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Int J Pediatr Otorhinolaryngol 2021 Apr 27;146:110746. Epub 2021 Apr 27.

Department of Otorhinolaryngology H & N Surgery, University of Maryland School of Medicine and University of Maryland Children's Hospital, Baltimore, MD, USA.

Objectives: Advances in neonatal intensive care have allowed successful resuscitation of children born at the border of viability. However, there has been little change in the incidence of bronchopulmonary dysplasia (BPD) and anatomical upper airway obstruction which may require a tracheostomy in that group. The benefits of the procedure are accompanied by sequelae that impact outcomes. Read More

Otolaryngol Head Neck Surg 2021 Feb 23:194599821994744. Epub 2021 Feb 23.

Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA.

Objectives: To compare outcomes of early and late tracheostomy change in neonatal patients. Early tracheostomy change (ETC) occurred 3 to 4 days after surgery, and late tracheostomy change (LTC) occurred 5 to 7 days after surgery.

Study Design: Retrospective cohort. Read More

Crit Care Res Pract 2021 13;2021:6036891. Epub 2021 Jan 13.

Dubbo Base Hospital, Dubbo, NSW 2830, Australia.

Background: High flow tracheostomy (HFT) is a commonly used weaning and humidification strategy for tracheostomised patients, but little is known as to how much PEEP or mechanical benefit it offers. Patient anatomy and device characteristics differentiate it from high flow nasal cannula and the physiological effects observed.

Objectives: (1) To review the available literature on the effects of HFT on airway pressure and indices of gas exchange. Read More

Am J Emerg Med 2021 04 31;42:70-77. Epub 2020 Dec 31.

Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia and New Zealand; Paediatric Emergency Department, Monash Medical Centre, Melbourne, Australia; Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Australia.

Background: Airway management procedures are critical for emergency medicine (EM) physicians, but rarely performed skills in pediatric patients. Worldwide experience with respect to frequency and confidence in performing airway management skills has not been previously described.

Objectives: Our aims were 1) to determine the frequency with which emergency medicine physicians perform airway procedures including: bag-mask ventilation (BMV), endotracheal intubation (ETI), laryngeal mask airway (LMA) insertion, tracheostomy tube change (TTC), and surgical airways, and 2) to investigate predictors of procedural confidence regarding advanced airway management in children. Read More

Rev Chil Pediatr 2020 Oct;91(5):691-696

Hospital Josefina Martínez, Santiago, Chile.

Introduction: Changing the tracheostomy tube in children is a key procedure, however, some of its aspects re main unclear.

Objective: To characterize the tracheostomy tube change in children from a long-stay health institution.

Patients And Method: Retrospective observational analytical study based on the 2-year clinical record of hospitalized children who underwent tracheostomy. Read More

Respir Care 2021 Jan;66(1):144-155

American Association for Respiratory Care, Irving, TX.

Children requiring a tracheostomy to maintain airway patency or to facilitate long-term mechanical ventilatory support require comprehensive care and committed, trained, direct caregivers to manage their complex needs safely. These guidelines were developed from a comprehensive review of the literature to provide guidance for the selection of the type of tracheostomy tube (cuffed vs uncuffed), use of communication devices, implementation of daily care bundles, timing of first tracheostomy change, type of humidification used (active vs passive), timing of oral feedings, care coordination, and routine cleaning. Cuffed tracheostomy tubes should only be used for positive-pressure ventilation or to prevent aspiration. Read More

BMJ Case Rep 2020 Dec 17;13(12). Epub 2020 Dec 17.

Department of ENT & Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India.

A 29-year-old male patient presented with a history of voice change and feeling of a lump in throat for the last 20 years. He was tracheostomised at the age of 10 years. Endolaryngeal examination showed a mucosal bulge in supraglottic region arising predominantly from right side. Read More

Zhonghua Zhong Liu Za Zhi 2020 Nov;42(11):976-979

Department of Otorhinolaryngology Head and Neck Surgery of the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.

To Investigate the application strategy and effect of cuffed tracheostomy tube with inner cannula in the treatment of postoperative complications of laryngeal and hypopharyngeal cancer. A total of 60 patients with laryngeal and hypopharyngeal cancer occurred serious postoperative complications, including 31 cases of severe postoperative neck infection, 8 cases of dyspnea, 5 cases of massive hemorrhage and 16 cases of seriously intractable aspiration. The tracheal cannula with inner cannula and outer cuff was immediately worn on these patients and the cuff was inflated. Read More

Oral Oncol 2021 02 31;113:105048. Epub 2020 Oct 31.

Otolaryngology- Head and Neck Surgery Department, Santa Croce Hospital AORMN, Fano, Italy.

