• Bleeding
• Bronchoscopy-guided tracheostomy
• Complications
• Critically ill patients
• Intensive care unit
• Laryngeal mask airway
• Percutaneous dilutional tracheostomy
• Ultrasound-guided tracheostomy

• Humans
• Tracheostomy/methods
• Tracheostomy/economics
• Male
• Bronchoscopy/methods
• Female
• Critical Illness/therapy
• Middle Aged
• Laryngeal Masks
• Ultrasonography, Interventional/methods
• Aged
• Dilatation/methods
• Intensive Care Units
• Respiration, Artificial
• Cost-Benefit Analysis

• Ciaglia technique
• Griggs
• aberrant artery
• endotracheal tube
• fibreoptic bronchoscopy
• percutaneous dilatational tracheostomy
• supraglottic airway device
• tracheal stenosis
• ultrasonography

• Humans
• Female
• Tracheostomy/methods
• Aged
• Bronchoscopy/methods
• Dilatation/methods
• Respiration, Artificial/methods
• Arteries/abnormalities
• Fiber Optic Technology
• Hematoma

• ARDS
• COVID-19
• mechanical ventilation
• percutaneous tracheotomy
• ventilator-free day

• Humans
• Intensive Care Units
• Intubation, Intratracheal/adverse effects
• Intubation, Intratracheal/instrumentation
• Critical Care
• Ventilators, Mechanical/adverse effects
• Respiration, Artificial/instrumentation
• Respiration, Artificial/adverse effects
• Critical Illness/therapy

• Decannulation
• Intracerebral hemorrhage
• Ischemic stroke
• Stroke
• Subarachnoid hemorrhage
• Tracheostomy

• Humans
• Airway Extubation
• Critical Care
• Dilatation/methods
• Intubation, Intratracheal
• Respiration, Artificial
• Stroke/surgery
• Stroke/therapy
• Tracheostomy/methods
• Male
• Female
• Middle Aged
• Aged

• P20 GM139745 NIGMS NIH HHS
• Universitätsklinikum Augsburg (8972)

• Early tracheostomy
• Late tracheostomy
• Mechanical ventilation
• Percutaneous dilatation tracheostomy
• Surgical tracheostomy
• Survival
• Tracheostomy
• Weaning

• COVID-19
• algorithms
• coronavirus
• critical care
• mechanical ventilation
• patient care bundles
• patient care team
• patient safety
• quality improvement
• tracheostomy

• Humans
• Hospitals, Community
• Tracheostomy/adverse effects
• Pandemics
• COVID-19
• Intensive Care Units
• Critical Care

• 5-R017433 NIH HHS
• 5-R017433 NIH HHS
• National Institutes of Health
• Uniformed Services University of the Health Sciences

• bedside tracheostomy
• percutaneous tracheostomy

• Humans
• Tracheostomy/adverse effects
• Tracheostomy/methods
• Cartilage
• Time Factors
• Cadaver

• cardiac surgery
• respiratory weaning
• tracheostomy
• ventilation

• Dilatation
• Female
• Humans
• Male
• Middle Aged
• Pneumonia, Ventilator-Associated/epidemiology
• Pneumonia, Ventilator-Associated/etiology
• Risk Factors
• Surgical Wound Infection/epidemiology
• Surgical Wound Infection/etiology
• Tracheostomy/adverse effects
• Tracheostomy/methods

• anemia
• blood loss
• coagulation
• hemoglobin
• intensive care unit
• transfusion

• intensive care unit
• mechanical ventilation
• outcome
• tracheostomy
• traumatic brain injury

Percutaneous dilatational tracheostomy (PDT) has become the preferred method in several intensive care units (ICUs), but data on PDT performed in immunosuppressed and thrombocytopenic patients are scarce. This study aimed to analyze the feasibility of PDT in immunosuppressed and thrombocytopenic patients compared to conventional open surgical tracheostomy (OST).

We retrospectively analyzed the charts of patients who underwent PDT or OST between May 2017 and November 2020. Our outcomes were stoma site infections and bleeding complications.

63 patients underwent PDT, and 21 patients underwent OST. Distribution of gender ratio, age, SAPS II, time of ventilation before tracheostomy, and preexisting hematooncological diseases was comparable between the two groups. After allogeneic stem cell transplantation (alloSCT), patients were more likely to undergo PDT than OST (p=0.033). The PDT cohort suffered from mucositis more frequently (p=0.043). There were no significant differences in leucocyte or platelet count on the tracheostomy day. Patients with coagulation disorders and patients under immunosuppression were distributed equally among both groups. Stoma site infection was documented in five cases in PDT and eight cases in the OST group. Moderate infections were remarkably increased in the OST group. Smears were positive in six cases in the PDT group; none of these patients had local infection signs. In the OST group, smears were positive in four cases; all had signs of a stroma site infection. Postprocedural bleedings occurred in eight cases (9.5%) and were observed significantly more often in the OST group (p=0.001), leading to emergency surgery in one case of the OST group.

