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Background: Tracheostomy tube changes are a considerable part of the management of patients with tracheostomy and are necessary for preventing aspiration pneumonia, especially in patients with long‐term tracheostomy. The process of tracheostomy tube changes in many patients may not be timely, safe or efficient. Aim: The objectives were to implement a quality improvement intervention that reduces the incidence of aspiration pneumonia in patients with tracheostomy, improve staff knowledge about tracheostomy tube changes and improve staff adherence to documentation. Methods: A pre‐post intervention design was used in this quality improvement project. We created a change strategy bundle that included identification of the need for and observation determination of the timing of tube changes timing, change assessments, identification of the person and location, preparation, co‐operation and maintenance. A tracheostomy tube change workflow was also created. Then, the intervention was implemented in the clinic after staff training. The incidence of aspiration pneumonia, staff knowledge and staff adherence were compared before and after the intervention. Results: Two hundred and 20 patients were enrolled (105 in the preintervention group; 115 in the postintervention group) with 88 tracheostomy tube change episodes (23 in the preintervention group; 65 in the postintervention group). Thirty‐five staff members completed the training and surveys. The incidence of pneumonia decreased from 43.8% to 27.8% after the intervention (p =.013). The knowledge score of staff increased from 46.57 ± 11.10 to 88.14 ± 6.76, and the implementation rate of the audit increased to 67.32%–100%. Conclusions: This quality improvement project regarding tracheostomy changes reduced the incidence of pneumonia, increased staff knowledge about tracheostomy tube changes and improved staff adherence. Relevance to Clinical Practice: A standardized tracheostomy tube change bundle, education, interprofessional collaboration and culture changes were important to ensure the best outcomes in this quality improvement project. These factors improved the timeliness, efficiency and safety of tracheostomy tube changes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the utility of ordering chest x‐rays after pediatric tracheostomy tube placement in identifying acute, post‐operative complications and how it impacts clinical decision‐making. Methods: In this retrospective cohort study, we identified tracheostomies performed in 139 pediatric patients through CPT codes over a 5‐year period from 2013 to 2018. Manual chart review was performed for demographic and clinical characteristics, pre‐procedure and post‐procedure chest x‐ray interpretations, and the presence of complications. Each complication was reviewed to see if action was taken due to post‐procedure chest x‐ray findings. Multivariable logistic regression was performed to determine associations with changes in pre‐procedure versus post‐procedure chest x‐rays. Results: In a cohort of 139 pediatric patients with pre‐procedure and post‐procedure chest x‐rays, 40 (28.8%) of patients had new significant post‐procedure chest x‐ray findings compared to pre‐procedure chest x‐ray findings. Of these 40 instances of changes in pre‐procedure versus post‐procedure chest x‐ray findings, only eight resulted in action being taken due to the observed findings. Among these eight instances of action being taken, only one instance involved in invasive action being taken with a bronchoscopy. With multivariable regression analysis, patient age, race, gender, and the presences of genetic syndromes, were not found to be significant risk factors in predicting changes in pre‐procedure versus post‐procedure chest x‐ray. Conclusion: In our study, post‐procedure chest x‐ray after tracheostomy tube placement did not significantly impact clinical decision making. It may be worth reconsidering the value in routine chest x‐rays after tracheostomy tube placement in pediatric patients. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objective To evaluate the utility of ordering chest x‐rays after pediatric tracheostomy tube placement in identifying acute, post‐operative complications and how it impacts clinical decision‐making. Methods In this retrospective cohort study, we identified tracheostomies performed in 139 pediatric patients through CPT codes over a 5‐year period from 2013 to 2018. Manual chart review was performed for demographic and clinical characteristics, pre‐procedure and post‐procedure chest x‐ray interpretations, and the presence of complications. Each complication was reviewed to see if action was taken due to post‐procedure chest x‐ray findings. Multivariable logistic regression was performed to determine associations with changes in pre‐procedure versus post‐procedure chest x‐rays. Results In a cohort of 139 pediatric patients with pre‐procedure and post‐procedure chest x‐rays, 40 (28.8%) of patients had new significant post‐procedure chest x‐ray findings compared to pre‐procedure chest x‐ray findings. Of these 40 instances of changes in pre‐procedure versus post‐procedure chest x‐ray findings, only eight resulted in action being taken due to the observed findings. Among these eight instances of action being taken, only one instance involved in invasive action being taken with a bronchoscopy. With multivariable regression analysis, patient age, race, gender, and the presences of genetic syndromes, were not found to be significant risk factors in predicting changes in pre‐procedure versus post‐procedure chest x‐ray. Conclusion In our study, post‐procedure chest x‐ray after tracheostomy tube placement did not significantly impact clinical decision making. It may be worth reconsidering the value in routine chest x‐rays after tracheostomy tube placement in pediatric patients.

Tracheal air leak during mechanical ventilation in critical care units, especially when coupled with pulmonary parenchymal pathology, causes life-threatening hypoxemia and hypercapnia. Assuming the air leak is related exclusively to the cuff itself is a common clinical practice. The broad differential diagnosis for the air leak demands an understanding of the variable etiologies so that corrective measures can be undertaken. Here, we present a case of air leak following a tracheostomy tube (TT) cuff herniating anteriorly into the peri-tracheostomy site. [ABSTRACT FROM AUTHOR]

