Percutaneous Tracheostomy: A Bedside Procedure

Khaja, Misbahuddin; Haider, Asim; Alapati, Anuhya; Qureshi, Zaheer A; Yapor, Laura

doi:10.7759/cureus.24083

Cited by 7 publications

(5 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is a mechanical ventilator setting recommended by the National Institutes of Health (NIH)-National Heart, Lung, and Blood Institute (NHLBI) ARDS Clinical Network Mechanical Ventilation Protocol; it suggests tidal volume should be 4-8 mL/kg of ideal body weight, respiratory rate up to 35 bpm, SpO2 should be 88-95%, plateau pressure less than 30 cmH2O, pH goal should be 7.30-7.45, and inspiratory-to-expiratory time ratio less than 1. Although the current patient presented with a unique presentation of ARDS, she was given a similar therapeutic approach with the goal of effective lung alveolar recruitment [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Segmental Shielding: A Rare Case of Acute Respiratory Distress Syndrome with Middle Lobe Sparing

Altaf,

Bhatt,

Sekhon

et al. 2024

Cureus

View full text Add to dashboard Cite

Acute respiratory distress syndrome (ARDS) presents a formidable challenge in critical care, often resulting in high mortality rates, particularly in severe cases or those compounded by preexisting conditions. Despite substantial advancements in critical care, the heterogeneous nature of ARDS necessitates nuanced clinical approaches. ARDS is generally diagnosed through clinical evaluation, radiographic imaging, and laboratory tests, as well as acute onset, bilateral lung infiltrates on imaging, and a partial pressure of oxygen in arterial blood (PaO2)/fraction of inspiratory oxygen concentration (FiO2) ratio of less than 300 mmHg. Management involves measurements to improve oxygenation and provide mechanical ventilation to assist breathing. The typical manifestation of ARDS is diffuse lung involvement, which affects multiple lobes symmetrically. Here, we report an unusual case of ARDS in a 53-year-old female who was brought into the hospital in an unresponsive state, exhibiting hypoxic and hypotension requiring intubation. Subsequent imaging revealed a distinctive pattern: the preservation of the right middle lobe, diverging from the conventional diffuse pulmonary affliction. This case underscores the need for clinical vigilance and adaptability, as such atypical presentations can confound diagnosis and management, posing unique clinical challenges. This case highlights the importance of recognizing ARDS' diverse presentations. Moreover, understanding the mechanisms behind the lobar sparing could provide greater insight into the disease heterogeneity and guide tailored therapeutic approaches. The imperative for further research into these uncommon presentations is clear, as it may be vital to improving outcomes for a broader spectrum of ARDS patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Segmental Shielding: A Rare Case of Acute Respiratory Distress Syndrome with Middle Lobe Sparing

Altaf,

Bhatt,

Sekhon

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…PDT contributes to the reduction of overall tracheostomy procedure time by eliminating the need for transportation to the operating room and the associated waiting time, as well as the risks associated with general anesthesia. PDT is increasingly considered the procedure of choice due to its efficiency and cost-effectiveness ( 11 - 13 ). Several high-quality prospective randomized studies support the superiority of PDT over surgical techniques in critically ill patient ( 14 - 17 ).…”

Section: Discussionmentioning

confidence: 99%

Optimal methodology for percutaneous dilatational tracheostomy: a comparative analysis between conventional and multidisciplinary approaches utilizing ultrasound, flexible bronchoscopy, and microcatheter puncture in critically ill individuals of diminutive stature—a longitudinal single-institutional experience and retrospective analysis

Lee,

Kim,

et al. 2024

J Thorac Dis

View full text Add to dashboard Cite

“…A PDT is usually selected as a method of choice in critical care patients in a particular study. According to a review by Khaja et al [ 19 ], PDT is a bedside procedure that is safe to perform, has less procedural time, has low cost, and does not need operating schedule time. Also, complications like bleeding and infection are minimal with a percutaneous tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

Tracheostomy-related data from an intensive care unit for two consecutive years before the COVID-19 pandemic

Papaioannou,

Vagiana,

Kotoulas

et al. 2024

World J Methodol

View full text Add to dashboard Cite

BACKGROUND Tracheostomy is commonly used in intensive care unit (ICU) patients who are expected to be on long-term mechanical ventilation or suffer from emergency upper airway obstruction. However, some studies have conflicting findings regarding the optimal technique and its timing and benefits. AIM To provide evidence of practice, characteristics, and outcome concerning tracheostomy in an ICU of a tertiary care hospital. METHODS This was a retrospective cohort study including adult critical care patients in a single ICU for two consecutive years. Patients’ demographic characteristics, severity of illness (APACHE II score), level of consciousness [Glasgow Coma Scale (GCS)], comorbidities, timing and type of tracheostomy procedure performed and outcome were recorded. We defined late as tracheostomy placement after 8 days or no tracheotomy. RESULTS Data of 660 patients were analyzed (median age of 60 years), median APACHE II score of 19 and median GCS score of 12 at admission. Tracheostomy was performed in 115 patients, of whom 63 had early and 52 late procedures. Early tracheostomy was mainly executed in case of altered level of consciousness and severe critical illness polyneuromyopathy, however there were no significant statistical results (47.6% vs 36.5%, P = 0.23) and (23.8% vs 19.2%, P = 0.55) respectively. Regarding the method selected, early surgical tracheostomy (ST) was conducted in patients with maxillofacial injuries (50.0% vs 0.0%, P = 0.033), whereas late surgical tracheostomy was selected for patients with goiter (44.4% vs 0.0% P = 0.033). Patients with early tracheostomy spent significantly fewer days on mechanical ventilation (15.3 ± 8.5 vs 22.8 ± 9.6, P < 0.001) and in ICU in general (18.8 ± 9.1 vs 25.4 ± 11.5, P < 0.001). Percutaneous dilatation tracheostomy (PDT) vs ST was preferable in older critical care patients in the case of Central Nervous System underlying cause of admission (62.5% vs 26.3%, P = 0.004). ST was the method of choice in compromised airway (31.6%, vs 7.3% P = 0.008). A large proportion of patients (88/115) with tracheostomy managed to wean from mechanical ventilation and were transferred out of the ICU (100% vs 17.4%, P < 0.001). CONCLUSION PDT was performed more frequently in our cohort. This technique did not affect mechanical ventilation days, ventilator-associated pneumonia (VAP), ICU length of stay, or survival. No complications were observed in the percutaneous or surgical tracheostomy groups. Patients undergoing early tracheostomy benefited in terms of mechanical ventilation days and ICU length of stay but not of discharge status, presence of VAP, or survival.

show abstract

Percutaneous Tracheostomy: A Bedside Procedure

Cited by 7 publications

References 25 publications

Segmental Shielding: A Rare Case of Acute Respiratory Distress Syndrome with Middle Lobe Sparing

Segmental Shielding: A Rare Case of Acute Respiratory Distress Syndrome with Middle Lobe Sparing

Tracheostomy-related data from an intensive care unit for two consecutive years before the COVID-19 pandemic

Contact Info

Product

Resources

About