Decannulation factors in patients after serious brain injuries

Background. Patients with a long term tracheotomy (longer than 4 weeks) are quite frequent patients in the Neurorehabilitation Wards. These are especially patients after serious traumatic brain injuries, ischemic or hemorrhagic strokes, ischemic brain injuries and others. A correct multidisciplinary treatment requires a very close cooperation of: physiotherapists, neurologists, laryngologists and speech therapists. The aim of our study was to analyze factors that may influence positive decanulation in patients with tracheotomy performed because of the traumatic brain injury, stroke or cardiac arrest. Methods. Our material includes 127 patients hospitalized in our Department of Rehabilitation between 2002 and 2005. All of them had tracheotomy performed after the brain injury. We analyzed factors like: age, sex, cause of tracheotomy, GCS scale, duration of tracheotomy, concomitant diseases, microbiology examination of the bronchial secretion and the influence of these factors on decanulation. Results. We confirmed that young age (less than 40), traumatic brain injury and short time of tracheotomy are the positive decannulation factors.Background. Patients with a long term tracheotomy (longer than 4 weeks) are quite frequent patients in the Neurorehabilitation Wards. These are especially patients after serious traumatic brain injuries, ischemic or hemorrhagic strokes, ischemic brain injuries and others. A correct multidisciplinary treatment requires a very close cooperation of: physiotherapists, neurologists, laryngologists and speech therapists. The aim of our study was to analyze factors that may influence positive decanulation in patients with tracheotomy performed because of the traumatic brain injury, stroke or cardiac arrest. Methods. Our material includes 127 patients hospitalized in our Department of Rehabilitation between 2002 and 2005. All of them had tracheotomy performed after the brain injury. We analyzed factors like: age, sex, cause of tracheotomy, GCS scale, duration of tracheotomy, concomitant diseases, microbiology examination of the bronchial secretion and the influence of these factors on decanulation. Results. We confirmed that young age (less than 40), traumatic brain injury and short time of tracheotomy are the positive decannulation factors

Przetoka skórno-gardłowa jako powikłanie po laryngektomii – wciąż aktualny problem kliniczny

Background. Pharyngocutaneous fistula following laryngectomy is a serious complication, and its incidence varies from 4% to 65%. The study’s objective was to determine the incidence of post laryngectomy fistulas in patients operated in our department to establish whether specific factors predispose to fistula formation. Methods. A retrospective study was performed in 573 patients who underwent laryngectomy. Results. Between 1989 and 1999, 835 cases of laryngeal carcinoma were diagnosed, 690 were treated surgically, 573 of them underwent laryngectomy in our department. Of these patients, 545 (95,1%) had total laryngectomy, while 28 (4,9%) partial laryngectomy. In 538 cases the laryngectomy was combined with radical or functional neck dissection. The presence of early postoperative fistula was established in 65 of the 573 patients (11,3%). Our study could not verify reports that any specific factors were significantly related to fistula formation, the only factors that did show statistical significance were the preoperative patient’s general health status and the kind of postoperative antibiotic therapy. Conclusions. On the base of literature review, the authors compare results obtained in the last decade of the 20 century with results obtained earlier. Although the incidence of post-laryngectomy pharyngocutaneous fistulas decreased in comparison with the fistula rate observed earlier, the problem is still unresolved, and the fistulae remain a serious complication of larynx oncology surgery