Introduction: Proper management of aspirated material above the tracheostomy tube cuff is crucial to prevent complications, such as aspiration pneumonia. This study aimed to thoroughly examine the effects of aspirated liquid viscosity, suction port positioning, and tube tilt angle on residual volume above the cuff (RVAC). Methods: Five types of tracheostomy tubes (approximately 9 mm outer diameter) were placed through a transparent cylinder with an inner diameter of 18 mm. The cuff was inflated to completely seal the interior of the cylinder. Four liquids with different viscosities were poured onto the cuff, and the liquid above the cuff was suctioned from the side port. The cylinder was angled at 90° and 20°, and each test was performed thrice to determine the average RVAC. Results: After side-port suctioning, some liquid residue was observed on the cuff of all tracheostomy tubes. The RVAC increased with higher liquid viscosity. The tubes with a longer distance from the suction port opening to the cuff top exhibited more RVAC. Moreover, the RVAC was almost the same regardless of the cylinder angle for tubes with a suction port on the lateral side. However, tubes with backside ports showed a decreased RVAC with cylinder tilt. Conclusions: This study underscores the persistence of residual material on cuffed tracheostomy tubes even with regular subglottic secretion drainage. This emphasizes the need for specialized tracheostomy tube development aimed at reducing post-suction RVAC. Improved designs can potentially minimize complications associated with residue accumulation. [ABSTRACT FROM AUTHOR]

Objective: To compare the outcomes of using a tracheostomy tie between a traditional cotton tape tracheostomy tie, and an innovative model, applied from a suction tube. Materials and Methods: One hundred sixty-four patients that underwent tracheostomy tube replacement between June 2022 and March 2023 at Sawanpracharak Hospital, Nakhonsawan Province, were analyzed by the ENT group. Eighty-two cases were randomly divided into groups using traditional tracheostomy ties of cotton tape and 82 cases using an innovative suction tube as a tracheostomy tie. The general data of the patients were evaluated using descriptive statistics. For comparison of differences between the two groups of data, categorical data was analyzed by chisquare and continuous data was analyzed by independent t-test and VAS score was analyzed by Mann-Whitney test. A p-value of less than 0.05 was considered as a statistically significant difference. Results: The result of the study showed that age and gender did not have statistically significant differences in both groups of patients. In the group that received the tracheostomy tie, the tracheostomy tube displacement was more frequent, and there was more dirt and moisture around the tracheostomy tie than in the group that received an innovative tracheostomy tie with a suction tube. This was statistically significant. Patients and caring nurses were statistically significantly more satisfied using the innovative tracheostomy tie made by a suction tube. Conclusion: A suction tube is an ideal alternative material for personal care, reducing superficial injury of the skin and reducing the risk of accidental decannulation. The tracheostomy tie made of a suction tube is considered an alternative use. [ABSTRACT FROM AUTHOR]

Background: A significant number of patients with severe respiratory failure related to COVID-19 require prolonged mechanical ventilation. Minimal data exists regarding the timing, safety, and efficacy of combined bedside percutaneous tracheostomy and endoscopy gastrostomy tube placement in these patients. The safety for healthcare providers is also in question. This study's objective was to evaluate the effectiveness and safety of combined bedside tracheostomy and gastrostomy tube placement in COVID-19 patients. Design and Methods: This is a single arm, prospective cohort study in patients with COVID-19 and acute respiratory failure requiring prolonged mechanical ventilation who underwent bedside tracheostomy and percutaneous endoscopic gastrostomy placement. Detailed clinical and procedural data were collected. Descriptive statistics were employed and time to event curves were estimated and plotted using the Kaplan Meier method for clinically relevant prespecified endpoints. Results: Among 58 patients, the median total intensive care unit (ICU) length of stay was 29 days (24.7-33.3) with a median of 10 days (6.3-13.7) postprocedure. Nearly 88% of patients were weaned from mechanical ventilation postprocedure at a median of 9 days (6-12); 94% of these were decannulated. Sixty-day mortality was 10.3%. Almost 90% of patients were discharged alive from the hospital. All procedures were done at bedside with no patient transfer required out of the ICU. A median of 3.0 healthcare personnel total were present in the room per procedure. Conclusion: This study shows that survival of critically ill COVID-19 patients after tracheostomy and gastrostomy was nearly 90%. The time-to-event curves are encouraging regarding time to weaning, downsizing, decannulation, and discharge. A combined procedure minimizes the risk of virus transmission to healthcare providers in addition to decreasing the number of anesthetic episodes, transfusions, and transfers patients must undergo. This approach should be considered in critically ill COVID-19 patients requiring prolonged mechanical ventilation.

A 61-year-old male patient diagnosed with Coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) was managed with tracheostomy and intermittent prone positioning in the intensive care unit. After a sudden deterioration, examination of tracheostomy tube (TT) and X-ray of the chest revealed that he had aspirated the fractured TT. The fractured tube was removed through the tracheostomy stoma using a rigid ventilating bronchoscope and forceps. Prone positioning is a beneficial postural therapy capable of improving patient oxygenation. However, it has some complications, like unplanned extubation and facial tissue injury. Percutaneous tracheostomy is also a valuable and safe procedure and has been increasingly performed in critical care patients, including those who suffer from COVID-19 ARDS. Fractures and aspiration of a tracheostomy tube can occur anytime after tracheostomy. We think prone positioning may contribute to the rupture and aspiration of the tracheostomy tube in this study.

A 61-year-old male patient diagnosed with Coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) was managed with tracheostomy and intermittent prone positioning in the intensive care unit. After a sudden deterioration, examination of tracheostomy tube (TT) and X-ray of the chest revealed that he had aspirated the fractured TT. The fractured tube was removed through the tracheostomy stoma using a rigid ventilating bronchoscope and forceps. Prone positioning is a beneficial postural therapy capable of improving patient oxygenation. However, it has some complications, like unplanned extubation and facial tissue injury. Percutaneous tracheostomy is also a valuable and safe procedure and has been increasingly performed in critical care patients, including those who suffer from COVID-19 ARDS. Fractures and aspiration of a tracheostomy tube can occur anytime after tracheostomy. We think prone positioning may contribute to the rupture and aspiration of the tracheostomy tube in this study. [ABSTRACT FROM AUTHOR]

