Diagnosis and conservative management of late tracheotomy complications in chronic ventilator-dependent patients

Ilan, Ophir; Gross, Menachem; Zaltzman, Yacov; Sasson, Ady; Marcus, Esther‐Lee

doi:10.1002/hed.23665

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…TPPV is associated with the risk of specific complications such as life-threatening – although rare – tracheal bleeding, ventilator-associated pneumonia, obstructive mucus plugging or tracheal granuloma formation and stenosis that may increase morbidity and mortality compared to NIV [224-226]. Data on outcomes of long-term tracheostomy ventilation come from cohort studies but have not been systematically analyzed and compared to NIV in a conclusive way [214, 215, 227, 228].…”

Section: Special Situationsmentioning

confidence: 99%

Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

et al. 2020

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Long-term mechanical ventilation is a well-established treatment for chronic hypercapnic respiratory failure (CHRF). It is aimed at improving CHRF-related symptoms, health-related quality of life, survival, and decreasing hospital admissions. In Switzerland, long-term mechanical ventilation has been increasingly used since the 1980s in hospital and home care settings. Over the years, its application has considerably expanded with accumulating evidence of beneficial effects in a broad range of conditions associated with CHRF. Most frequent indications for long-term mechanical ventilation are chronic obstructive pulmonary disease, obesity hypoventilation syndrome, neuromuscular and chest wall diseases. In the current consensus document, the Special Interest Group of the Swiss Society of Pulmonology reviews the most recent scientific literature on long-term mechanical ventilation and provides recommendations adapted to the particular setting of the Swiss healthcare system with a focus on the practice of non-invasive and invasive home ventilation in adults.

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Section: Special Situationsmentioning

confidence: 99%

Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

et al. 2020

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“…Especially, in patient with neuromuscular diseases such as Duchenne muscular dystrophy, suboptimal cannula placement can lead to mild or severe complications [1][2][3][4]. As the disease progresses, the progressive changes in anatomy can worsen problems with cannula positioning.…”

Section: Discussionmentioning

confidence: 99%

“…Beyond discomfort, suboptimal cannula placement may result in inflammation of the trachea, eventually leading to granulation tissue formation, airway obstruction, or even in fatal complications [2]. Several case reports and our own experience have shown patients who had a fistula of the trachea and Bertram J. de Kleijn and Joep Kraeima have equally contributed to the manuscript, therefore, sharing first authorship.…”

Section: Introductionmentioning

confidence: 98%

Virtual 3D planning of tracheostomy placement and clinical applicability of 3D cannula design: a three-step study

Kleijn

Kraeima

Wachters

et al. 2017

Eur Arch Otorhinolaryngol

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Aim We aimed to investigate the potential of 3D virtual planning of tracheostomy tube placement and 3D cannula design to prevent tracheostomy complications due to inadequate cannula position. Materials and methods 3D models of commercially available cannula were positioned in 3D models of the airway. In study (1), a cohort that underwent tracheostomy between 2013 and 2015 was selected (n = 26). The cannula was virtually placed in the airway in the pre-operative CT scan and its position was compared to the cannula position on post-operative CT scans. In study (2), a cohort with neuromuscular disease (n = 14) was analyzed. Virtual cannula placing was performed in CT scans and tested if problems could be anticipated. Finally (3), for a patient with Duchenne muscular dystrophy and complications of conventional tracheostomy cannula, a patient-specific cannula was 3D designed, fabricated, and placed. Results (1) The 3D planned and post-operative tracheostomy position differed significantly. (2) Three groups of patients were identified: (A) normal anatomy; (B) abnormal anatomy, commercially available cannula fits; and (C) abnormal anatomy, custom-made cannula, may be necessary. (3) The position of the custom-designed cannula was optimal and the trachea healed. Conclusions Virtual planning of the tracheostomy did not correlate with actual cannula position. Identifying patients with abnormal airway anatomy in whom commercially available cannula cannot be optimally positioned is advantageous. Patientspecific cannula design based on 3D virtualization of the airway was beneficial in a patient with abnormal airway anatomy.