Objective: Tracheostomy tube cuff balloon herniation is a rare event and can determine airway obstruction. Sometimes the obstruction is not very evident but, if it is not correctly solved, can determine a severe hypoxia with patient's death.

Material And Methods: We present a 49-year-old male patient, with cT4aN0M0 squamous cell carcinoma of the oral cavity, who was admitted to the hospital for definitive surgical resection. Read More

MedEdPORTAL 2020 10 1;16:10994. Epub 2020 Oct 1.

Associate Professor, Department of Pediatrics, Section of Pulmonology and Sleep Medicine, University of Colorado School of Medicine; Director of Ventilator Care Program, University of Colorado School of Medicine.

Introduction: Caring for technology-dependent children, such as those with tracheostomy and ventilator dependence, can be new and frightening for pediatric residents. Education about emergencies in this patient population is important because these children are at risk for in-hospital complications. Safe care of the tracheostomy-dependent child requires the ability to recognize common complications, such as tracheostomy tube obstruction or decannulation, and intervene appropriately by suctioning and/or replacing the tracheostomy tube. Read More

Zhonghua Shao Shang Za Zhi 2020 Sep;36(9):880-882

Department of Burns and Plastic Surgery, Guangzhou Red Cross Hospital, Guangzhou 510220, China.

In November 4, 2016, a 1 year and 3 months old male patient with face and neck scald complicated with severe scald of oropharynx was admitted to Guangzhou Red Cross Hospital 1 hour after injury. The child developed upper respiratory tract obstruction 2 hours after injury, therefore tracheotomy and intubation were performed immediately to establish an artificial airway, and symptomatic treatments such as anti-infection, fluid replacement, and dressing change were conducted. On the 10th day after injury, the child had difficult breathing during the test tube blocking before extubation, and it was difficult to extubate. Read More

Otolaryngol Head Neck Surg 2021 Apr 15;164(4):869-876. Epub 2020 Sep 15.

Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Objective: The first pediatric tracheostomy tube change often occurs within 7 days after placement; however, the optimal timing is not known. The primary objective was to determine the rate of adverse events of an early tube change. Secondary objectives compared rates of significant peristomal wounds, sedation requirements, and expedited intensive care discharges. Read More

Pediatr Investig 2019 Sep 26;3(3):141-145. Epub 2019 Sep 26.

Division of Otolaryngology Children's National Medical Center Washington DC USA.

Importance: Tracheotomy is one of the riskiest procedures for composite morbidity within pediatric otolaryngology. During the postoperative period, each time the tracheostomy tube is manipulated, there is opportunity for morbidity (e.g. Read More

Otolaryngol Head Neck Surg 2021 May 25;164(5):938-943. Epub 2020 Aug 25.

Department of Otolaryngology-Head and Neck Surgery, State University of New York at Buffalo, Buffalo, New York, USA.

Objectives: (1) Evaluate baseline airway knowledge of medical students (MSs) and internal medicine (IM) residents. (2) Improve MS and IM resident understanding of airway anatomy, general tracheostomy and laryngectomy care, and management of airway emergencies.

Methods: A before-and-after survey study was carried out over a single academic year. Read More

Indian J Otolaryngol Head Neck Surg 2020 Sep 22;72(3):398-401. Epub 2020 Jun 22.

Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Manjeri, Kerala India.

The novel corona virus disease (COVID-19) has unfolded into a pandemic and is continuing to propagate at a frightening speed. The aim of this article is to share our protocol for performing a safe surgical tracheostomy in this COVID-19 era. Tracheostomy procedures have a high risk of aerosol generation. Read More

Diagnostics (Basel) 2020 Jul 22;10(8). Epub 2020 Jul 22.

Department of Radiology, University Hospital Limerick, V94F858 Limerick, Ireland.

Tracheostomy is a commonly performed intervention in patients requiring ventilatory support. The insertion of inappropriately sized tracheostomy tubes carries a risk of decannulation, tissue damage, ventilatory difficulties, premature tube change or discomfort. Currently, no clear guidelines exist in determining the most appropriate size tube. Read More

HNO 2020 Nov;68(11):828-837

Abteilung für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Waldstraße 1, 1054, Erlangen, Deutschland.

Background: Since emergence of the new coronavirus in China in December 2019, many countries have been struggling to control skyrocketing numbers of infections, including among healthcare personnel. It has now been clearly demonstrated that SARS-CoV‑2 resides in the upper airways and transmits easily via aerosols and droplets, which significantly increases the risk of infection when performing upper airway procedures. Ventilated COVID-19 patients in a critical condition in the intensive care unit may require tracheotomy for long-term ventilation and to improve weaning. Read More

JA Clin Rep 2020 May 22;6(1):37. Epub 2020 May 22.

Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.

Background: Tracheo-innominate artery fistula (TIF) is a life-threatening complication of tracheostomy. We describe perioperative management for innominate artery transection in a case with TIF.

Case Presentation: A 4-year-old Japanese female with Marshal-Smith syndrome presented for management of TIF. Read More

ANZ J Surg 2020 11 17;90(11):2310-2314. Epub 2020 May 17.

Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.

Background: Tracheostomy-tube change protocols are implemented primarily due to concern regarding infections. Currently changes vary from within 4 weeks post-insertion to 3 monthly thereafter. However, currently no evidence-based guidelines exist to justify these protocols. Read More

Otolaryngol Head Neck Surg 2020 07 12;163(1):135-137. Epub 2020 May 12.

Anesthesiology and Intensive Care Unit, University of Insubria, Varese, Italy.

The COVID-19 outbreak poses continued struggles due to the unprecedented number of patients admitted to intensive care units and the overwhelming need for mechanical ventilation. We report a preliminary case series of 32 patients with COVID-19 who underwent elective tracheostomies after a mean intubation period of 15 days (range, 9-21 days). The procedure was performed with percutaneous (10 cases) and open (22 cases) surgical techniques. Read More

Am J Otolaryngol 2020 Mar - Apr;41(2):102376. Epub 2019 Dec 24.

Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA. Electronic address:

Purpose: Develop a model for quality improvement in tracheostomy care and decrease tracheostomy-related complications.

Methods: This study was a prospective quality improvement project at an academic tertiary care hospital. A multidisciplinary team was assembled to create institutional guidelines for clinical care during the pre-operative, intra-operative, and post-operative periods. Read More

Indian J Otolaryngol Head Neck Surg 2019 Oct 23;71(Suppl 1):852-854. Epub 2019 Jan 23.

Department of Anaesthesia, PGIMER, Chandigarh, India.

Tracheostomy tube change is a relatively common procedure once a tracheo-cutaneous tract matures. Regular tracheostomy tube changes prevent the formation of granulation tissue and reduce bacterial colonization (Yaremchuk and Yaremchuk in Laryngoscope 113(1):1-10, 2003). However, serious complications such as subcutaneous emphysema, loss of airway and mediastinitis, can occur if the tube exchange is performed inappropriately. Read More

Health Technol Assess 2019 09;23(48):1-114

Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.

Background: Invasive mechanical ventilation (IMV) is a life-saving intervention. Following resolution of the condition that necessitated IMV, a spontaneous breathing trial (SBT) is used to determine patient readiness for IMV discontinuation. In patients who fail one or more SBTs, there is uncertainty as to the optimum management strategy. Read More

Laryngoscope 2020 05 6;130(5):1249-1255. Epub 2019 Aug 6.

The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A.

Objective: The primary objective of our study was to determine the quality of life (QOL) using a talking tracheostomy tube.

Methods: Randomized clinical trial (NCT2018562). Adult intensive care unit patients who were mechanically ventilated, awake, alert, attempting to communicate, English-speaking, and could not tolerate one-way speaking valve were included. Read More

Spartan Med Res J 2019 Jul 1;4(1):9204. Epub 2019 Jul 1.

Authority Health.

Context: For many patients, end-of-life care (EOLC) wishes are unknown and are generally only brought up during healthcare crises. During such healthcare episodes, loved ones are often distraught, and as such, can find it difficult to focus on details surrounding the event. The best place for these discussions may be in non-acute settings including primary care clinics. Read More

Laryngoscope 2020 05 22;130(5):1316-1321. Epub 2019 Jun 22.

Department of ENT, Christian Medical College, Vellore, India.

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. Read More

Int J Pediatr Otorhinolaryngol 2019 May 8;120:78-81. Epub 2019 Feb 8.

Department of Pediatric Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.

Objectives: The first tracheostomy tube change is typically performed on days 5-7 post-operatively, however recent international consensus guidelines suggested that, with maturation sutures, days 3-5 is appropriate. We evaluate whether a first tube change on day 2 post-operatively is safe and effective.

Methods: We carried out a retrospective review of all patients undergoing tracheostomy between 2009 and 2018. Read More

JAMA Netw Open 2019 01 4;2(1):e187851. Epub 2019 Jan 4.

Fostering Improvement in End-of-Life Decision Science, University of Pennsylvania, Philadelphia.

Importance: Patients with serious illnesses are often encouraged to actively deliberate about the desirability of life support. Yet it is unknown whether deliberation changes the substance or quality of such decisions.

Objective: To identify differences in decisions about life support interventions and goals of care made intuitively vs deliberatively by patients with serious illnesses. Read More