Abstract Background Tracheostomy tube capping is a commonly used test to determine if the tracheostomy tube can be removed. The success of the capping trial depends on the patient’s ability to maintain sufficient spontaneous breathing with an occluded tracheostomy tube. The impact of an occluded tracheotomy tube on airway resistance is currently unknown. The aim of this study was to investigate tracheal pressure during capping or stoma button insertion and potential determinants concerning cuff. Methods Eight cuffed and uncuffed tracheostomy tubes and three stoma buttons of various manufacturers and sizes were inserted into the trachea model. Cuffs were completely deflated or contained atmospheric pressure. The trachea was ventilated bidirectional with a respirator in volume-controlled mode and volume flows 15–60 L/min. Tracheal pressure drop during inspiration as a parameter of pressure required to move gas through the airway was measured. Results Tracheal pressure drops occurred linearly or irregularly during capping trials to a maximum of 4.2 kPa at flow rates of 60 L/min for atmospheric pressure cuffs. In tracheostomy tubes with completely deflated cuffs, pressure drop in the trachea reaches a maximum of 3.4 kPa at a flow rate of 60 L/min. For tracheostomy tubes with cuff smaller inner or outer diameters do not regularly result in lower tracheal pressure drop. The pressure drop varies between different tracheostomy tubes depending on the manufacturer. In cuffed tracheostomy tubes, we observed three phenomena: sail-like positioning, folding over, and tightening of the cuff during flow. The maximum tracheal pressure drop during stoma button insertion reaches 0.014 kPa. Conclusions The cuff is a central element for the pressure drop in the airway and thus airway resistance during spontaneous translaryngeal breathing with a capped TT. Complete deflation reduces the pressure drop in the trachea. Due to deformation of the cuff, measured pressures are irregular as the volume flow is increased. Incomplete deflated cuffs and material characteristics of tracheostomy tubes and cuffs in addition to anatomical and clinical variables may cause unsuccessful capping trials due to increased airway resistance. All stoma buttons showed that pressure drop and thus airway resistance due to stoma buttons has no clinical relevance.

Background: The use of nanotechnology in the production of medical equipment has opened new possibilities to fight bacterial biofilm developing on their surfaces, which can cause infectious complications. In this study, we decided to use gentamicin nanoparticles. An ultrasonic technique was used for their synthesis and immediate deposition onto the surface of tracheostomy tubes, and their effect on bacterial biofilm formation was evaluated. Methods: Polyvinyl chloride was functionalized using oxygen plasma followed by sonochemical formation and the embedment of gentamicin nanoparticles. The resulting surfaces were characterized with the use of AFM, WCA, NTA, FTIR and evaluated for cytotoxicity with the use of A549 cell line and for bacterial adhesion using reference strains of S. aureus (ATCC® 25923™) and E. coli (ATCC® 25922™). Results: The use of gentamicin nanoparticles significantly reduced the adhesion of bacterial colonies on the surface of the tracheostomy tube for S. aureus from 6 × 105 CFU/mL to 5 × 103 CFU/mL and for E. coli from 1.655 × 105 CFU/mL to 2 × 101 CFU/mL, and the functionalized surfaces did not show a cytotoxic effect on A549 cells (ATTC CCL 185). Conclusions: The use of gentamicin nanoparticles on the polyvinyl chloride surface may be an additional supporting method for patients after tracheostomy in order to prevent the colonization of the biomaterial by potentially pathogenic microorganisms. [ABSTRACT FROM AUTHOR]

Dear Editor, The term "Decannulation" refers to the process of weaning which involves removal of tracheostomy tube and maintaining spontaneous respiration with airway protection. This step though appears very simple requires a near normal neuromuscular coordination for effective cough reflex, phonation, swallowing and respiration. Standard protocol (clearance from the primary care physician/surgeon,psychological counselling and endoscopy (retrograde or transnasal) to visualise the laryngeal air column) should be followed during this process before planning closure. It will help to prevent complication which can become life threatening. Tracheostomy tube plays a major role as the patient has to be spigotted. Spigotting is a process of closing the tracheostomy tube while maintaining the tube in-situ. It is a preparatory procedure before decannulation to assess the patients airway. Patient was encouraged to breathe normally through the nose, via the port in the tube while maintaining the track. All normal activities should be encouraged during spigotting to check the anatomical patency of airway and physiological respiratory effort by the patient. The reasons for failed decannulation include elderly patients, obesity, infections, poor neurological coordination, tenacious secretions with poor cough reflex,small size Shiley tube and subglottic granulations [1,2]. The method of decannulation varies depending on the patient, clinical scenario and the facilities available. While some authors preferred tracheostomy tube occlusion after downsizing the fenestrated tubes or changing to non fenestrated tube before closure [2,3], others directly cap the tracheostomy tube without downsizing [4]. In some hospitals, the tracheostomy tube is removed directly [5]. Here, the author would like to highlight her experience and difficulties during decannulation in two patients, one due to obesity and other due to improper care during spigotting. Both the cases were appropriate candidates for removal of tube but problems were encountered. Case 1 A 52-year-old obese female patient weighing around 90 kg was intubated for Chronic Obstructive Pulmonary Disease (COPD) with retained secretions. To aid regular suctioning, tracheostomy was done five days later, five patients was on tracheostomy tube for 25 days. Once the primary cause was resolved decannulation was planned. Standard protocol followed. Spigotting was attempted with 6 size double lumen Shiley tracheostomy tube but, the patient did not with stand spigotting for more than 30 minutes. Computed Tomography (CT) neck was done and there was no narrowing of subglottic and laryngeal air column. On flexible bronchoscopy the port of Shiley was not visible in tracheal lumen. As the patient was very obese with short neck, the curvature of tube was not enough and the port was in the subcutaneous tissue. Since, there was lot of intraluminal space round the tracheostomy tube, patient withstood closure for around 30 minutes and after that developed desaturation [Table/Fig-1]. In this patient, the author changed Shiley’s to Fuller’s biphlanged metal tube. Since, here the outer tube is biphlanged, there was effective communication between upper and lower airway and not on small single port like Shiley tube. Spigotting was done only with the outer tube in place to maintain the track. Decannulation was done after 48 hours and it was uneventful. Case 2 A 65-year-old male patient who met with Road Traffic Accident (RTA). Burr hole craniotomy was done. Glasgow Coma Scale (GCS) score of patient was low. Patient was on ventilator support for four months so that, surgical tracheostomy was done. Once the primary condition was resolved patient was referred for closure. Without following standard protocols spigotting was done and the patient was sent home for two days. On the 3rd day, patient came to hospital and as the patient said, he was comfortable so that, decannulation was done and sent home. Five hours later, patient presented in emergency room with respiratory difficulty so that, emergency intubation was done. Then on retrograde clinical evaluation, patient revealed that, he was not comfortable with closure and every one hour, was removing the spigott and did not close the tracheostomy tube in night. Then on flexible bronchoscopy, there was subglottic stenosis with narrowing of air column. Revision tracheostomy was done. Patient was explained about the condition and the need for surgical laryngeal and tracheal reconstruction. Patient was not willing and went to home town with the tube. Decannulation is a procedure to remove the tracheostomy tube, close the stoma and allow the patient spontaneous breathing through the nose. It has to be done meticulously with proper planning, as it can lead to emergency situations. This is mainly documented to stress that, decannulation is equally important and life saving like tracheostomy and all medical and paramedical should be trained in it.

