Browsing by Subject "Tracheostomy"

Now showing 1 - 6 of 6
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    Decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry
    (American Association of Neurological Surgeons, 2018) Kim, Irene; Hopson, Betsy; Aban, Inmaculada; Rizk, Elias B.; Dias, Mark S.; Bowman, Robin; Ackerman, Laurie L.; Partington, Michael D.; Castillo, Heidi; Castillo, Jonathan; Peterson, Paula R.; Blount, Jeffrey P.; Rocque, Brandon G.; Neurological Surgery, School of Medicine
    Objective: The purpose of this study was to determine the rate of decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry (NSBPR). In addition, the authors explored the variation in rates of Chiari II decompression across NSBPR institutions, examined the relationship between Chiari II decompression and functional lesion level of the myelomeningocele, age, and need for tracheostomy, and they evaluated for temporal trends in rates of Chiari II decompression. Methods: The authors queried the NSBPR to identify all individuals with myelomeningocele between 2009 and 2015. Among these patients, they identified individuals who had undergone at least 1 Chiari II decompression as well as those who had undergone tracheostomy. For each participating NSBPR institution, the authors calculated the proportion of patients enrolled at that site who underwent Chiari II decompression. Logistic regression was performed to analyze the relationship between Chiari II decompression, functional lesion level, age at decompression, and history of tracheostomy. Results: Of 4448 individuals with myelomeningocele identified from 26 institutions, 407 (9.15%) had undergone at least 1 Chiari II decompression. Fifty-one patients had undergone tracheostomy. Logistic regression demonstrated a statistically significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, with a more rostral lesion level associated with a higher likelihood of posterior fossa decompression. Similarly, children born before 2005 and those with history of tracheostomy had a significantly higher likelihood of Chiari II decompression. There was no association between functional lesion level and need for tracheostomy. However, among those children who underwent Chiari II decompression, the likelihood of also undergoing tracheostomy increased significantly with younger age at decompression. Conclusions: The rate of Chiari II decompression in patients with myelomeningocele in the NSBPR is consistent with that in previously published literature. There is a significant relationship between Chiari II decompression and functional lesion level of the myelomeningocele, which has not previously been reported. Younger children who undergo Chiari II decompression are more likely to have undergone tracheostomy. There appears to be a shift away from Chiari II decompression, as children born before 2005 were more likely to undergo Chiari II decompression than those born in 2005 or later.
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    Developmental Outcomes of Very Preterm Infants with Tracheostomies
    (Elsevier, 2014-06) DeMauro, Sara B.; D'Agostino, Jo Ann; Bann, Carla; Bernbaum, Judy; Gerdes, Marsha; Bell, Edward F.; Carlo, Waldemar A.; D'Angio, Carl; Das, Abhik; Higgins, Rosemary; Hintz, Susan R.; Laptook, Abbot R.; Natarajan, Girija; Nelin, Leif; Poindexter, Brenda B.; Sanchez, Pablo J.; Shankaran, Seetha; Stoll, Barbara J.; Truog, William; Van Meurs, Krisa P.; Vohr, Betty; Walsh, Michele C.; Kirpalani, Haresh; Department of Pediatrics, IU School of Medicine
    Objectives To evaluate the neurodevelopmental outcomes of very preterm (<30 weeks) infants who underwent tracheostomy. Study design Retrospective cohort study from 16 centers of the NICHD Neonatal Research Network over 10 years (2001-2011). Infants who survived to at least 36 weeks (N=8,683), including 304 infants with tracheostomies, were studied. Primary outcome was death or neurodevelopmental impairment (NDI, a composite of one or more of: developmental delay, neurologic impairment, profound hearing loss, severe visual impairment) at a corrected age of 18-22 months. Outcomes were compared using multiple logistic regression. We assessed impact of timing, by comparing outcomes of infants who underwent tracheostomy before and after 120 days of life. Results Tracheostomies were associated with all neonatal morbidities examined, and with most adverse neurodevelopmental outcomes. Death or NDI occurred in 83% of infants with tracheostomies and 40% of those without [odds ratio (OR) adjusted for center 7.0 (95%CI, 5.2-9.5)]. After adjustment for potential confounders, odds of death or NDI remained higher [OR 3.3 (95%CI, 2.4-4.6)], but odds of death alone were lower [OR 0.4 (95%CI, 0.3-0.7)], among infants with tracheostomies. Death or NDI was lower in infants who received their tracheostomies before, rather than after, 120 days of life [adjusted OR 0.5 (95%CI, 0.3-0.9)]. Conclusions Tracheostomy in preterm infants is associated with adverse developmental outcomes, and cannot mitigate the significant risk associated with many complications of prematurity. These data may inform counseling about tracheostomy in this vulnerable population.
