developements in tracheostomy and laryngectomy management.

1. Acta Med Okayama. 2014 Apr;68(2):57-62.

Effects of antibiotics administration on the incidence of wound infection in
percutaneous dilatational tracheostomy.

Hagiya H(1), Naito H, Hagioka S, Okahara S, Morimoto N, Kusano N, Otsuka F.

Author information:
(1)Department of General Medicine, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences, Okayama 700-8558,
Japan.e_dai_for_all@hotmail.com.

The effect of antibiotics during the perioperative period of percutaneous
dilatational tracheostomy (PDT) is still controversial. A total of 297 patients
who underwent the PDT procedure were divided into 2 groups:those administered
antibiotics perioperatively and those not administered antibiotics. Wound
infections were noted in 7 cases (incidence rate, 2.36%) and no death was
recorded. Of the 69 patients without antibiotics, 5 developed wound infections
(incidence rate, 7.25%), while only 2 of the 228 patients with antibiotics
developed wound infections (incidence rate, 0.88%) (p=0.002;risk ratio, 8.82;95%
confidence interval, 1.67-46.6). Of the 7 cases of wound infection, 5 cases
occurred during the early period after PDT (within 7 days). Collectively, the
present results suggest that prophylactic administration of antibiotics may
prevent the incidence of PDT-induced wound infection, especially in the early
phase after the PDT procedures. The need for antibiotics in PDT should be
reconsidered.

PMID: 24743781 [PubMed - in process]

2. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2014 Feb;49(2):164.

[Use of nasal endoscopy to take out fractured tracheostomy tubes in the
tracheo-bronchial tree:a case report].

[Article in Chinese]

Cheng Y(1), Zheng Y, Liu F.

Author information:
(1)Email: nmtlkeq@sina.com.

PMID: 24742519 [PubMed - in process]

3. J Laryngol Otol. 2014 Apr 15:1-7. [Epub ahead of print]

Does early oral feeding increase the likelihood of salivary fistula after total
laryngectomy?

Sousa AA(1), Porcaro-Salles JM(1), Soares JM(2), de Moraes GM(1), Silva GS(1),
Sepulcri RA(2), Savassi-Rocha PR(1).

Author information:
(1)Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal
de Minas Gerais, Belo Horizonte, Brazil.
(2)Department of Medicine, Universidade Federal de São João Del Rei, Divinópolis,
Minas Gerais, Brazil.

Objective: This study compared the incidence of salivary fistula between groups
with an early or late reintroduction of oral feeding, and identified the
predictive factors for salivary fistula. Methods: A randomised trial was
performed using 89 patients with larynx or hypopharynx cancer, assigned to 2
groups (early or late). In the early group, oral feeding was started 24 hours
after total laryngectomy or total pharyngolaryngectomy, and in the late group, it
was started from post-operative day 7 onwards. The occurrence of salivary fistula
was evaluated in relation to the following variables: early or late oral feeding,
nutritional status, cancer stage, surgery performed, and type of neck dissection.
Results: The incidence of salivary fistula was 27.3 per cent (n = 12) in the
early group and 13.3 per cent (n = 6) in the late group (p = 0.10). The following
variables were not statistically significant: nutritional status (p = 0.45);
tumour location (p = 0.37); type of surgery (p = 0.91) and type of neck
dissection (p = 0.62). A significant difference (p = 0.02) between the free
margins and invasive carcinoma was observed. Conclusion: The early reintroduction
of oral feeding in total laryngectomised patients did not increase the incidence
of salivary fistula.

PMID: 24736040 [PubMed - as supplied by publisher]

4. Laryngoscope. 2014 Apr 12. doi: 10.1002/lary.24717. [Epub ahead of print]

Changing trends of speech outcomes after total laryngectomy in the 21st century:
A single-center study.

Moon S(1), Raffa F, Ojo R, Landera MA, Weed DT, Sargi Z, Lundy D.

Author information:
(1)Department of Otolaryngology, University of Miami Miller School of Medicine,
Miami, Florida, USA.