Background: Tracheostomy tube capping is a commonly used test to determine if the tracheostomy tube can be removed. The success of the capping trial depends on the patient's ability to maintain sufficient spontaneous breathing with an occluded tracheostomy tube. The impact of an occluded tracheotomy tube on airway resistance is currently unknown. The aim of this study was to investigate tracheal pressure during capping or stoma button insertion and potential determinants concerning cuff. Methods: Eight cuffed and uncuffed tracheostomy tubes and three stoma buttons of various manufacturers and sizes were inserted into the trachea model. Cuffs were completely deflated or contained atmospheric pressure. The trachea was ventilated bidirectional with a respirator in volume-controlled mode and volume flows 15–60 L/min. Tracheal pressure drop during inspiration as a parameter of pressure required to move gas through the airway was measured. Results: Tracheal pressure drops occurred linearly or irregularly during capping trials to a maximum of 4.2 kPa at flow rates of 60 L/min for atmospheric pressure cuffs. In tracheostomy tubes with completely deflated cuffs, pressure drop in the trachea reaches a maximum of 3.4 kPa at a flow rate of 60 L/min. For tracheostomy tubes with cuff smaller inner or outer diameters do not regularly result in lower tracheal pressure drop. The pressure drop varies between different tracheostomy tubes depending on the manufacturer. In cuffed tracheostomy tubes, we observed three phenomena: sail-like positioning, folding over, and tightening of the cuff during flow. The maximum tracheal pressure drop during stoma button insertion reaches 0.014 kPa. Conclusions: The cuff is a central element for the pressure drop in the airway and thus airway resistance during spontaneous translaryngeal breathing with a capped TT. Complete deflation reduces the pressure drop in the trachea. Due to deformation of the cuff, measured pressures are irregular as the volume flow is increased. Incomplete deflated cuffs and material characteristics of tracheostomy tubes and cuffs in addition to anatomical and clinical variables may cause unsuccessful capping trials due to increased airway resistance. All stoma buttons showed that pressure drop and thus airway resistance due to stoma buttons has no clinical relevance. [ABSTRACT FROM AUTHOR]

Abstract Background Surgery to prevent aspiration has complications related to tracheostomy tube, such as the trachea-brachiocephalic artery fistula. Glottic closure procedure makes tracheostoma at a position higher than the first ring of the trachea and theoretically has a potential to prevent such complications owing to a longer distance between the tip of tracheostomy tube and the tracheal membrane adjacent to the brachiocephalic artery. Our aim is to evaluate the safety of glottic closure in neurologically impaired patients by comparing outcomes with laryngotracheal separation. Methods This study is a single-center retrospective study from 2004 to 2019, using data of 15 and 12 patients who underwent glottic closure (GC) and laryngotracheal separation (LTS). The primary outcome was the incidence of postoperative complications induced by tracheostomy tube placement and adjustment of the tracheostomy tube position to prevent these complications, such as by converting to a length-adjustable tube and/or placing gauze between the skin and tube flange. Additionally, we analyzed the anatomical relationship between the tracheostomy tube tip and brachiocephalic artery and measured the distance between them using postoperative CT images. Results No patients in either group had trachea-brachiocephalic artery fistula. Erosion or granuloma formation occurred in 1 patient (7%) and 4 patients (33%) in the GC and LTS groups, respectively. Adjustment of the tracheostomy tube was needed in 2 patients (13%) and 6 patients (50%) in the GC and LTS groups. CT revealed a higher proportion of patients with the tracheostomy tube tip superior to the brachiocephalic artery in GC than LTS group. The mean tracheostoma-brachiocephalic artery distance was 40.8 and 32.4 mm in the GC and LTS groups. Conclusions Glottic closure reduces the risk of postoperative complications related to a tracheostomy tube. This may be due to the higher position of the tracheostoma at the level of the cricoid cartilage, increasing the distance between the tracheostoma and brachiocephalic artery.

Tracheostomy a lifesaving procedure done more frequently for critically ill patients for mechanical ventilation, bronchopulmonary toileting, reduce pulmonary effort has variable complications to itself. The common being secondary infection with bacteria and fungi, which in turn lead to granulation formation in stoma and on peristomal region. This prospective study was done with an aim to study, correlate and compare the microbial organisms grown in culture from tracheostomy tubes and peristomal granulation in ventilated and non-ventilated patient. We studied 210 patients out of them 100 patients satisfied the inclusion and exclusion criteria and they were included in this study. We found 89 patients staining positive for bacterial cultures and 8 patients staining positive for fungi and the granulation increases as the time taken for tube change is more than 1 month. So, we concluded it is ideal to change tracheostomy tube within a month duration and most common organism complicating infection in stoma as Pseudomonas aeruginosa followed by coagulase negative Staphylococcus aureus. [ABSTRACT FROM AUTHOR]