PDT is a feasible and safe procedure in a predominantly immunosuppressed and thrombocytopenic patient cohort without an increased risk for stoma site infections or bleeding complications.

• Laryngotrachael stenosis
• mechanical ventilation
• paediatric burns
• sub glottic stenosis
• tracheal stenosis

An increasing number of laryngotracheal complications in mechanically ventilated COVID-19 patients has been reported in the last few months. Many etiopathogenetic hypotheses were proposed but no clear explanation of these complications was identified. In this paper we evaluated the possibility that the tracheal mucosa could be a high viral replication site that could weaken the epithelium itself.

Subjects for the COVID-19 group and the control group were selected retrospectively according to specific criteria. Patients’ basic and clinical data were recorded and analyzed. Tracheal samples of both groups were collected during surgical tracheostomies and then analyzed from a histological and genetic-transcriptional point of view.

Four COVID-19 patients were enrolled in this study and compared with four non-COVID-19 patients. No laryngotracheal complications were identified in both groups. The SARS-CoV-2 was detected in one out of four COVID-19 samples. A subepithelial inflammatory lymphomonocyte infiltrate was observed in all patients but two cases of the COVID-19 group showed vasculitis of small subepithelial vessels associated with foci of coagulative necrosis. Two gene sets (HALLMARK_INFLAMMATORY_RESPONSE and HALLMARK_ESTROGEN_RESPONSE_LATE) were significantly deregulated in COVID-19 patients compared to the control group.

The altered inflammatory response of the COVID-19 patients could be another possible explanation of the increasing number of laryngotracheal complications.

• COVID-19
• SARS-CoV-2
• prolonged mechanical ventilation
• tracheal lesions
• virus replication

• COVID-19
• COVID-19 Vaccines/administration & dosage
• Consensus
• Delphi Technique
• Health Personnel/standards
• Humans
• Infection Control/standards
• Infectious Disease Transmission, Patient-to-Professional/prevention & control
• Intensive Care Units/standards
• Personal Protective Equipment/standards
• SARS-CoV-2/isolation & purification

Various complications may arise from prolonged mechanical ventilation, but the risk of tracheal stenosis occurring late after translaryngeal intubation or tracheostomy is less common. This study aimed to determine the prevalence, type, risk factors, and management of tracheal stenoses in mechanically ventilated tracheotomized patients deemed ready for decannulation following prolonged weaning.

A retrospective observational study on 357 prolonged mechanically ventilated, tracheotomized patients admitted to a specialized weaning center over seven years. Flexible bronchoscopy was used to discern the type, level, and severity of tracheal stenosis in each case. We described the management of these stenoses and used a binary logistic regression analysis to determine independent risk factors for stenosis development.

On admission, 272 patients (76%) had percutaneous tracheostomies, and 114 patients (32%) presented mild to moderate tracheal stenosis following weaning completion, with a median tracheal cross-section reduction of 40% (IQR 25–50). The majority of stenoses (88%) were located in the upper tracheal region, most commonly resulting from localized granulation tissue formation at the site of the internal stoma (96%). The logistic regression analysis determined that obesity (OR 2.16 [95%CI 1.29–3.63], P < 0.01), presence of a percutaneous tracheostomy (2.02 [1.12–3.66], P = 0.020), and cricothyrotomy status (5.35 [1.96–14.6], P < 0.01) were independently related to stenoses. Interventional bronchoscopy with Nd:YAG photocoagulation was a highly effective first-line treatment, with only three patients (2.6%) ultimately referred to tracheal surgery.

Tracheal stenosis is commonly observed among prolonged ventilated patients with tracheostomies, characterized by localized hypergranulation and mild to moderate airway obstruction, with interventional bronchoscopy providing satisfactory results.

The online version contains supplementary material available at 10.1186/s12890-022-01821-6.

