Prevention of tracheal cartilage injury with modified Griggs technique during percutaneous tracheostomy - Randomized controlled cadaver study

Introduction: Tracheal stenosis is the most common severe late complication of percutaneous tracheostomy causing significant decrease in quality of life. Applying modified Griggs technique reduced the number of late tracheal stenoses observed in our clinical study. The aim of this study was to investigate the mechanism of this relationship. Materials and methods: Forty-six cadavers were randomized into two groups according to the mode of intervention during 2006-2008. Traditional versus modified Griggs technique was applied in the two groups consequently. Wider incision, surgical preparation, and bidirectional forceps dilation of tracheal wall were applied in modified technique. Injured cartilages were inspected by sight and touch consequently. Age, gender, level of intervention, and number of injured tracheal cartilages were registered. Results: Significantly less frequent tracheal cartilage injury was observed after modified (9%) than original (91%) Griggs technique (p<0.001). A moderate association between cartilage injury and increasing age was observed, whereas the level of intervention (p=0.445) and to gender (p=0.35) was not related to injury. Risk of cartilage injury decreased significantly (OR: 0.0264, 95%, CI: 0.005-0.153) with modified Griggs technique as determined in adjusted logistic regression model. Discussion: Modified Griggs technique decreased the risk of tracheal cartilage injury significantly in our cadaver study. This observation may explain the decreased number of late tracheal stenosis after application of the modified Griggs method. © 2012 Akadémiai Kiadó, Budapes

Primary laryngospasm in a patient with Parkinson's disease : treatment with CPAP via minitracheostomy following intubation

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Percutaneous tracheostomy on the instensive care unit.

Contains fulltext : 19484.pdf (publisher's version ) (Open Access)KUN Katholieke Universiteit Nijmegen, 9 september 2004Promotor : Hoeven, J.G. van der Co-promotor : Hoogen, F.J.A. van den192 p

Complications of percutaneous dilating tracheostomy.

Contains fulltext : 59196.pdf ( ) (Open Access

Incidence of cardiac arrests and unexpected deaths in surgical patients before and after implementation of a rapid response system

BACKGROUND: Rapid response systems (RRSs) are considered an important tool for improving patient safety. We studied the effect of an RRS on the incidence of cardiac arrests and unexpected deaths.METHODS: Retrospective before- after study in a university medical centre. We included 1376 surgical patients before (period 1) and 2410 patients after introduction of the RRS (period 2). Outcome measures were corrected for the baseline covariates age, gender and ASA.RESULTS: The number of patients who experienced a cardiac arrest and/or who died unexpectedly decreased non significantly from 0.50% (7/1376) in period 1 to 0.25% (6/2410) in period 2 (odds ratio (OR) 0.43, CI 0.14-1.30). The individual number of cardiac arrests decreased non-significantly from 0.29% (4/1367) to 0.12% (3/2410) (OR 0.38, CI 0.09-1.73) and the number of unexpected deaths decreased non-significantly from 0.36% (5/1376) to 0.17% (4/2410) (OR 0.42, CI 0.11-1.59). In contrast, the number of unplanned ICU admissions increased from 2.47% (34/1376) in period 1 to 4.15% (100/2400) in period 2 (OR 1.66, CI 1.07-2.55). Median APACHE ll score at unplanned ICU admissions was 16 in period 1 versus 16 in period 2 (NS). Adherence to RRS procedures. Observed abnormal early warning scores ?72 h preceding a cardiac arrest, unexpected death or an unplanned ICU admission increased from 65% (24/37 events) in period 1 to 91% (91/101 events) in period 2 (p?&lt;?0.001). Related ward physician interventions increased from 38% (9/24 events) to 89% (81/91 events) (p?&lt;?0.001). In period 2, ward physicians activated the medical emergency team in 65% of the events (59/91), although in 16% (15/91 events) activation was delayed for one or two days. The overall medical emergency team dose was 56/1000 admissions.CONCLUSIONS: Introduction of an RRS resulted in a 50% reduction in cardiac arrest rates and/or unexpected death. However, this decrease was not statistically significant partly due to the low base-line incidence. Moreover, delayed activation due to the two-tiered medical emergency team activation procedure and suboptimal adherence of the ward staff to the RRS procedures may have further abated the positive results

[Benefits of time-limited trials in intensive-care medicine]

A time-limited trial (TLT) is an option to deal with scarce ICU-beds. A TLT is an agreement made at an early stage of ICU-admission to initiate treatment for a certain period of time to gain a realistic understanding of the patient's chances of a meaningful recovery. If the patient improves, treatment will be continued. However, if treatment goals are not achieved, palliative care is initiated. Chang et. al. investigated the efficacy of introduction of this method. The study was conducted in 2017-2019 and consisted of the structural introduction of TLTs for ICU-patients at risk for non-beneficial ICU-treatments. The main outcome of the study is that after introduction of TLTs, the median stay at the ICU or in the hospital significantly decreased without an increase in mortality. A TLT can be of added value in Dutch ICUs, provided that the staff fully supports the method and is properly trained before implementation

[Tracheotomy in the intensive care unit is a tailor-made decision]

Tracheotomy is one of the oldest interventions in medical sciences. It is a procedure that is frequently used in patients who have been admitted to the intensive care unit. Over the last twenty years, the use of the dilation technique has increased in frequency. We believe that the timing of a tracheostoma placement should be evaluated individually for every patient and should always be weighed against the potential risks of an operative intervention. This is illustrated with case reports of four patients with respiratory problems; in the case of one of these patients, the decision was made not to perform tracheotomy, which nonetheless resulted in a favourable clinical outcome

Preoperatieve screening.

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[Tracheotomy in the intensive care unit is a tailor-made decision]

Item does not contain fulltextTracheotomy is one of the oldest interventions in medical sciences. It is a procedure that is frequently used in patients who have been admitted to the intensive care unit. Over the last twenty years, the use of the dilation technique has increased in frequency. We believe that the timing of a tracheostoma placement should be evaluated individually for every patient and should always be weighed against the potential risks of an operative intervention. This is illustrated with case reports of four patients with respiratory problems; in the case of one of these patients, the decision was made not to perform tracheotomy, which nonetheless resulted in a favourable clinical outcome

Electric cardioversion of atrial flutter in a critically ill patient in the prone position.

Item does not contain fulltex