Introduction: In hospitalized patients, tracheostomy tubes (TTs) are susceptible to colonization by biofilm- producing potentially pathogenic microorganisms (PPMs). Contact with TTs, which are situated in a critical region of the body with enormous microbial exposure, may lead to the emer-gence of resistant respiratory infections. Objective: Our study aimed to isolate and identify Gram-positive and Gram-negative PPMs, mark their antibiotic resistance and determine the bacteriological pattern of the biofilm colonizing the TTs. Methods: The study was conducted on 45 tracheostomy tubes obtained from 45 hospitalized adult patients with tracheostomy with intubation periods ranging from 1 to 28 days. Tracheal aspirates (TA) obtained from polyvinyl chloride (PVC) TTs were used for the analysis. Bacteria in biofilms were identified by standard microbiological techniques, tested for antibiotic resistance and phenotypic resistance according to the EUCAST guidelines and visualized by SEM. Results: Out of 45 TTs, 100% were found to be positive in bacterial cultures with 58 PPM isolates (10 spe-cies) correlating well with the SEM findings. Overall, 72% of isolates were Gram-negative bacilli, followed by Gram-positive cocci (28%). Staphylococcus aureus was the predominant bacterium (identified in 35.5% of patients), followed by Klebsiella pneumoniae (identified in 23.8%). Among the Gram-negative PPMs, 50% of isolates were identified as multidrug-resistant (MDR), 8.6% as extremely drug-resistant (XDR) and 5.2% were pandrug-resistant (PDR). Conclusions: Our study showed a rapid colonization of the TT surface by biofilm- producing PPMs. Patients with tracheostomies, also those with non-infectious conditions, were mainly colonized with highly re-sistant bacteria. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this project was to develop a novel airway-exchange broncholaryngoscope (AEBLScope) to improve the efficiency and accuracy of airway-exchange procedures., Methods: The AEBLScope was designed to combine a bronchoscope and airway-exchange catheter (AEC) into a single device and to reduce the blind placement of AECs. The prototype was constructed by modifying an existing distal-chip bronchoscope. A custom AEC was procured to fit concentrically over the flexible portion of the scope. The catheter was connected to the scope handpiece by a customized push-pull locking attachment. The AEBLScope was used to perform airway-exchange procedures with both tracheostomy and endotracheal tubes using two different airway models. Experimental procedures were recorded with still photography to evaluate the exchange of tubes and placement of AECs., Results: In two airway models using the AEBLScope, both tracheostomy and endotracheal tubes were successfully exchanged on first-pass attempt, and AECs were accurately placed under visual guidance., Conclusion: The AEBLScope combines a bronchoscope and AEC into a single tool. Based on these first results, this novel scope has the potential to perform airway-exchange procedures more safely compared with standard procedures by increasing the accuracy of placement, decreasing procedural time, and reducing the morbidity and mortality that can occur from blind placement of AECs., Level of Evidence: NA Laryngoscope, 134:4488-4493, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Copyright of Nouveau Praticien Vétérinaire Canine & Féline is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Bacterial biofilm on the surface of tracheostomy tubes (TTs) is a potential reservoir of potentially pathogenic bacteria, including S. aureus. For this reason, our study aimed to investigate biofilm production in vitro and the presence of icaAD and MSCRAMM genes in clinical S. aureus strains derived from TTs, with respect to antibiotic resistance and genetic variability. Methods: The clonality of the S. aureus strains was analyzed by the PFGE method. The assessment of drug resistance was based on the EUCAST recommendations. The isolates were evaluated for biofilm production by the microtiter plate method and the slime-forming ability was tested on Congo red agar (CRA). The presence of icaAD genes was investigated by PCR and MSCRAMM genes were detected by multiplex PCR. Results: A total of 60 patients were enrolled in the study. One TT was obtained from each patient (n = 60). Twenty-one TTs (35%) were colonized with S. aureus. A total of 24 strains were isolated as 3 patients showed colonization with 2 SA clones (as confirmed by PFGE). PFGE showed twenty-two unique molecular profiles. Two isolates (8%) turned out to be MRSA, but 50% were resistant to chloramphenicol, 25% to erythromycin and 8% to clindamycin (two cMLSB and four iMLSB phenotypes were detected). The microtiter plate method with crystal violet confirmed that 96% of the strains were biofilm formers. Representative strains were visualized by SEM. All isolates had clfAB, fnbA, ebpS and icaAD. Different MSCRAMM gene combinations were observed. Conclusions: the present study showed that the S. aureus isolated from the TTs has a high diversity of genotypes, a high level of antibiotic resistance and ability to produce biofilm. [ABSTRACT FROM AUTHOR]

Abstract Background Tracheostomy is widely used for securing the airway; however, complications do occur. One such rare complication is a fracture of the tracheostomy tube which presents as a foreign body of the tracheobronchial tree. Case presentation We report a case of a 7-year-old child who presented with mild respiratory distress following fracture and migration of non-metallic tracheostomy tube in the airway. Successful removal was done via rigid bronchoscopy under general anaesthesia. Conclusion Careful inspection of the tracheostomy tube before placing and appropriate tracheostomy care is the cornerstone to prevent such rare complications associated with a tracheostomy.

