Items 1 - 9 of 9

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. c-mitaka@juntendo.ac.jp.
(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. mabouyared@med.miami.edu.
(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. rdu@bwh.harvard.edu.

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: mbren@med.umich.edu.

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.