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1. J Am Vet Med Assoc. 2018 Nov 1;253(9):1158-1163. doi: 10.2460/javma.253.9.1158. Risk factors for temporary tracheostomy tube placement following surgery to alleviate signs of brachycephalic obstructive airway syndrome in dogs. Worth DB, Grimes JA, Jiménez DA, Koenig A, Schmiedt CW. OBJECTIVE To identify risk factors for temporary tracheostomy tube placement (TTTP) following surgery for alleviation of signs associated with brachycephalic obstructive airway syndrome (BOAS) in dogs. DESIGN Retrospective case-control study. ANIMALS 122 client-owned dogs with BOAS that underwent surgery to alleviate clinical signs (BOAS surgery). PROCEDURES The medical records database of a veterinary teaching hospital was searched to identify dogs that underwent BOAS surgery from January 2007 through March 2016. Of the 198 dogs identified, 12 required postoperative TTTP (cases); 110 of the remaining 186 dogs were randomly selected as controls. Data regarding signalment and select preoperative, intraoperative, and postoperative variables were extracted from the medical record of each dog. Variables were compared between cases and controls and evaluated for an association with the odds of postoperative TTTP. RESULTS Body condition score, tracheal diameter-to-thoracic inlet ratio, staphylectomy technique, and mortality rate did not differ significantly between cases and controls. The odds of postoperative TTTP increased approximately 30% (OR, 1.3) for each 1-year increase in patient age. Postoperative administration of corticosteroids and presence of pneumonia were also positively associated with the odds of postoperative TTTP. Median duration of hospitalization was significantly longer for cases than controls. CONCLUSIONS AND CLINICAL RELEVANCE Age was positively associated with the odds of TTTP in dogs after BOAS surgery, and TTTP led to prolonged hospitalization. Thus, early identification and intervention may be beneficial for dogs with BOAS. The associations between TTTP and postoperative corticosteroid use or pneumonia were likely not causal, but reflective of patient disease severity. DOI: 10.2460/javma.253.9.1158 PMID: 30311524 2. J Med Case Rep. 2018 Oct 12;12(1):292. doi: 10.1186/s13256-018-1832-7. High-flow oxygen via tracheostomy facilitates weaning from prolonged mechanical ventilation in patients with restrictive pulmonary dysfunction: two case reports. Mitaka C(1), Odoh M(2), Satoh D(2), Hashiguchi T(3), Inada E(2). Author information: (1)Department of Anesthesiology and Pain Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. firstname.lastname@example.org. (2)Department of Anesthesiology and Pain Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. (3)Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo, Japan. BACKGROUND: Weaning from prolonged mechanical ventilation is extremely difficult in tracheostomized patients with restrictive pulmonary dysfunction. High-flow oxygen via tracheostomy supplies heated and humidified oxygen gas at > 10 L/minute. However, little has been reported on the use of high-flow oxygen via tracheostomy during weaning from ventilators in patients with restrictive pulmonary dysfunction. We report successful weaning from ventilators in patients with restrictive pulmonary dysfunction using high-flow oxygen via tracheostomy. CASE PRESENTATION: The first patient is a 78-year-old Japanese man with severe pneumococcal pneumonia who was mechanically ventilated for more than 1 month after esophagectomy for esophageal cancer. After he underwent tracheostomy because of prolonged mechanical ventilation, restrictive pulmonary dysfunction appeared: tidal volume 230-240 mL and static compliance 14-15 mL/cmH2O with 10 cmH2O pressure support ventilation. He was weaned from the ventilator under inspiratory support with high-flow oxygen via tracheostomy over a period of 16 days (flow at 40 L/minute and fraction of inspired oxygen of 0.25). The second patient is a 69-year-old Japanese man who developed aspiration pneumonia after esophagectomy and received prolonged mechanical ventilation via tracheostomy. He developed restrictive pulmonary dysfunction. High-flow oxygen via tracheostomy (flow at 40 L/minute with fraction of inspired oxygen of 0.25) was administered with measurement of the airway pressure and at the entrance of the tracheostomy tube. The measured values were as follows: 0.21-0.3 cmH2O, 