A tracheostomy involves opening the airway Early operations aimed at relieving obstructions. The Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Background: In tracheostomies, the use of tubes with appropriate bending angles and flange-to-angle lengths (FtLs) is essential to avoid complications. Objective: To assessed computed tomography (CT) scans of the normal anatomy of individuals to determine the appropriate bending angles and FtLs. Materials and Methods: Three-hundred thirty-eight patients underwent CT between January 2012 and July 2018, and their neck anatomy, include larynx and trachea, could be clearly visualized. The bending angle and FtL were measured using the standard measuring tools. Data were analyzed. A p-value of less than 0.05 indicated significant differences. Results: The median age was 53 years. The median body mass index was 21.16 kg/m² in men and 22.04 kg/m² in women. The median bending angle was 102° in both genders, and the difference between genders was not significant. The median FtL was 19.93 mm in males and 21.68 mm in females, and the difference between genders was significant (U=10,461, z=-3.58, p<0.001). The bending angle and FtL showed a statistically significant medium positive correlation. Conclusion: Females had significant deeper tracheal area than males at 21.68 mm versus 19.93 mm. There was a positive correlation between the bending angle and the FtL. The median bending angle was 102° in both genders. [ABSTRACT FROM AUTHOR]

The management of patients with tracheostomy requires specific knowledge and skills of the multidisciplinary team which takes care of them. If the clinical conditions make it possible, in addition to weaning the patient from mechanical ventilation, the aim of the intervention should also be to wean the patient from the tracheostomy tube. The presence in the team of professionals such as the respiratory physiotherapist makes it possible to reduce the incidence of adverse events and to improve patient outcomes through a more effective evaluation and intervention process. [ABSTRACT FROM AUTHOR]

ObjectiveHypopharyngeal cancer is managed by either surgical resection or radiation therapy-based treatment. In choosing the treatment modality, the patient’s swallowing function should be considered to achieve optimal treatment outcomes. This study aimed to stratify the risk factors predictive of postoperative dysphagia in hypopharyngeal cancer.Study DesignRetrospective study.SettingTertiary referral center.MethodsWe enrolled 100 patients who were diagnosed with hypopharyngeal cancer and underwent curative surgery between January 2010 and December 2019, and retrospectively reviewed their medical records.ResultsPostoperative dysphagia occurred in 29 patients (29%) who required a tracheostomy tube or percutaneous gastrostomy tube for feeding or preventing aspiration; additionally, the overall survival rate was lower in those patients than in those without dysphagia. The univariate analysis revealed that postoperative dysphagia was associated with clinical T stage (p = 0.016), N stage (p = 0.002), and surgical resection extent of the larynx and pharynx (p

Background: Surgery to prevent aspiration has complications related to tracheostomy tube, such as the trachea-brachiocephalic artery fistula. Glottic closure procedure makes tracheostoma at a position higher than the first ring of the trachea and theoretically has a potential to prevent such complications owing to a longer distance between the tip of tracheostomy tube and the tracheal membrane adjacent to the brachiocephalic artery. Our aim is to evaluate the safety of glottic closure in neurologically impaired patients by comparing outcomes with laryngotracheal separation.Methods: This study is a single-center retrospective study from 2004 to 2019, using data of 15 and 12 patients who underwent glottic closure (GC) and laryngotracheal separation (LTS). The primary outcome was the incidence of postoperative complications induced by tracheostomy tube placement and adjustment of the tracheostomy tube position to prevent these complications, such as by converting to a length-adjustable tube and/or placing gauze between the skin and tube flange. Additionally, we analyzed the anatomical relationship between the tracheostomy tube tip and brachiocephalic artery and measured the distance between them using postoperative CT images.Results: No patients in either group had trachea-brachiocephalic artery fistula. Erosion or granuloma formation occurred in 1 patient (7%) and 4 patients (33%) in the GC and LTS groups, respectively. Adjustment of the tracheostomy tube was needed in 2 patients (13%) and 6 patients (50%) in the GC and LTS groups. CT revealed a higher proportion of patients with the tracheostomy tube tip superior to the brachiocephalic artery in GC than LTS group. The mean tracheostoma-brachiocephalic artery distance was 40.8 and 32.4 mm in the GC and LTS groups.Conclusions: Glottic closure reduces the risk of postoperative complications related to a tracheostomy tube. This may be due to the higher position of the tracheostoma at the level of the cricoid cartilage, increasing the distance between the tracheostoma and brachiocephalic artery. [ABSTRACT FROM AUTHOR]

Introduction: Patients with COVID-19 ARDS require significant amounts of sedation and analgesic medications which can lead to longer hospital/ICU length of stay, delirium, and has been associated with increased mortality. Tracheostomy has been shown to decrease the amount of sedative, anxiolytic and analgesic medications given to patients. The goal of this study was to assess whether tracheostomy decreased sedation and analgesic medication usage, improved markers of activity level and cognitive function, and clinical outcomes in patients with COVID-19 ARDS. Study Design and Methods: A retrospective registry of patients with COVID-19 ARDS who underwent tracheostomy creation at the University of Pennsylvania Health System or the Johns Hopkins Hospital from 3/2020 to 12/2020. Patients were grouped into the early (≤14 days, n=31) or late (15+days, n=97) tracheostomy groups and outcome data collected. Results: 128 patients had tracheostomies performed at a mean of 19.4 days, with 66% performed percutaneously at bedside. Mean hourly dose of fentanyl, midazolam, and propofol were all significantly reduced 48-h after tracheostomy: fentanyl (48-h pre-tracheostomy: 94.0 mcg/h, 48-h post-tracheostomy: 64.9 mcg/h, P =.000), midazolam (1.9 mg/h pre vs. 1.2 mg/h post, P= .0012), and propofol (23.3 mcg/kg/h pre vs. 8.4 mcg/kg/h post, P =.0121). There was a significant improvement in mobility score and Glasgow Coma Scale in the 48-h pre- and post-tracheostomy. Comparing the early and late groups, the mean fentanyl dose in the 48-h pre-tracheostomy was significantly higher in the late group than the early group (116.1 mcg/h vs. 35.6 mcg/h, P = .03). ICU length of stay was also shorter in the early group (37.0 vs. 46.2 days, P =.012). Interpretation: This data supports a reduction in sedative and analgesic medications administered and improvement in cognitive and physical activity in the 48-h period post-tracheostomy in COVID-19 ARDS. Further, early tracheostomy may lead to significant reductions in intravenous opiate medication administration, and ICU LOS. [ABSTRACT FROM AUTHOR]

