Distinctions of Tracheostomy in Patients with Burn Injuries in Neck Region
Authors:
K. Procházková 1; R. Zajíček 2; M. Kendra 2; O. Profant 1
; K. Trnková 1; D. Kolářová 1; O. Bradáč 3; M. Chovanec 1
Authors place of work:
Otorinolaryngolo gická klinika, Univerzita Karlova, 3. lékařská fakulta a Fakultní nemocnice Královské Vinohrady, Praha
1; Klinika popáleninové medicíny, Univerzita Karlova, 3. lékařská fakulta a Fakultní nemocnice Královské Vinohrady, Praha
2; Neurochirurgická a neuroonkologická klinika, Univerzita Karlova, 1. lékařská fakulta a Ústřední vojenská nemocnice, Praha
3
Published in the journal:
Otorinolaryngol Foniatr, 68, 2019, No. 4, pp. 204-210.
Category:
Original Article
Summary
Introduction: Tracheostomy is one of the most frequent surgical procedures in critical care patients. Tracheostomy in burn injury patients is, however, very specific topic. The purpose of our research is the evaluation of such topic.
Methods: We conducted a retrospective study of patients hospitalized at ICU of Department of Burn Injuries at University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University in Prague between 1. 1. 2012 – 31. 12. 2017, who underwent tracheostomy performed by an otorhinolaryngologist. 47 patients were enrolled to the study. We evaluated the complications of tracheostomy and its correlation to the factors of the site of the burn injury, timing of tracheostomy and experience of the surgeon.
Results: There was no significant difference between the group with burn injury in the neck region versus burn injury outside the neck in terms of surgical complications, stoma infections, postoperative pneumonia, colonization of the respiratory tract mucosa by multi-resistant bacteria nor mortality. Regarding the timing of tracheostomy, we found higher occurrence of multi resistant nosocomial bacteria in lower respiratory tract in the late tracheostomy group (p=0.07). Although the overall complications rate was higher in tracheostomies performer by resident otorhinolaryngologists, the difference was not statistically significant.
Conclusion: Tracheostomy in burn injury is a specific topic given the patient’s primary illness. The management usually follows the international societies’ guidelines. The most controversial long-term airway management is in the presence of burn trauma directly in the neck region. According to our study results, there was no higher incidence of complications in such patients though. Timing of tracheostomy may play role in multi-resistant bacteria colonization of the lower respiratory tract. The choice of a level of experience of a surgeon to be performing tracheostomy in burn injury should be carefully considered.
Keywords:
complications – tracheostomy – burn injury
Zdroje
1. Aggarwal, S., Smailes, S., Dziewulski, P.: Tracheostomy in burns patients revisited. Burns, 35, 2009, 7, s. 962-966.
2. Blot, F., Similowski, T., Trouillet J. L. et al.: Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients. Intensive Care Med, 34, 2008, 10, s. 1779-1787.
3. Delaney, A., Bagshaw, S. M., Nalos, M.: Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systemic review and meta-analysis. Critical Care, 10, 2006, 2, s. R55.
4. Dunham, C. M., Ransom, K. J.: Assessment of early tracheostomy in trauma patients: a systematic review and meta-analysis. Am Surg, 72, 2006, 3, s. 276-281.
5. Griffiths, J., Barber, V. S., Morgan, L. et al.: Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ, 330, 2005, 7502, s. 1243-1246.
6. Hosokawa, K., Nishimura, M., Egi, M. et al.: Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care, 19, 2015, 1, s. 424.
7. Chrobok, V., Astl, J., Komínek, P. et al.: Tracheostomie a koniotomie, techniky, komplikace a ošetřovatelská péče. Praha: Maxdorf, 2004.
8. ISBI Practice Guidelines Committee, Steering Subcommittee; Advisory Subcommittee. ISBI Practice Guidelines for Burn Care. Burns, 42, 2016, 5, s. 953-1021.
9. Jones, W. G., Madden, M., Finkelstein, J. et al: Tracheostomies in burn patients. Ann Surg, 4, 1989, 209, s. 471–474.
10. Koch, T., Hecker, B., Hecker, A. et al.: Early tracheostomy decreases ventilation time but has no impact on mortality of intensive care patients: a randomized study. Langenbecks Arch Surg, 397, 2012, 6, s. 1001-1008.
11. Lipový, B., Brychta, P., Řihová, H. et al.: Effect of timing of tracheostomy on changes in bacterial colonisation of the lower respiratory tract in burned children. Burns, 39, 2013, 2, s. 255-261.
12. Liu, C. C., Livingstone, D., Dixon, E. et al.: Early versus Late Tracheostomy: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg, 152, 2015, 2, s. 219–227.
13. Mourelo, M., Galeiras, R., Pértega, S. et al.: Tracheostomy in the management of patients with thermal injuries. Indian J Crit Care Med, 19, 2015, 8, s. 449–455.
14. Plummer, A. L., Gracey, D. R.: Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest, 96, 1989, s. 178-80.
15. Průcha, M., Průcha, I., Hahn, A. et al.: Tracheotomie u urgentních stavů. Otorinolaryng a Foniat /Prague/, 51, 2002, 2, s. 108-111.
16. Rambousek, P.: Tracheotomie. V: Krška Z. a kolektiv. Techniky a technologie v chirurgických oborech. 1. vydání. Praha, Grada, 2011, s. 110-111.
17. Rumbak, M. J., Newton, M., Truncale, T. et al.: A prospective, randomized study comparing early percutaneous dilatational tracheostomy to prolonged translaryngeal intubation (delayed tracheostomy) in critically ill medical patients. Crit Care Med, 32, 2004, 8, s. 1689-1694.
18. Saffle, J. R., Morris, S. E., Edelman, L.: Early tracheostomy does not improve outcome in burn patients. J Burn Care Rehabil, 23, 2002, 6, s. 431-438.
19. Sas, I.: Nozokomiální infekce a infekce multirezistentními organismy v podmínkách intenzívní péče. Postgrad med, 12, 2010, 9, s. 1079-1087.
20. Siempos, I. I., Ntaidou, T. K., Filippidis, F. T. et al.: Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. The Lancet, 3, 2015, 2, s. 150-158.
21. Terragni, P. P., Antonelli, M., Fumagalli, R. et al.: Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA, 303, 2010, 15, s. 1483-1489.
22. Zheng, Y., Sui, F., Chen, X. K. et al.: Early versus late percutaneous dilational tracheostomy in critically ill patients anticipated requiring prolonged mechanical ventilation. Chin Med J (Engl), 125, 2012, 11, s. 1925-1930.
Štítky
Audiology Paediatric ENT ENT (Otorhinolaryngology)Článok vyšiel v časopise
Otorhinolaryngology and Phoniatrics
2019 Číslo 4
Najčítanejšie v tomto čísle
- Video Head Impulse Test, závrať, vestibulární neuronitida, vestibulární vyšetření, učební křivka
- Bilateral Peritonsillar Abscess
- Primary Vasculitis in Otorhinolaryngology: Review of the Literature and Case Reports
- Balloon Eustachian Tuboplasty in Treatment of Chronic Otitis Media with Effusion