Search Our Scientific Publications & Authors

Anaesth Intensive Care 2022 May 6;50(3):243-249. Epub 2021 Dec 6.

Department of Intensive Care Medicine, Sir Charles Gairdner Hospital, Perth, Australia.

Tracheostomy tubes are chosen primarily based on their internal diameter; however, the length of the tube may also be important. We performed a prospective clinical audit of 30 critically ill patients following tracheostomy to identify the type of tracheostomy tube inserted, the incidence of malpositioning and the factors associated with the need to change the tracheostomy tube subsequently. Anthropometric neck measurements, distance between the skin and tracheal rings and the position of the tracheostomy cuff relative to the tracheal stoma were recorded and analysed. Read More

Nutrients 2021 Oct 21;13(11). Epub 2021 Oct 21.

Department of Neurology, Korea University Anam Hospital, Korea University Medicine, Seoul 02841, Korea.

Adequate nutritional support and high body mass index (BMI) are good prognostic factors for disease progression and survival in amyotrophic lateral sclerosis (ALS). However, whether the composition of body weight, such as body fat percentage, has an independent effect on ALS prognosis remains unclear. The clinical data of 53 ALS patients were collected by medical record review. Read More

Pediatr Pulmonol 2022 01 4;57(1):176-184. Epub 2021 Oct 4.

Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey.

Background: Tracheostomy-related morbidity and mortality mainly occur due to decannulation, misplacement, or obstruction of the tube. A standardized training can improve the skills and confidence of the caregivers in tracheostomy care (TC).

Objective: Our primary aim was to evaluate the efficiency of standardized training program on the knowledge and skills (changing-suctioning the tracheostomy tube) of the participants regarding TC. Read More

Am J Otolaryngol 2022 Jan-Feb;43(1):103240. Epub 2021 Sep 16.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical center, New York, NY 10032, USA. Electronic address:

Purpose: At the height of the COVID-19 pandemic, our institution instituted a Safe Tracheostomy Aftercare Taskforce (STAT) team to care for the influx of patients undergoing tracheostomies. This review was undertaken to understand this team's impact on outcomes of tracheostomy care.

Methods: We compared retrospective data collected from patients undergoing tracheostomies at our institution from February to June 2019, prior to creation of the STAT team, to prospectively collected data from tracheostomies performed from February to June 2020, while the STAT team was in place and performed statistical analysis on outcomes of care such as decannulation prior to discharge, timely tube change, and post-discharge follow-up. Read More

J Am Heart Assoc 2021 09 13;10(18):e021499. Epub 2021 Sep 13.

ICES Toronto Canada.

Background Temporal trends in life-sustaining care after acute stroke are not well characterized. We sought to determine contemporary trends by age and sex in the use of life-sustaining care after acute ischemic stroke and intracerebral hemorrhage in a large, population-based cohort. Methods and Results We used linked administrative data to identify all hospitalizations for acute ischemic stroke or intracerebral hemorrhage in the province of Ontario, Canada, from 2003 to 2017. Read More

Indian J Otolaryngol Head Neck Surg 2021 Aug 22:1-4. Epub 2021 Aug 22.

Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India.

Foreign body of the trachea and the bronchus are critical emergencies which can lead to life threatening complications. But the advent of the 2019 novel corona virus disease, pandemic has dramatically changed the comfort of these procedures since aerosol generating medical procedures pose a risk and spread of infection to the health care workers. Even the patients are uncomfortable visiting the hospital due to the fear of acquiring the COVID infection. Read More

Braz J Anesthesiol 2022 Mar-Apr;72(2):189-193. Epub 2021 Jul 27.

IRCCS San Raffaele Scientific Institute, Department of Anesthesia and Intensive Care, Milan, Italy.

Background: Percutaneous dilation tracheostomy is an aerosol-generating procedure carrying a documented infectious risk during respiratory virus pandemics. For this reason, during the COVID-19 outbreak, surgical tracheostomy was preferred to the percutaneous one, despite the technique related complications increased risk.

Methods: We describe a new sequence for percutaneous dilation tracheostomy procedure that could be considered safe both for patients and healthcare personnel. Read More

Indian J Crit Care Med 2021 Jun;25(6):642-647

Department of Critical Care Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background: Percutaneous dilatation tracheostomy (PDT) is required in patients with novel coronavirus disease-2019 (COVID-19) with severe respiratory involvement, but the procedure needs modification to minimize the risk of aerosol exposure to caregivers.

Aim And Objective: To share the experience of apnea approach of PDT in COVID patients. Also, to demonstrate the safety of the technique for healthcare workers (HCWs) and patients with respect to hemodynamic and oxygenation parameters. Read More

Laryngoscope 2022 05 27;132(5):944-948. Epub 2021 Jul 27.

Pediatric Otolaryngology - Head and Neck Surgery, Texas Children's Hospital, Houston, Texas, U.S.A.

Objectives/hypothesis: To analyze tracheostomy-related complications in pediatric patients with scoliosis.

Study Design: Retrospective chart review.

Methods: A retrospective chart review of all patients with tracheostomy and scoliosis was performed at a single institution. Read More

Crit Care Explor 2021 Jul 25;3(7):e0459. Epub 2021 Jun 25.

Department of Internal Medicine, Fairview hospital, Cleveland Clinic Foundation, Cleveland OH.

Objectives: Early palliative medicine consult in the ICU can significantly improve outcomes in high-risk patients. We describe a pilot study of including a recommendation for palliative medicine consult in the ICU morning huddle.

Design: A prospective, observational, quality improvement study. Read More

Int J Pediatr Otorhinolaryngol 2021 Jul 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 11 23;165(5):716-721. 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 04 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 05 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