Children with tracheostomies have multiple challenges with respect to achieving normal deglutition. These children may have underlying neurologic or genetic conditions that can predispose to dysphagia, but even in children without underlying comorbidities, the presence of a tracheostomy tube impacts the mechanics of swallowing, leading to difficulty with different consistencies as well as management of normal oral secretions. Intubation prior to tracheostomy also impacts sensation in the upper aerodigestive tract increasing the risk of aspiration. Occlusion of the tracheostomy with a speaking valve or cap improves outcomes in swallow and prognosis for oral feeding., Competing Interests: Disclosure The author has no relevant disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The increasing frequency of S. aureus antimicrobial resistance has spurred interest in identifying alternative therapeutants. We investigated the S. aureus- inhibitory capacity of B. velezensis strains in mouse and bovine models. Among multiple B. velezensis strains that inhibited S. aureus growth in vitro , B. velezensis AP183 provided the most potent inhibition of S. aureus proliferation and bioluminescence in a mouse cutaneous wound (P = 0.02). Histology revealed abundant Gram-positive cocci in control wounds that were reduced in B. velezensis AP183-treated tissues. Experiments were then conducted to evaluate the ability of B. velezensis AP183 to prevent S. aureus biofilm formation on a tracheostomy tube substrate. B. velezensis AP183 could form a biofilm on a tracheostomy tube inner cannula substrate, and that this biofilm was antagonistic to S. aureus colonization. B. velezensis AP183 was also observed to inhibit the growth of S. aureus isolates originated from bovine mastitis cases. To evaluate the inflammatory response of mammary tissue to intramammary inoculation with B. velezensis AP183, we used high dose and low dose inocula in dairy cows. At the high dose, a significant increase in somatic cell count (SCC) and clinical mastitis was observed at all post-inoculation time points (P < 0.01), which resolved quickly compared to S. aureus- induced mastitis; in contrast, the lower dose of B. velezensis AP183 resulted in a slight increase of SCC and no clinical mastitis. In a subsequent experiment, all mammary quarters in four cows were induced to have grade 1 clinical mastitis by intramammary inoculation of a S. aureus mastitis isolate; following mastitis induction, eight quarters were treated with B. velezensis AP183 and milk samples were collected from pretreatment and post-treatment samples for 9 days. In groups treated with B. velezensis AP183, SCC and abundance of S. aureus decreased with significant reductions in S. aureus after 3 days post-inoculation with AP183 (P = 0.04). A milk microbiome analysis revealed significant reductions in S. aureus relative abundance in the AP183-treated group by 8 days post-inoculation (P = 0.02). These data indicate that B. velezensis AP183 can inhibit S. aureus biofilm formation and its proliferation in murine and bovine disease models. [ABSTRACT FROM AUTHOR]

Background: For patients with severe chronic obstructive pulmonary disease under invasive mechanical ventilation, medication for aerosol therapy is delivered through tracheostomy or endotracheal airways. Typically, these medications (such as bronchodilators) are long-acting formulations that are delivered through Soft Mist™ Inhalers (SMI), or Pressurized Metered-Dose Inhalers. The Respimat® SMI has been shown to have increased efficiency because of its slow and prolonged aerosol mist and has gained popularity in clinical settings. However, the Respimat was not designed for drug delivery through artificial airways. Therefore, there is a need for SMI adapters in intensive care for use in mechanical ventilator circuits. The purpose of this study was to evaluate the performance of a new Respimat adapter (ODAPT™ for mechanical ventilator [ODAPT MV]) for use in mechanical ventilator circuits which, in combination with a Pulmodyne T-piece adapter, allows use without interruption of the circuit in case of medication replacement. Methods: Tiotropium delivery to the lungs, using Respimat, was assessed using the ODAPT MV adapter within an in vitro setup, including a three-dimensional printed trachea model and a mechanical ventilator. Medication deposition and losses were investigated using two commonly used tracheostomy tube (TT) sizes (6 and 8 mm inner canula) for two flow rates (45 and 60 L/min) under different conditions (30%–50%. and 100% relative humidity [RH]). Medication delivery using the ODAPT MV adapter was compared with the RTC-26C in-line adapter under similar conditions (8 mm TT size, 100% RH at 45 L/min). Results: It was found that 7.1%–13.4% of the nominal dose (ND) was lost in the ODAPT MV adapter for different TT size, RH, and flow rates used. Higher losses were found in the inhaler's mouthpiece ranging from 15.7% to 29.1% ND. The percentage of the delivered medication reaching the lungs was determined to be 13.7%–18.5% ND delivered without significant differences between the experimental conditions tested. The ODAPT MV performed well compared with the RTC-26C under similar conditions (17.9% and 16.6% ND, respectively). Conclusion: The medication delivered through mechanical ventilation using the ODAPT MV adapter represents about one third the dose delivered directly through the Respimat SMI in vivo. [ABSTRACT FROM AUTHOR]

Background & Problems: The need to use an indwelling nasogastric tube, urinary catheter, or tracheostomy tube (the so-called "three tubes") because of illness or prolonged bedrest is increasing. The functions and effectiveness of these tubes may be maintained only with correct care. Improper care, slippage, obstruction, or infection may in severe cases cause septic shock or even death. Purpose: To increase the completeness of the reverse demonstration of three tubes care instructions by primary caregivers to further improve related care quality. Resolution: Between February 10th and March 31st, 2019, the completeness rates of reverse demonstration of nasogastric tube, urinary catheter, and tracheostomy tube care instructions among the primary caregivers participating in this study were shown to be low, at 42.5%, 38%, and 58.3%, respectively. The plausible causes were: 1. Human: Poor communication, forgetting the care steps, having no time for learning, and fear of performing nasogastric tube rotation; 2. Instrument: Lack of graphic demonstrations in health education materials; 3. Policy: Lack of standards and auditing. The implemented intervention involved creating innovative health-education instruments, videos and flash cards about three tubes care in multiple languages, and straps for holding the urinary catheter and developing standards and an auditing system for the reverse demonstration of three tube care instructions by primary caregivers. Results: The completeness rates for the reverse demonstration of nasogastric tube, urinary catheter, and tracheostomy tube care instructions among the primary caregivers improved to 97.3%, 96.3%, and 95%, respectively. Conclusions: Using the innovative health-education aids and improvements introduced in this study, the ability of primary caregivers to correctly perform the care steps should improve significantly. [ABSTRACT FROM AUTHOR]