0.21-0.56 cmH2O, 0.54-0.91 cmH2O, 0.76-2.01 cmH2O, 1.17-2.01 cmH2O, and 1.76-2.01 cmH2O at 10 L/minute, 20 L/minute, 30 L/minute, 40 L/minute, 50 L/minute, and 60 L/minute, respectively. The airway pressures were continuously positive and did not become negative even during inspiration, suggesting that high-flow oxygen via tracheostomy reduces inspiratory effort. He was weaned from the ventilator under inspiratory support with high-flow oxygen via tracheostomy over a period of 12 days. CONCLUSIONS: High-flow oxygen via tracheostomy may reduce the inspiratory effort and enhance tidal volume by delivering high-flow oxygen and facilitate weaning from prolonged mechanical ventilation in patients with restrictive pulmonary dysfunction. DOI: 10.1186/s13256-018-1832-7 PMID: 30309381 3. Head Neck. 2018 Oct 11. doi: 10.1002/hed.25373. [Epub ahead of print] Risk analysis for tracheostomy dependency in curatively treated laryngeal cancer with organ preservation. Anschuetz L(1), Visini M(1), Shelan M(2), Elicin O(2), Giger R(1). Author information: (1)Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. (2)Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. BACKGROUND: A tracheostomy has an enormous negative impact on the patient's quality of life. The purpose of this study is to describe risk factors for permanent tracheostomies in patients undergoing curative organ-preserving treatment of laryngeal cancer. METHODS: The charts of all patients with laryngeal cancer diagnosed at our tertiary referral center were reviewed. Cases receiving a tracheostomy before, during, or after primary organ-preserving treatment were eligible. RESULTS: A total of 87 patients who underwent tracheostomies were enrolled in the present study. During follow-up, 48 patients (55%) required a permanent tracheostomy, whereas 39 patients (45%) were decannulated. Multivariate analysis revealed primary radiotherapy (RT; odds ratio [OR] 12.857; P < .001) and recurrence (OR 25.84; P < .001) as independent factors of permanent tracheostomy. CONCLUSION: This study identifies primary curative RT and tumor relapse as independent risk factors of permanent tracheostomy dependency in patients with laryngeal cancer undergoing a tracheostomy during or after primary curative organ-preserving treatment. © 2018 Wiley Periodicals, Inc. DOI: 10.1002/hed.25373 PMID: 30307670 4. Head Neck. 2018 Oct 11. doi: 10.1002/hed.25363. [Epub ahead of print] Factors associated with complications in total laryngectomy without microvascular reconstruction. Helman SN(1), Brant JA(2), Kadakia SK(1), Newman JG(2), Cannady SB(2), Chai RL(3). Author information: (1)Department of Otolaryngology - Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York. (2)Department of Otolaryngology - Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. (3)Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. BACKGROUND: There is little population-level data evaluating risk factors for postoperative complications after total laryngectomy. METHODS: We conducted a retrospective review of the American College of Surgeons National Quality Improvement Program identifying patients who underwent total laryngectomy as a primary procedure from 2005 to 2014. Multivariate analysis was performed to identify variables that were independently associated with overall and major complications. RESULTS: Eight hundred seventy-one cases met inclusion criteria. Three hundred twenty-eight patients (37.7%) had complications, with operative time (hours; P < .0001), class III (P < .001) wound status, and patient age (decade; P = .003) associated with overall complications. Two hundred one patients had major complications that were associated with steroid use (P = .01) and class III (P = .0083) wound classification. Preoperative hematocrit was correlated with a reduction of all and major complications on multivariate analysis (P < .0001 and P = .036). CONCLUSION: Identifying and optimizing risk factors may improve outcomes in total laryngectomy. © 2018 Wiley Periodicals, Inc. DOI: 10.1002/hed.25363 PMID: 30307661 5. J Laryngol Otol. 2018 Oct 11:1-5. doi: 10.1017/S0022215118001615. [Epub ahead of print] Hypocalcaemia following laryngectomy: prevalence and risk factors. Harris AS(1), Prades E(2), Passant CD(1), Ingrams DR(1). Author information: (1)Department of Otolaryngology Head and Neck Surgery,Aneurin Bevan University Health Board, Royal Gwent Hospital,Newport,Wales,UK. (2)Department