Tracheal A-frame Deformity: A Challenging Variant of Tracheal Stenosis
TRACHEAL stenosis after tracheostomy has a reported incidence of 6 to 21% and most commonly occurs secondary to granulation tissue around the stoma or cuff site or circumferential scarring ensuing due to pressure necrosis.1,2 Alternatively, a variant known as a tracheal “A-frame” deformity (see image) can develop, which results from loss of anterior support from tracheal rings.3 Consequently, there is inward collapse of the lateral tracheal walls, which gives the trachea the characteristic “A” shape at the previous stoma site.
Sedation and anaesthesia are used universally to facilitate mechanical ventilation – with larger cumulative doses being used in those with prolonged ventilation. Transitioning from an endotracheal to a tracheostomy tube enables the depth of sedation to be reduced. Early use of speaking valves with tracheostomised patients has become routine in some intensive care units (ICUs). T he return of verbal communication has been observed to improve ease of patient care and increase patient and family engagement, with a perceived reduction in patient agitation.
Kapil D Soni, Thanigai Arasu, Richa Aggarwal, Vanlal DarlongJournal of Anaesthesiology Clinical Pharmacology 2019 35(3):412-413
Authors: Mahfouz M. AbdulKader,*, Mohammad RM, Mohammed KS, Murugan L Abstract Anesthetic management of cases of post-tracheostomy stenosis is challenging for most of the anesthesiologists. We are describing a case of severe post-tracheostomy stenosis and its management using Hunsaker Mon-Jet laser resistant tube. PMID: 31435468 [PubMed]
The current study investigates the effect of bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) on the evolution of respiratory acidosis depending on endotracheal tube (ET) sizes. In addition, th...
Background: Percutaneous tracheostomy, almost associated with cough reflex and hemodynamic fluctuations, is a common procedure for traumatic brain injury (TBI) patients, especially those in neurosurgery intensive care units (NICUs). However, there are currently a lack of effective preventive measures to reduce the risk of secondary brain injury. The aim of this study was to compare the effect of dexmedetomidine (DEX) vs sufentanil during percutaneous tracheostomy in TBI patients. Methods: The 196 TBI patients who underwent percutaneous tracheostomy were randomized divided into 3 groups: group D1 (n = 62, DEX infusion ...
We describe the case of a 7 year old case of Harberland syndrome with special focus on the difficulties faced by us in mask ventilation, as well as intubation and the need for elective ventilation and planned extubation. We also discuss the precautions to be taken while undertaking such a case like preparations for emergency tracheostomy and possibility of re-intubation after extubation. A meticulous preoperative workup along with neurological and airway examination along with preparation for elective ventilation and tracheostomy is a prerequisite for the successful management of this case.
Authors: Mishra N, Singh S PMID: 31257817 [PubMed - as supplied by publisher]
Conclusions: The incidence of POPC was 12.1% following infratentorial tumor surgery. The predictors for the occurrence of POPCs were postoperative blood transfusion, LCN palsy, prolonged ICU stay, and tracheostomy.
This study assessed the clinical impact of this technique in brain-injured patients. Materials and Methods: This is a retrospective analysis of prospectively collected data from adult brain-injured patients who had undergone modified TLT during the period spanning from January 2010 to December 2016 at the Neurointensive care unit, San Gerardo Hospital (Monza, Italy). The incidence of intraprocedural complications, including episodes of intracranial hypertension (intracranial pressure [ICP]>20 mm Hg), was documented. Neurological, ventilatory, and hemodynamic parameters were retrieved before, during, and...
CONCLUSION The prospective observational study confirms the relationship between ultrasound assessment of the anterior soft tissues of the neck and difficult laryngoscopy and DMV. DSHB and the other distances extend the available evidence, not only for difficult laryngoscopy but also for DMV. TRIAL REGISTRATION Clinicaltrials.gov. identified NCT03592758.