Background: Bacterial biofilm on the surface of tracheostomy tubes (TTs) is a potential reservoir of potentially pathogenic bacteria, including S. aureus. For this reason, our study aimed to investigate biofilm production in vitro and the presence of icaAD and MSCRAMM genes in clinical S. aureus strains derived from TTs, with respect to antibiotic resistance and genetic variability. Methods: The clonality of the S. aureus strains was analyzed by the PFGE method. The assessment of drug resistance was based on the EUCAST recommendations. The isolates were evaluated for biofilm production by the microtiter plate method and the slime-forming ability was tested on Congo red agar (CRA). The presence of icaAD genes was investigated by PCR and MSCRAMM genes were detected by multiplex PCR. Results: A total of 60 patients were enrolled in the study. One TT was obtained from each patient (n = 60). Twenty-one TTs (35%) were colonized with S. aureus. A total of 24 strains were isolated as 3 patients showed colonization with 2 SA clones (as confirmed by PFGE). PFGE showed twenty-two unique molecular profiles. Two isolates (8%) turned out to be MRSA, but 50% were resistant to chloramphenicol, 25% to erythromycin and 8% to clindamycin (two cMLSB and four iMLSB phenotypes were detected). The microtiter plate method with crystal violet confirmed that 96% of the strains were biofilm formers. Representative strains were visualized by SEM. All isolates had clfAB, fnbA, ebpS and icaAD. Different MSCRAMM gene combinations were observed. Conclusions: the present study showed that the S. aureus isolated from the TTs has a high diversity of genotypes, a high level of antibiotic resistance and ability to produce biofilm.

Background: Covid-19 pandemic has resulted in the development of severe and persistent respiratory failure requiring long term ventilatory support. This necessitates the need for a reliable and easy to implement tracheostomy protocol given the concern for viral transmission risk to the involved healthcare personnel due to the aerosol generating nature of the procedure. We describe a protocol with unique and novel modifications to the Ciaglia dilatational percutaneous tracheostomy, effectively implemented during the Covid-19 pandemic at our institution. Methods: We describe the baseline characteristics of our initial 11 patients who underwent the procedure. Outlined are the healthcare personnel involved and the steps which are organized into 4 phases: planning, pre-procedure, intra-procedure and post-procedure. We have tracked procedural duration, provider safety as well as the development of new complications. Results: We describe use of this protocol for 11 bedside percutaneous tracheostomies performed on patients with COVID-19. The average total procedural duration as well as incision to tracheostomy tube placement times was 32.6 minutes and 5.8 minutes respectively. All 3 providers performing the tracheostomies remained asymptomatic with negative COVID-19 RT-PCR testing at 3 weeks. Conclusions: We report an efficacious and adaptable protocol for elective bedside percutaneous tracheostomies for patients with persistent ventilatory requirements due to COVID-19 with an intent to provide standardized and safe care for the patient and the involved healthcare personnel. [ABSTRACT FROM AUTHOR]

A temporary tracheostomy tube can be placed to provide short term opening into the airway when the upper aspect of the respiratory system is affected. The upper airway can be affected by trauma, neoplasia, foreign bodies, medical conditions, or anatomical issues for brachycephalic breeds. Nursing care is vitally important to prevent post placement issues and to keep the patient comfortable until the temporary tracheostomy tube can be removed once the patient is suitably recovered. [ABSTRACT FROM AUTHOR]

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The COVID-19 pandemic has profoundly affected health care delivery worldwide. A small yet significant number of patients with respiratory failure will require prolonged mechanical ventilation while recovering from the viral-induced injury. The majority of reports thus far have focused on the epidemiology, clinical factors, and acute care of these patients, with less attention given to the recovery phase and care of those patients requiring extended time on mechanical ventilation. In this paper, we review the procedures and methods to safely care for patients with COVID-19 who require tracheostomy, gastrostomy, weaning from mechanical ventilation, and final decannulation. The guiding principles consist of modifications in the methods of airway care to safely prevent iatrogenesis and to promote safety in patients severely affected by COVID-19, including mitigation of aerosol generation to minimize risk for health care workers. [ABSTRACT FROM AUTHOR]

Objective: Age-based formulas for selecting the appropriate size of tracheostomy tubes in children are based on data on tracheal dimensions. This study aims to measure the tracheal dimensions of Indian children by computerized tomography (CT) and to compare this with the dimensions of age-appropriate tracheostomy tubes.Methods: CT scans of children aged less than 16 years that were taken for indications other than respiratory distress were included. Tracheal diameters at the tracheostomy point and tracheal length from the tracheostomy point to the carina were calculated from the scans. These dimensions were correlated with age, weight, and height. The measurement on the CT scan was used to predict the appropriate size of tracheostomy tube, which was compared with the tracheostomy tube sizes.Results: Two hundred and fourteen CT scans of children aged below 16 years were included in the study. On multiple logistic regression analysis, tracheal diameter correlated well with age and weight (P = 0.04 and 0.001, respectively), whereas tracheal length correlated well with age and height of the child (P = 0.03 and 0 < 0.001, respectively). On comparison with dimensions of the tracheostomy tube, tracheal diameter correlated well, and the length was found to be longer than needed to prevent endobronchial intubation. The regression value was used to predict the size of an ideal tracheostomy tube.Conclusion: Tracheal diameter of Indian children correlates well with the outer diameter of age-appropriate tracheostomy tubes, but the length of these tubes is longer than the ideal length. This would necessitate a change in the design of these tubes.Level Of Evidence: 2b Laryngoscope, 130:1316-1321, 2020. [ABSTRACT FROM AUTHOR]