of Otolaryngology Head and Neck Surgery,Betsi Cadwaladr University Health Board, Glan Clwyd Hospital,Rhyl,Wales,UK. OBJECTIVES: To establish the prevalence of hypocalcaemia following laryngectomy and demonstrate that total thyroidectomy is a risk factor. METHODS: A retrospective cohort study was conducted that included all patients who underwent total laryngectomy from 1st January 2006 to 1st August 2017. Exclusion criteria were: pre-operative calcium derangement, previous thyroid or parathyroid surgery, concurrent glossectomy, pharyngectomy, or oesophagectomy. RESULTS: Ninety patients were included. Sixteen patients had early hypocalcaemia (18 per cent), seven had protracted hypocalcaemia (8 per cent) and six had permanent hypocalcaemia (10 per cent). Exact logistic regression values for hypocalcaemia following total thyroidectomy compared to other patients were: early hypocalcaemia, odds ratio = 15.5 (95 per cent confidence interval = 2.2-181.9; model p = 0.002); protracted hypocalcaemia, odds ratio = 13.3 (95 per cent confidence interval = 1.5-117.1; model p = 0.01); and permanent hypocalcaemia, odds ratio = 22.7 (95 per cent confidence interval = 1.9-376.5; model p = 0.005). CONCLUSION: This is the largest study to investigate the prevalence of hypocalcaemia following laryngectomy and the first to include follow up of longer than three months. Total thyroidectomy significantly increased the risk of hypocalcaemia at all time frames and independent of other variables. DOI: 10.1017/S0022215118001615 PMID: 30305187 6. Head Neck Pathol. 2018 Oct 8. doi: 10.1007/s12105-018-0974-7. [Epub ahead of print] Abnormal Microvasculature in Laryngectomy Mucosal Margins may be Associated with Increased Risk of Fistula. Abouyared M(1), Kerr DA(2), Burroway B(2), Sabra J(2), Sargi Z(2), Nicolli E(2), Leibowitz J(2). Author information: (1)Department of Otolaryngology, University of Miami, 1120 NW 14th Street, 5th floor, Miami, FL, 33136, USA. email@example.com. (2)Department of Otolaryngology, University of Miami, 1120 NW 14th Street, 5th floor, Miami, FL, 33136, USA. Pharyngocutaneous fistula after laryngectomy is common and significantly increases the morbidity of the procedure. Intraoperative, objective variables that can reliably predict fistula formation would be useful to surgeons deciding how to reconstruct the laryngectomy defect. Retrospective chart review of 50 radiated patients and 10 non-radiated patients who underwent total laryngectomy at a single tertiary care institution. Patients with pharyngocutaneous fistula were selected to ensure a representative sample were available for comparison. All patients had pathology slides available for re-review by a single, blinded pathologist. Margins of both radiated (n = 50) and non-radiated (n = 10) larynges were examined for 7 histologic features, and odds ratios were calculated to assess whether these features were associated with fistula. When evaluating all 60 patients, both telangiectatic capillaries and hyalinized arterioles were associated with fistula (OR 3.72 and 9.21, respectively). Collinearity between the variables was evaluated; findings indicated a high likelihood of having hyalinized arterioles if telangiectatic capillaries were also present (OR 31.67 [3.13, 320.06]). Microvascular changes in radiated tissue have previously been described in other anatomic subsites, but the larynx and pharynx have not been specifically evaluated. Laryngectomy mucosal margins appear to display similar changes, and evidence of this damage may be associated with fistula formation. These features could potentially guide the surgeon to alter the reconstructive technique. DOI: 10.1007/s12105-018-0974-7 PMID: 30298338 7. Neurocrit Care. 2018 Oct 8. doi: 10.1007/s12028-018-0619-4. [Epub ahead of print] The Timing of Tracheostomy and Outcomes After Aneurysmal Subarachnoid Hemorrhage: A Nationwide Inpatient Sample Analysis. Dasenbrock HH(1), Rudy RF(1), Gormley WB(1), Frerichs KU(1), Aziz-Sultan MA(1), Du R(2). Author information: (1)Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. (2)Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. firstname.lastname@example.org. BACKGROUND: The goal of this study was to investigate the association of tracheostomy timing with outcomes after aneurysmal subarachnoid hemorrhage (SAH) in a national population. METHODS: Poor-grade aneurysmal SAH patients were extracted from the Nationwide