Objective: To describe the speech rehabilitation outcomes of patients undergoing
total laryngectomy (TL) in the 21st century. Study Design: Retrospective chart
review. Setting: Tertiary academic center Subjects and Methods: Retrospective
review of 167 patients who underwent TL from June 2000 to February 2012.
Demographics, disease variables, and surgical factors were reviewed. Primary
alaryngeal speech modality, speech outcome, and TEP complication rates were
assessed. Results: Overall TEP speech success rate (primary or secondary) was
72%; overall TEP speech success rate for those with primary TEP was 76% and for
secondary TEP was 68%. TEP speech success rates at 1st, 2nd, and beyond 2nd year
were 75%, 72%, and 70%, respectively. Success rates for primary TL, salvage TL,
primary TL with pharyngeal reconstruction, or salvage TL with pharyngeal
reconstruction groups were 71%, 72%, 73%, and 71%, respectively. TEP-related
complications occurred in 43% of patients, with no difference in complication
rates between primary versus salvage TL or primary versus secondary TEP. Of those
with complications, TEP success rate was 65%. Conclusion: This study showed TEP
speech outcome success rates lower than what has been historically reported.
There was no significant difference in TEP speech outcome between primary versus
salvage TL or primary versus secondary TEP. Patients with TEP-related
complications had TEP speech outcome success rates comparable to those without
any complication. TEP may continue to be a superior option as a mode of speech in
patients with TL including those undergoing salvage TL.

Copyright © 2014 The American Laryngological, Rhinological, and Otological
Society, Inc.

PMID: 24729127 [PubMed - as supplied by publisher]

5. Cell Biochem Biophys. 2014 Apr 13. [Epub ahead of print]

Respiratory Nursing Interventions Following Tracheostomy in Acute Traumatic
Cervical Spinal Cord Injury.

Luo C(1), Yang H, Chen Y, Zhang Z, Gong Z.

Author information:
(1)Department of Orthopedics, Xinqiao Hospital, Third Military Medical University,
183 Xinqiao Street, Shapingba District, Chongqing, 400037, China.

Tracheostomy is frequently performed in severe cervical spinal cord injury (SCI)
patients with the pulmonary dysfunction. A series of respiratory nursing
interventions are required to plan tracheostomy removal. Tracheostomy was
performed in 29 patients after acute traumatic cervical SCI. A series of
respiratory nursing interventions were introduced in these patients after closed
tracheostomy and decannulation, including closed tracheostomy tube training,
manually assisted cough. Chacheostomy was successfully removed in 21 patients
after the respiratory nursing interventions. In contrast, eight patients died
from associated injuries. The average time from tracheostomy to decannulation was
40 days (14-104 days), the average time from closed tracheostomy to decannulation
was 18.80 ± 13.50 days. Second tracheostomy was performed in one patient after
29 days' removal due to pulmonary infection. One patient presented with delayed
incision healing for 29 days. Closed tracheostomy tube training and manually
assisted cough are key factors for tracheostomy removal, although intensive
nursing are also needed. The time from tracheostomy to decannulation and from
closed tracheostomy to decannulation is increased in case of "late" (>24 h)
tracheostomy and longer mechanical ventilation.

PMID: 24728962 [PubMed - as supplied by publisher]

6. J Pediatr Surg. 2014 Apr;49(4):590-2. doi: 10.1016/j.jpedsurg.2013.09.002.

Early tracheostomy improves outcomes in severely injured children and
adolescents.

Holscher CM(1), Stewart CL(2), Peltz ED(3), Burlew CC(4), Moulton SL(5), Haenel
JB(3), Bensard DD(6).

Author information:
(1)University of Colorado School of Medicine, Aurora, CO, USA. Electronic address:
cmholscher@gmail.com.
(2)University of Colorado School of Medicine, Aurora, CO, USA.
(3)Denver Health Medical Center, Denver, CO, USA.
(4)University of Colorado School of Medicine, Aurora, CO, USA; Denver Health Medical
Center, Denver, CO, USA.
(5)University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital
Colorado, Aurora, CO, USA.
(6)University of Colorado School of Medicine, Aurora, CO, USA; Denver Health Medical
Center, Denver, CO, USA. Electronic address: denis.bensard@dhha.org.

BACKGROUND: Early tracheostomy has been advocated for adult trauma patients to
improve outcomes and resource utilization. We hypothesized that timing of
tracheostomy for severely injured children would similarly impact outcomes.
METHODS: Injured children undergoing tracheostomy over a 10-year period
(2002-2012) were reviewed. Early tracheostomy was defined as post-injury day ≤7.
Data were compared using Student's t test, Pearson chi-squared test and Fisher
exact test. Statistical significance was set at p<0.05 with 95% confidence
intervals.
RESULTS: During the 10-year study period, 91 patients underwent tracheostomy
following injury. Twenty-nine (32%) patients were <12years old; of these, 38%
received early tracheostomy. Sixty-two (68%) patients were age 13 to 18; of
these, 52% underwent early tracheostomy. Patients undergoing early tracheostomy
had fewer ventilator days (p=0.003), ICU days (p=0.003), hospital days (p=0.046),
and tracheal complications (p=0.03) compared to late tracheostomy. There was no
difference in pneumonia (p=0.48) between early and late tracheostomy.
CONCLUSION: Children undergoing early tracheostomy had improved outcomes compared
to those who underwent late tracheostomy. Early tracheostomy should be considered
for the severely injured child.
SUMMARY: Early tracheostomy is advocated for adult trauma patients to improve
patient comfort and resource utilization. In a review of 91 pediatric trauma
patients undergoing tracheostomy, those undergoing tracheostomy on post-injury
day ≤7 had fewer ventilator days, ICU days, hospital days, and tracheal
complications compared to those undergoing tracheostomy after post-injury day 7.