• Mechanical ventilation
• Tracheostomy
• Ventilator weaning

• COVID-19
• SARS-CoV-2
• laryngoscopy
• safety
• tracheostomy

• Critical care
• critical illness
• respiratory insufficiency
• tracheostomy

Percutaneous dilatational tracheostomy (PDT) and percutaneous endoscopic gastrostomy (PEG) tube placements are routine procedures performed in the intensive care units (ICUs). They are performed to facilitate care and promote healing. They also help prevent complications from prolonged endotracheal intubation and malnutrition. In most cases, both are performed simultaneously. Physicians performing them require knowledge of local anatomy, tissue and vascular relationships, along with advance bronchoscopy and endoscopy skills. Although PDTs and PEGs are considered relatively low-risk procedures, operators need to have the knowledge and skill to recognize and prevent adverse outcomes. Current published literature on post-procedural care and stoma wound management was reviewed. Available recommendations for the routine care of tracheostomy and PEG tubes are included in this review. Signs and symptoms of early PDT- and PEG-related complications and their management are discussed in detail. These include hemorrhage, infection, accidental decannulation, tube obstruction, clogging, and dislodgement. Rare, life-threatening complications are also discussed. Multidisciplinary teams are needed for improved patient care, and members should be aware of all pertinent care aspects and potential complications related to PDT and PEG placement. Each institute is strongly encouraged to have detailed protocols to standardize care. This review provides a state-of-the-art guidance on the care of patients with tracheostomies and gastrostomies specifically in the ICU setting.

• Critical care
• gastrostomy
• nursing care
• tracheostomy
• wounds

Background: A significant number of patients with severe respiratory failure related to COVID-19 require prolonged mechanical ventilation. Minimal data exists regarding the timing, safety, and efficacy of combined bedside percutaneous tracheostomy and endoscopy gastrostomy tube placement in these patients. The safety for healthcare providers is also in question. This study's objective was to evaluate the effectiveness and safety of combined bedside tracheostomy and gastrostomy tube placement in COVID-19 patients. Design and Methods: This is a single arm, prospective cohort study in patients with COVID-19 and acute respiratory failure requiring prolonged mechanical ventilation who underwent bedside tracheostomy and percutaneous endoscopic gastrostomy placement. Detailed clinical and procedural data were collected. Descriptive statistics were employed and time to event curves were estimated and plotted using the Kaplan Meier method for clinically relevant prespecified endpoints. Results: Among 58 patients, the median total intensive care unit (ICU) length of stay was 29 days (24.7-33.3) with a median of 10 days (6.3-13.7) postprocedure. Nearly 88% of patients were weaned from mechanical ventilation postprocedure at a median of 9 days (6-12); 94% of these were decannulated. Sixty-day mortality was 10.3%. Almost 90% of patients were discharged alive from the hospital. All procedures were done at bedside with no patient transfer required out of the ICU. A median of 3.0 healthcare personnel total were present in the room per procedure. Conclusion: This study shows that survival of critically ill COVID-19 patients after tracheostomy and gastrostomy was nearly 90%. The time-to-event curves are encouraging regarding time to weaning, downsizing, decannulation, and discharge. A combined procedure minimizes the risk of virus transmission to healthcare providers in addition to decreasing the number of anesthetic episodes, transfusions, and transfers patients must undergo. This approach should be considered in critically ill COVID-19 patients requiring prolonged mechanical ventilation.

• COVID-19
• gastrostomy
• mechanical ventilation
• respiratory failure
• tracheostomy tube

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.

We describe a new sequence for percutaneous dilation tracheostomy procedure that could be considered safe both for patients and healthcare personnel. A fiberscope was connected to a video unit to allow bronchoscopy. Guidewire positioning was performed as usual. While the established standard procedure continues with the creation of the stoma without any change in mechanical ventilation, we retracted the bronchoscope until immediately after the access valve in the mount tube, allowing normal ventilation. After 3 minutes of ventilation with 100% oxygen, mechanical ventilation was stopped without disconnecting the circuit. During apnea, the stoma was created by dilating the trachea and the tracheostomy cannula was inserted. Ventilation was then resumed. We evaluated the safeness of the procedure by recording any severe desaturation and by performing serological tests to all personnel.

Thirty-six patients (38%) of 96 underwent tracheostomy; 22 (23%) percutaneous dilation tracheostomies with the new approach were performed without any desaturation. All personnel (150 operators) were evaluated for serological testing: 9 (6%) had positive serology but none of them had participated in tracheostomy procedures.

This newly described percutaneous dilation tracheostomy technique was not related to severe desaturation events and we did not observe any positive serological test in health workers who performed the tracheostomies.

• Apnea
• COVID-19
• Critical care
• Intensive care
• Percutaneous dilation tracheostomy
• Tracheotomy

• Bronchoscopy
• airway management
• critical care
• intensive care
• medical education
• tracheostomy

One of the main symptoms of severe infection with the new coronavirus‑2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate.

Evaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19.

Retrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital.

Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation.

Clinical and ventilation data were obtained from medical records in a retrospective manner.

