Current scenario of tracheostomy: our experience
Keywords:Tracheostomy, Decannulation, Strapping
Background: Tracheostomy is an important surgical procedure done by ENT surgeons. In this study we have assessed the indications and complications encountered during tracheostomy and decannulation.
Methods: 100 patients undergoing tracheostomy by the Department of Otolaryngology and Head and Neck Surgery between 1st January and 31st December 2015 in a tertiary care hospital in Central India were included in the study. The various indications of tracheostomy along with the complications encountered and decannulation following tracheostomy were studied.
Results: In this study, most commonly (22%) tracheostomies were performed in young (31-40) years, male (73%) patients. This included 79% elective and 21% emergency tracheostomies. The indications of tracheostomy were retained secretions 61%, laryngopharyngeal obstruction 21%, and respiratory insufficiency 19%. 21 intra-operative complications included bleeding (18% cases) and apnoea (3% cases). Wound infection 19%; subcutaneous emphysema 10%; tube block 6% and haemorrhage 2% constituted 37 immediate post-operative complications. 17 late post-operative complications included stoma stenosis 9%; granuloma formation 4% and trachea-oesophageal fistula and aspiration 2% each. 33% of total patients were decannulated easily.
Conclusions: In conclusion we found that elective tracheostomy is associated with lower morbidity and mortality and strapping of tracheostomy site is an easy, safe and effective method of tracheostomy closure in properly selected patients.
Heidi HO, Conor MD, Alexander C, White MD. Tracheostomy Decannulation. Respiratory Care. 2010;55(8):1076-81.
Santus P, Gramegna A, Radovanovic D, Raccanelli R, Valentri V, Rabbiosi D, Vitacca M, Nava S. A systematic review of tracheostomy decannulation: a proposal of quantitative and semi-quantative clinical score. BMC Pulmonary Med. 2014;14:201.
Budwiser S, Baur T, Jorres RA, Kollert F, Pfeifer M, Heinemann F. Predictors of successful decannulation using tracheostomy retainer in patients with prolonged weaning and persisting respiratory failure. Respiration. 2012;84:469-76.
Wahid FI, Hamza A, Khan Q, Zada B, Khan IA. An Audit of Tracheostomy at a Tertiary Care Hospital. J Postgrad Med Inst. 2012;26(2):206-11.
Prialla C, Scarano E, Guidi ML, Galli J, Paludetti G. Current trends in pediatric tracheostomies. Int J Pediatr Otorhinolaryngology. 2007;71(10):1563-7.
Kermer B, Kremer BA, Ecket HE, Schlorndoff G. Indications, complications and surgical techniques for pediatric tracheostomies. J Pediatr Surg. 2002;37(11):1556-62.
Gilyoma JM, Balumka DD, Chalya PL. Ten years experiences with Tracheostomy at a University teaching hospital in Northwestern Tanzania: A retrospective review of 214 cases. World J Emerg Surg. 2011;6:38.
Zias N, Chroneou A, Tabba MK, Gonzalez AV, Gray AW, Lamb CR, et al. Post tracheostomy and post intubation tracheal stenosis: Report of 31 cases and review of the literature. BMC Pulmonary Medicine. 2008;8:18.
Hsu CL, Yu K, Chang CH, Shuin JJ, Yu CJ, Yang PC. Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Critical Care. 2005;9:46-52.
Khan FA, Asharfi SK, Iqbal H, Sohail Z, Wadood. Operative complications of tracheostomy. Pak J Surg. 2010;26(4):308-10.
Stock MC, Woodward CG, Shapiro BA, Cane FD, Lewis V, Pecaro B. Peri-operative complications of elective tracheostomy in critically ill patients. Critical Care Med. 1986;14:861-3.
Shlugman D, Krishna SR, Loh L. Acute fatal haemorrhage during percutaneous dilatational tracheostomy. Br J Anaesth. 2003;90:517-20.
Santus P, Gramegna A, Radovanovic D, Raccanelli R, Valentri V, Rabbiosi D, et al. A systematic review of tracheostomy decannulation: a proposal of quantitative and semi-quantitative clinical score. BMC Pulmonary Med. 2014;14:201.
Stelfox HT, Crimi C, Berra L, Noto A, Schmidt U, Bigatello LM, et al. Determinants of tracheostomy decannulation: an international survey. Critical Care. 2008;12:1.
Arabi Y, Haddad S, Shirawi N, Shimemeri AA. Early tracheostomy in intensive care trauma patients improves resource utilisation: a cohort study and literature review. Critical Care. 2004;8:347-52.