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“…Tracheostomy‐associated granulation tissue is a common and recurrent problem that occurs in tracheostomy‐dependent patients, attributed to chronic mucosal irritation secondary to the prosthesis. Tracheostomy‐associated granulation tissue occurs in 4% to 80% of all pediatric tracheostomies 1 and can also develop in adult patients requiring tracheostomy for chronic ventilator dependence or laryngotracheal stenosis (LTS) 2,3 . Acutely, tracheostomy‐associated granulation tissue can lead to bleeding, upper airway obstruction, respiratory failure after decannulation, failure to wean from the ventilator, and failure to decannulate 4 .…”

Section: Introductionmentioning

confidence: 99%

“…Tracheostomy-associated granulation tissue occurs in 4% to 80% of all pediatric tracheostomies 1 and can also develop in adult patients requiring tracheostomy for chronic ventilator dependence or laryngotracheal stenosis (LTS). 2,3 Acutely, tracheostomy-associated granulation tissue can lead to bleeding, upper airway obstruction, respiratory failure after decannulation, failure to wean from the ventilator, and failure to decannulate. 4 In the long term, granulation tissue at the site of the tracheostoma promotes circumferential wound contracture and can lead to fibrosis and tracheal stenosis that ultimately require intervention.…”

Section: Introductionmentioning

confidence: 99%

Myeloid Phenotypes in Tracheostomy‐Associated Granulation Tissue

Berges¹,

Ospino²,

Lina³

et al. 2023

The Laryngoscope

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Objective(s)Tracheostomy‐associated granulation tissue is a common, recurrent problem occurring secondary to chronic mucosal irritation. Although granulation tissue is composed of predominantly innate immune cells, the phenotype of monocytes and macrophages in tracheostomy‐associated granulation tissue is unknown. This study aims to define the myeloid cell population in granulation tissue secondary to tracheostomy.MethodsGranulation tissue biopsies were obtained from 8 patients with tracheostomy secondary to laryngotracheal stenosis. Cell type analysis was performed by flow cytometry and gene expression was measured by quantitative real‐time polymerase chain reaction. These methods and immunohistochemistry were used to define the monocyte/macrophage population in granulation tissue and were compared to tracheal autopsy control specimens.ResultsFlow cytometry demonstrated macrophages (CD45+CD11b+) and monocytes (CD45+FSClowSSClow) represent 23.2 ± 6% of the granulation tissue cell population. The M2 phenotype (CD206) is present in 77 ± 11% of the macrophage population and increased compared to the M1 phenotype (p = 0.012). Classical monocytes (CD45+CD14highCD16low) were increased in granulation tissue compared to controls (61.2 ± 7% and 30 ± 8.5%, p = 0.038). Eighty‐five percent of macrophages expressed pro‐inflammatory S100A8/A9 and 36 ± 4% of macrophages co‐localized CD169, associated with tissue‐resident macrophages. M2 gene expression (Arg1/CD206) was increased in granulation tissue (3.7 ± 0.4, p = 0.035 and 3.5 ± 0.5, p = 0.047) whereas M1 gene expression (CD80/CD86) was similar to controls (p = 0.64, p = 0.3). Immunohistochemistry of granulation tissue demonstrated increased cells co‐localizing CD11b and CD206.ConclusionsM2 macrophages are the dominant macrophage phenotype in tracheostomy‐associated granulation tissue. The role of this cell type in promoting ongoing inflammation warrants future investigation to identify potential treatments for granulation tissue secondary to tracheostomy.Level of Evidence3 Laryngoscope, 133:2346–2356, 2023

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Diagnosis and conservative management of late tracheotomy complications in chronic ventilator-dependent patients

Abstract: In nonsurgical candidates, insertion of a longer tube is a conservative and feasible long-term treatment.

Cited by 8 publications

References 26 publications

Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

Long-Term Mechanical Ventilation: Recommendations of the Swiss Society of Pulmonology

Virtual 3D planning of tracheostomy placement and clinical applicability of 3D cannula design: a three-step study

Myeloid Phenotypes in Tracheostomy‐Associated Granulation Tissue

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