A total of 18 patients with confirmed SARS-CoV‑2 infection and surgical tracheostomy were analyzed. The age range was 42–87 years. All patients received open tracheostomy between 2–16 days after admission. Ventilation after tracheostomy was less invasive (reduction in PEAK and positive end-expiratory pressure [PEEP]) and lung compliance increased over time after tracheostomy. Also, sedative drugs could be reduced, and patients had a reduced need of norepinephrine to maintain hemodynamic stability. Six of 18 patients died. All surgical staff were equipped with N99-masks and facial shields or with powered air-purifying respirators (PAPR).

Our data suggest that open surgical tracheostomy can be performed without severe complications in patients with COVID-19. Tracheostomy may reduce invasiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.

• Coronavirus
• Mortality
• Surgery
• Tracheostomy
• Ventilation

• Covid-19
• Mechanical ventilation
• Percutaneous tracheostomy
• Surgical tracheostomy

• End of life
• Epidemiology
• Mechanical ventilation
• Neurorehabilitation
• Pathophysiology
• Prolonged weaning
• Pulmonary rehabilitation

The surge in critically ill patients requiring mechanical ventilation fueled by the COVID-19 pandemic has strained healthcare systems globally. With the increasing need for critical care resources, tracheostomy can facilitate weaning from mechanical ventilation and potentially increase availability of critical care resources. In this case series of three patients, we describe our technique for performing bedside percutaneous tracheostomy on patients with persistently positive SARS-CoV-2 real time polymerase chain reaction (RT-PCR). We hope to provide proceduralists with a specific method for percutaneous tracheostomies that is both safe for the patient and provider.

• COVID-19
• Percutaneous tracheostomy

Tracheostomy in COVID-19-related severe acute respiratory syndrome is at high risk of viral dissemination. The percutaneous dilatation technique could reduce this risk, being performed at the bedside and minimising airway opening. In the COVID-19 context, however, with precarious respiratory status, it requires specific preparation. We designed a 3-hour training module, and here provide a step-by-step schedule, including video analysis, a demonstration of the kit, the recommended precautions related to COVID-19, and several simulation scenarios of increasing difficulty, using a high-tech mannequin. A low-tech procedural simulator was also developed for practicing the steps of the procedure. Our experience (3 sessions with 14 participants) highlighted the difficult points of the procedure in the COVID-19 context, and defined a checklist for clinical practice and an assessment grid. This type of simulation helps to prepare teams for a potentially delicate technical act.

• COVID-19
• Checklist
• Percutaneous dilatational tracheostomy
• Simulation

Patients who become severely ill from coronavirus disease 2019 (COVID‐19) have a high likelihood of needing prolonged intubation, making tracheostomy a likely consideration. The infectious nature of COVID‐19 poses an additional risk of transmission to healthcare workers that should be taken into consideration.

We explore current literature and recommendations for tracheostomy in patients with COVID‐19 and look back at previous data from severe acute respiratory syndrome coronavirus 1 (SARS‐CoV‐1), the virus responsible for the SARS outbreak of 2003.

Given the severity and clinical uncertainty of patients with COVID‐19 and the increased risk of transmission to clinicians, careful consideration should be taken prior to performing tracheostomy. If tracheostomy is performed, we recommend a bedside approach to limit exposure time and number of exposed personnel. Bronchoscopy use with a percutaneous approach should be limited in order to decrease viral exposure.

Thorough preprocedural planning, use of experienced personnel, enhanced personal protective equipment where available, and a thoughtful anesthesia approach are instrumental in maximizing positive patient outcomes while successfully protecting the safety of healthcare personnel. Laryngoscope, 130:2546–2549, 2020

• COVID-19, percutaneous tracheostomy, open tracheostomy, bedside tracheostomy

The COVID-19 pandemic is placing unprecedented demand upon critical care services for invasive mechanical ventilation. There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients with COVID-19 pneumonia. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure.

Literature review and proposed practical guideline based on the experience of a tertiary healthcare institution with 195 critical care admissions for COVID-19 up until 4th April 2020.

A synthesis of the current international literature and reported experience is presented with respect to prognosis, viral load and staff safety, thus leading to a pragmatic recommendation that tracheostomy is not performed until at least 14 days after endotracheal intubation in COVID-19 patients. Practical steps to minimise aerosol generation in percutaneous tracheostomy are outlined and we describe the process and framework for setting up a dedicated tracheostomy team.

In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Both percutaneous and open techniques can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment. ORL-HNS surgeons can play a valuable role in forming tracheostomy teams to support critical care teams during this global pandemic.

