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1. Awake tracheostomy in a patient with acute upper airway obstruction: an emergency application of an elective percutaneous procedure

Author

Fusco,Pierluigi, Iuorio,Angela, Della Valle,Mirco, and Ferraro,Fausto

Subjects
Open Access Emergency Medicine
Abstract

Pierluigi Fusco, Angela Iuorio, Mirco Della Valle, Fausto FerraroDipartimento Della Donna, Del Bambino, Della Chirurgia Generale e Specialistica, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, IT 80138, ItalyAbstract: Since its introduction in 1985 with Ciaglia, percutaneous tracheostomy (PT) was contraindicated in emergency settings and obesity. However, several case series in the last 20 years have documented the use of PT in life-threatening airway emergencies. We present a case of severe acute airway obstruction in a 66-year-old woman successfully treated with a placement of an awake PT. The woman’s glottic obstruction was caused by a recurrent laryngeal neoplasia and revealed by nasoendoscopy. This acute condition required a serious effort from the patient to oxygenate and thereforeprevented orotracheal intubation as well as the use of any supraglottic device and/or sedation. Blood aspiration after a first attempt to make a quick access to the tracheal lumen with an emergency cricothyroidotomy, and difficulties in the exact identification of tumor infiltration, led us to perform an awake tracheostomy. Due to elevated risk of airway bleeding, we started with a surgical approach to better identify anatomical structures.After the correct inter-tracheal ring space identification, sudden worsening of clinical symptoms required that we complete the procedure quickly with the aid of a Ciaglia Blue Rhino™-Cook (CBR) tracheostomy kit. At the tracheostomy tube placement, the patient quickly resolved her dyspnea and physiological breathing was restored.Keywords: emergency, hypoxia, tracheostomy

Published
2019

2. Caval filters in intensive care: a retrospective study

Author

Ferraro,Fausto, Di Gennaro,Teresa Letizia, Torino,Annarita, Petruzzi,Jole, d'Elia,Anna, Fusco,Pierluigi, Marfella,Raffaele, Lettieri,Biagio, Ferraro,Fausto, Di Gennaro,Teresa Letizia, Torino,Annarita, Petruzzi,Jole, d'Elia,Anna, Fusco,Pierluigi, Marfella,Raffaele, and Lettieri,Biagio

Abstract

F Ferraro,1 TL Di Gennaro,1 A Torino,1 J Petruzzi,1 A d’Elia,1 P Fusco,1 R Marfella,2 B Lettieri1 1Department of Anesthesiological, Surgical and Emergency Sciences, 2Department of Geriatrics and Metabolic Diseases, Second University of Naples, Naples, Italy Aim: To evaluate the effectiveness of a caval vein filter (CVF) peri-implant monitoring protocol in order to reduce pulmonary embolism (PE) mortality and CVF-related morbidity.Background: The reduction in mortality from PE associated with the use of CVF is affected by the risk of increase in morbidity. Therefore, CVF implant is a challenging prophylactic or therapeutic option. Nowadays, we have many different devices whose rational use, by applying a strict peri-implant monitoring protocol, could be safe and effective.Materials and methods: We retrospectively studied 62 patients of a general Intensive Care Unit (ICU) scheduled for definitive, temporary, or optional bedside CVF implant. A peri-implant monitoring protocol including a phlebocavography, an echo-Doppler examination, and coagulation tests was adopted.Results: In our study, no thromboembolic recurrence was registered. We implanted 48 retrievable and only 20 definitive CVFs. Endothelial adhesion (18%), residual clot (5%), cranial or caudal migration (6%), microbial colonization of the filter in the absence of clinical signs of infection (1%), caval thrombosis (1%), and pneumothorax (1%) were reported. Deep-vein thrombosis (DVT) was reported (8%) as early complication. All patients with DVT had a temporary or optional filter implanted. However, in our cohort, definitive CVFs were reserved only to 32% of patients and they were not associated with DVT as complication.Conclusion: CVF significantly reduces iatrogenic PE without affecting mortality. Generally, ICU patients have a transitory thromboembolic risk, and so the temporary CVF has been proved to be a first-line option to our cohort. A careful monitoring may contribute to a satisfactory outco

Published
2014

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