© 2014.

PMID: 24726119 [PubMed - in process]

7. ORL Head Neck Nurs. 2014 Winter;32(1):20-3.

Heat and moisture exchange devices for patients undergoing total laryngectomy.

Icuspit P, Yarlagadda B, Garg S, Johnson T, Deschler D.

Patients undergoing total laryngectomy face the challenge of an altered anatomy
with the resultant changes in quality of life and significant requirements for
post-operative care. Increased production of secretions and sputum, the need for
ongoing suctioning, and the formation of stomal crusting require meticulous
post-operative care. The use of Heat and Moisture Exchange (HME) devices has been
shown to decrease the effect of these factors. This article describes the nature
of these devices and their use. The literature is reviewed regarding the long
term benefits and new data are presented suggesting an immediate post-operative
benefit as well. Finally, costs and other considerations for successful use of
HME devices are presented.

PMID: 24724345 [PubMed - in process]

8. ORL Head Neck Nurs. 2014 Winter;32(1):14-9.

Clinical consensus statement: tracheostomy care-putting statements into action!

Dawson C, Farrington M.

A clinical consensus statement (CCS) on tracheostomy care for adults and children
was developed to improve care for this patient population. Statements were
identified using a modified Delphi method with the goal to reduce practice
variations among tracheostomy patients. Integration of these statements into
daily practice in the care setting is the next step for information
dissemination. The CCS affected current policies, procedures, protocols, staff
education, and patient education. The process of updating practice at a large
tertiary care center is described using evidence-based implementation strategies.

PMID: 24724344 [PubMed - in process]

9. ORL Head Neck Nurs. 2014 Winter;32(1):6-8, 10-3.

Exploring quality of life in critically ill tracheostomy patients: a pilot study.

Pandian V, Bose S, Miller C, Schiavi A, Feller-Kopman D, Bhatti N, Mirski M.

BACKGROUND: Tracheostomies are performed to improve health-related quality of
life (QOL) in patients requiring prolonged mechanical ventilation. As the lengths
of stay in intensive care units (ICU) increase and higher rates of tracheostomies
are becoming more prevalent, issues regarding patient perceptions of their own
prognoses and outcomes after tracheostomy can considerably impact QOL and in turn
their care and recovery. Whether tracheostomy improves QOL, however, has not been
studied adequately. Current studies investigating QOL have been limited to pre-
and post-ICU admission, have relied on surrogate measures such as clinical
outcomes and proxy reports, and have used inadequate instruments, failing to
capture all domains of QOL. Studies using a robust instrument to investigate QOL
in the ICU before and after tracheostomy are lacking.
PURPOSE: To explore the feasibility of assessing patient-reported QOL of
mechanically ventilated ICU patients with a tracheostomy.
METHODS: A prospective longitudinal pilot study was conducted in awake and
interactive patients who were mechanically ventilated in an ICU using a modified
version of the University of Washington QOL Questionnaire. Data were collected at
three measurement time points--Time 0 (T0), Time 1 (T1), and Time 2 (T2)--five
days apart. The QOL scores were compared between patients who received a
tracheostomy and those who did not, as well as between those who received a
tracheostomy before and after ten days of intubation.
RESULTS: The modified University of Washington Quality of Life (UWQOL)
questionnaire was easily administered by one person. Patients were able to answer
all the questions by writing or pointing at the answer choices with either an
endotracheal or a tracheostomy tube in place. The mean time to complete the
questionnaire was 7.5 minutes. QOL scores ranging from 0 to 800 were
administered. Pain and speech were the most important domains contributing to
QOL. The median QOL scores were 242 at T0 and T1, and 383 at T2. There was a
significant difference in the median QOL scores between those who received a
tracheostomy (458) and those who remained endotracheally intubated (175) at T2.
Similarly, patients who received early tracheostomy reached a higher QOL score by
T1 compared to those who did not (417 vs. 267).
CONCLUSIONS: This pilot study demonstrates that a modified questionnaire to
assess QOL in patients with prolonged mechanical ventilation is feasible, and
useful in capturing artificial airway-related QOL. Further studies should
evaluate the utility of this tool in a larger study.

PMID: 24724343 [PubMed - in process]

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