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    Pneumomediastinum and pneumoperitoneum caused by tracheostomy displacement
    (BMJ Publishing Group Ltd., 2015-07-03) Kniese, Christopher M.; Jan, Muhammad Y.; Diab, Khalil; Medicine, School of Medicine
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    Tracheostomy Post Liver Transplant: Predictors, Complications, and Outcomes
    (International Scientific Information, 2020-08-11) Graham, Ryan C.; Bush, Weston J.; Mella, Jeffrey S.; Fridell, Jonathan A.; Ekser, Burcin; Mihaylov, Plamen; Kubal, Chandrashekhar A.; Mangus, Richard S.; Surgery, School of Medicine
    Background Liver transplant (LT) patients have an increased risk of postoperative respiratory failure requiring tracheostomy. This study sought to characterize objective clinical predictors of tracheostomy. Material/Methods The records for 2017 LT patients at a single institution were reviewed. Patients requiring tracheostomy were first compared with all other patients. A case-control subgroup analysis was conducted in which 98 tracheostomy patients were matched with 98 non-tracheostomy LT patients. For the case-control study, muscle mass was assessed using preoperative computed tomography scans. Results Among 2017 LT patients, 98 required tracheostomy (5%), with a 19% complication rate. Tracheostomy patients were older and had a higher model for end-stage liver disease score, a lower body mass index (BMI), and a greater smoking history. Tracheostomy patients had a longer hospital stay (45 vs. 10 days, P<0.001) and worse 1-year survival (65% vs. 91%, P<0.001). Ten-year Cox regression patient survival for tracheostomy patients was significantly worse (32% vs. 68%, P<0.001). In the case-control analysis, respiratory failure patients were older (P<0.01) and had a lower BMI (P=0.05). They also had a muscle mass deficit of −39% compared with matched LT controls (P<0.001). No significant differences were seen with pre-LT total protein or albumin or with forced expiratory volume in 1 s divided by forced vital capacity (FEV1/FVC) values. Conclusions Predictors for respiratory failure requiring post-LT tracheostomy include higher model for end-stage liver disease score, older age, lower BMI, greater smoking history, and worse sarcopenia. Patients requiring tracheostomy have dramatically longer hospital stays and worse survival.
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    Tracheostomy Post Liver Transplant: Predictors, Complications, and Outcomes
    (ISI, 2020-08-11) Graham, Ryan C.; Bush, Weston J.; Mella, Jeffrey S.; Fridell, Jonathan A.; Ekser, Burcin; Mihaylov, Plamen; Kubal, Chandrashekhar A.; Mangus, Richard S.; Surgery, School of Medicine
    BACKGROUND Liver transplant (LT) patients have an increased risk of postoperative respiratory failure requiring tracheostomy. This study sought to characterize objective clinical predictors of tracheostomy. MATERIAL AND METHODS The records for 2017 LT patients at a single institution were reviewed. Patients requiring tracheostomy were first compared with all other patients. A case-control subgroup analysis was conducted in which 98 tracheostomy patients were matched with 98 non-tracheostomy LT patients. For the case-control study, muscle mass was assessed using preoperative computed tomography scans. RESULTS Among 2017 LT patients, 98 required tracheostomy (5%), with a 19% complication rate. Tracheostomy patients were older and had a higher model for end-stage liver disease score, a lower body mass index (BMI), and a greater smoking history. Tracheostomy patients had a longer hospital stay (45 vs. 10 days, P<0.001) and worse 1-year survival (65% vs. 91%, P<0.001). Ten-year Cox regression patient survival for tracheostomy patients was significantly worse (32% vs. 68%, P<0.001). In the case-control analysis, respiratory failure patients were older (P<0.01) and had a lower BMI (P=0.05). They also had a muscle mass deficit of -39% compared with matched LT controls (P<0.001). No significant differences were seen with pre-LT total protein or albumin or with forced expiratory volume in 1 s divided by forced vital capacity (FEV1/FVC) values. CONCLUSIONS Predictors for respiratory failure requiring post-LT tracheostomy include higher model for end-stage liver disease score, older age, lower BMI, greater smoking history, and worse sarcopenia. Patients requiring tracheostomy have dramatically longer hospital stays and worse survival.
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    Tracheostomy Practices and Outcomes in Children during Respiratory ECMO
    (Wolters Kluwer, 2022-04) Kohne, Joseph G.; MacLaren, Graeme; Rider, Erica; Carr, Benjamin; Mallory, Palen; Gebremariam, Acham; Friedman, Matthew L.; Barbaro, Ryan P.; Pediatrics, School of Medicine
    Objectives: Children receiving prolonged extracorporeal membrane oxygenation (ECMO) support may benefit from tracheostomy during ECMO by facilitating rehabilitation; however the procedure carries risks, especially hemorrhagic complications. Knowledge of tracheostomy practices and outcomes of ECMO-supported children who undergo tracheostomy on ECMO may inform decision-making. Design: Retrospective cohort study Setting: ECMO centers contributing to the Extracorporeal Life Support Organization (ELSO) Registry Patients: Children birth to 18 years who received ECMO support for 7 days or greater for respiratory failure from January 1st 2015 to December 31st 2019. Interventions: None Measurements and Main Results: 3685 children received at least seven days of ECMO support for respiratory failure. The median duration of ECMO support was 13.0 days (IQR 9.3-19.9), and in-hospital mortality was 38.7% (1426/3685). A tracheostomy was placed during ECMO support in 94/3685 (2.6%). Of those who received a tracheostomy on ECMO, the procedure was performed at a median 13.2 days (IQR 6.3-25.9) after initiation of ECMO. Surgical site bleeding was documented in 26% of children who received a tracheostomy (12% after tracheostomy placement). Among children who received a tracheostomy, the median duration of ECMO support was 24.2 days (IQR 13.0-58.7); in-hospital mortality was 30/94 (32%). Those that received a tracheostomy before 14 days on ECMO were older (median age 15.8 years (IQR 4.7-15.5) versus 11.7 years (IQR 11.5-17.3); p-value=0.002) and more likely to have been supported on VV-ECMO (84% vs 52%, p=0.001). Twenty-two percent (11/50) of those who received a tracheostomy before 14 days died in the hospital, compared to 19/44 (43%) of those who received a tracheostomy at 14 days or later (p=0.03). Conclusions: Tracheostomies during ECMO were uncommon in children. One in four patients who received a tracheostomy on ECMO had surgical site bleeding. Children who had tracheostomies placed after 14 days were younger and had worse outcomes, potentially representing tracheostomy as a “secondary” strategy for prolonged ECMO support.