• COVID-19
• Mechanical ventilation
• Novel coronavirus
• SARS-CoV-2
• Tracheostomy

The rapid spread of SARS‐CoV‐2 in 2019 and 2020 has resulted in a worldwide pandemic characterized by severe pulmonary inflammation, effusions, and rapid respiratory compromise. The result of this pandemic is a large and increasing number of patients requiring endotracheal intubation and prolonged ventilator support. The rapid rise in endotracheal intubations coupled with prolonged ventilation requirements will certainly lead to an increase in tracheostomy procedures in the coming weeks and months. Performing tracheostomy in the setting of active SARS‐CoV‐2, when necessary, poses a unique situation, with unique risks and benefits for both the patient and the health care providers. The New York Head and Neck Society has collaborated on this document to provide guidance on the performance of tracheostomies during the SARS‐CoV‐2 pandemic.

• COVID19
• SARS-CoV-2
• airway
• tracheal stenosis
• tracheostomy

• Tracheotomy
• emergencies
• postoperative complications
• retrospective studies

The aim of this study was to determine and compare the incidence of long- and short-term complications of percutaneous dilatation tracheotomies (PDT) and surgical tracheotomies (ST).

A single-centre retrospective study.

305 patients undergoing a tracheotomy (PDT or ST) in the University Medical Center Groningen from 2003 to 2013 were included. Data were gathered from patient files.

Short-term and long-term complications including tracheal stenosis.

The incidence of short- and long-term complications, including tracheal stenosis, was similar in both groups. Analysis of a small high-risk subgroup showed no difference in long-term complications.

The rate of short- and long-term complications, including tracheal stenosis, is equal in PDT and ST. PDT is a safe alternative for ST in selected patients.

• Intraoperative complications
• Long-term complications
• Percutaneous dilatation tracheotomy
• Short-term complications
• Surgical tracheotomy
• Tracheostomy
• Tracheotomy

• Airway management
• Diagnostic equipment
• Intensive care
• Intubation, intratracheal
• Respiration, artificial

• Cerebral hemorrhage
• Cerebral ischemia
• Critical care
• Decannulation
• Stroke
• Tracheostomy

• Innominate artery
• Major hemorrhage
• Percutaneous tracheostomy
• Tracheostomy

• Airway obstruction
• percutaneous tracheostomy
• post-intubation tracheal stenosis
• surgical cricothyroidotomy

• Percutaneous dilatational tracheostomy
• Surgical tracheostomy
• Systematic review with meta-analysis
• Tracheostomy

• Tracheostomy

• Awake tracheostomy
• Comorbidities
• Morbid obesity
• Open tracheostomy
• Otolaryngology
• Percutaneous tracheostomy

• Adult
• Aged
• Female
• Humans
• Intraoperative Complications/epidemiology
• Male
• Middle Aged
• Obesity, Morbid/complications
• Otolaryngology
• Postoperative Complications/epidemiology
• Referral and Consultation
• Retrospective Studies
• Risk Factors
• Tracheostomy

The risk of bleeding during extracorporeal membrane oxygenation (ECMO) is a potential deterrent in performing tracheostomy at many centers. To evaluate the safety of surgical tracheostomy (ST) in critically ill patients supported by ECMO, we reviewed the clinical correlation between preoperative coagulation status and bleeding complication-related ST during ECMO.

From April 1, 2012 to March 31, 2016, ST was performed on 38 patients supported by ECMO. We retrospectively reviewed and analyzed the medical records including complications related to ST.

Heparin was administered to 23 patients (60.5%) for anticoagulation during ECMO, but 15 patients (39.5%) underwent ECMO without anticoagulation. Of the 23 patients administered anticoagulation therapy, heparin infusion was briefly paused in 13 prior to ST. The median platelet count, international normalized ratio, and activated partial thromboplastin time before ST were 126 × 10⁹/L (range, 46 to 434 × 10⁹/L), 1.2 (range, 1 to 2.3) and 62 seconds (27 to 114.2 seconds), respectively. No peri-procedural clotting complications related to ECMO were observed. Two patients (5.3%) suffering from ST-related major bleeding required surgical hemostasis. Minor bleeding after ST occurred in two cases (5.3%). No significant difference was found according to anticoagulation management (P = 0.723). No fatality was attributable to ST.

The complication rates of ST in the patients supported by ECMO were low. Therefore, ST performed by an experienced operator, and with careful optimization of coagulation status, is a relatively safe procedure; the use of ST with ECMO should thus not be dismissed on account of the potential for bleeding caused by the administration of anticoagulants.

• anticoagulation
• bleeding
• extracorporeal membrane oxygenation
• tracheostomy