Inpatient Sample (2002-2011). Multivariable linear regression was used to analyze predictors of tracheostomy timing and multivariable logistic regression was used to evaluate the association of timing of intervention with mortality, complications, and discharge to institutional care. Covariates included patient demographics, comorbidities, severity of subarachnoid hemorrhage (measured using the NIS-SAH severity scale), hospital characteristics, and other complications and length of stay. RESULTS: The median time to tracheostomy among 1380 poor-grade SAH admissions was 11 (interquartile range: 7-15) days after intubation. The mean number of days from intubation to tracheostomy in SAH patients at the hospital (p < 0.001) was the strongest predictor of tracheostomy timing for a patient, while comorbidities and SAH severity were not significant predictors. Mortality, neurologic complications, and discharge disposition did not differ significantly by tracheostomy time. However, later tracheostomy (when evaluated continuously) was associated with greater odds of pulmonary complications (p = 0.004), venous thromboembolism (p = 0.04), and pneumonia (p = 0.02), as well as a longer hospitalization (p < 0.001). Subgroup analysis only found these associations between tracheostomy timing and medical complications in patients with moderately poor grade (NIS-SAH severity scale 7-9), while there were no significant differences by timing of intervention in very poor-grade patients (NIS-SAH severity scale > 9). CONCLUSIONS: In this analysis of a large, national data set, variation in hospital practices was the strongest predictor of tracheostomy timing for an individual. In patients with moderately poor grade, later tracheostomy was independently associated with pulmonary complications, venous thromboembolism, pneumonia, and a longer hospitalization, but not with mortality, neurological complications, or discharge disposition. However, tracheostomy timing was not significantly associated with outcomes in very poor-grade patients. DOI: 10.1007/s12028-018-0619-4 PMID: 30298335 8. Otolaryngol Clin North Am. 2018 Oct 5. pii: S0030-6665(18)30161-0. doi: 10.1016/j.otc.2018.08.006. [Epub ahead of print] Multidisciplinary Tracheostomy Care: How Collaboratives Drive Quality Improvement. Bedwell JR(1), Pandian V(2), Roberson DW(3), McGrath BA(4), Cameron TS(5), Brenner MJ(6). Author information: (1)Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 650, Houston, TX 77030, USA. (2)Johns Hopkins School of Nursing, 525 North Wolfe Street, Room 442, Baltimore, MD 21205, USA. (3)Global Tracheostomy Collaborative, 165 Russett Road, West Roxbury, MA 03122, USA. (4)Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK. (5)Austin Health, 3rd Floor Lance Townsend Building, PO Box 5555, Heidelberg, Victoria 3084, Australia. (6)Department of Otolaryngology-Head and Neck Surgery, University of Michigan School of Medicine, 1500 East Medical Center Drive SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA. Electronic address: email@example.com. There have been reports of successful quality-improvement initiatives surrounding tracheostomy care for more than a decade, but widespread adoption of best practices has not been universal. Five key drivers have been found to improve the quality of care for tracheostomy patients: multidisciplinary synchronous ward rounds, standardization of care protocols, appropriate interdisciplinary education and staff allocation, patient and family involvement, and use of data to drive improvement. The Global Tracheostomy Collaborative is a quality-improvement collaborative dedicated to improving the care of tracheostomy patients worldwide through communication, dissemination, and implementation of proven strategies based on these 5 key drivers. Copyright © 2018 Elsevier Inc. All rights reserved. DOI: 10.1016/j.otc.2018.08.006 PMID: 30297183 9. Indian J Crit Care Med. 2018 Sep;22(9):683. doi: 10.4103/ijccm.IJCCM_307_18. Speech and Swallowing Function Outcome Following Early Tracheostomy in Patients Who Underwent Neurosurgical Intervention. Ghosh PS(1), Naskar S(2), Azim A(1). Author information: (1)Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. (2)Department of Head and Neck Surgery, Tata Medical Center, Kolkata, West Bengal, India. DOI: 10.4103/ijccm.IJCCM_307_18 PMCID: PMC6161580 PMID: 30294139 Conflict of interest statement: There are no conflicts of interest.