Thread by @Vapourologist, #JanuAirway Day 13. Tracheostomies – more than just ETT through the neck. [...]

Vapourologist

#JanuAirway Day 13. Tracheostomies – more than just ETT through the neck. Here’s a #OnePager covering the different types. Let’s dive in…
@AirwayFirst @AirwayInfo @dasairway @dastrainees @theairwaysite @OTJOnline @UniversalAirway @ENT_UK @UKWENTS @theairwayapp @lizrossauc

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#JanuAirway Tracheostomis have potentially been performed since ancient Egypt. The first non-emergeny trache was thought to be performed by Asclepiades. He was also a proponent of music therapy – might be of interest to @VeenaGraffMD

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#JanuAirway Tracheostomis have potentially been performed since ancient Egypt. The first non-emergeny trache was thought to be performed by Asclepiades. He was also a proponent of music therapy – might be of interest to @VeenaGraffMD2/9

#JanuAirway There are 4 basic indications for tracheostomy: -
1) Provide patent airway
2) Protect the airway
3) Clear secretions
4) Aid weaning from ventilator – the timing of which was investigated in the Tracman study in 2013 ( http://jama.jamanetwork.com/article.aspx?articleid=1690674)

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Effect of Early vs Late Tracheostomy Placement on Survival in Patients Receiving Mechanical...

In a trial to determine whether early vs late tracheostomy was associated with lower mortality among adult patients requiring mechanical ventilation, Young and coauthors randomly assigned 455...

http://jama.jamanetwork.com/article.aspx?articleid=1690674

#JanuAirway. What physiological changes are associated with tracheostomies?
1) Loss of humidification from upper airway
2) Reduced airway resistance & dead space
3) Inability to speak – unless able to use a speaking valve
4) Difficulty swallowing from inflated trache cuff

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#JanuAirway Traches = surgical / percutaneous. 3 main surgical techniques –window, slit & Bjork flap. Important difference = time for tract maturity: -
Perc – 7-10days
Surgical 2-4days
Important in decannulation, false tract can occur if trach re-inserted before maturity!

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#JanuAirway MUST establish whether upper airway is present – i.e. tracheostomy or laryngectomy (neck-breather). NAP4 & NCEPOD show poor outcomes still occur. NTSP has fantastic algorithms for both emergency scenarios.
https://www.ncepod.org.uk/2014tc.html
https://www.niaa.org.uk/NAP4-Report?newsid=513#pt

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#JanuAirway

Here are some papers / links that you might find interesting: -
1) http://www.tracheostomy.org.uk/
2) …https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2044.2012.07217.x
3) https://bjaed.org/article/S2058-5349(19)30125-8/fulltext
4) https://www.bjanaesthesia.org.uk/article/S0007-0912(20)30537-7/fulltext

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Opening Pandora's box: surgical tracheostomy in mechanically ventilated COVID-19 patients

Editor—Coronavirus disease 2019 (COVID-19) is the third coronavirus infection witnessed in past two decades.1 Key lessons derived from the cumulative experience of Asian and European ICUs, which...

http://www.tracheostomy.org.uk/

#JanuAirway Remember USS can aid with tracheostomy – here’s the #OnePager from Day 5! @jeffgadsden @KiJinnChin @EMARIANOMD @amit_pawa

There’s much more to tracheostomy care – here's an amazing resource from Portsmouth ICU http://www.portsmouthicu.com/resources/2017-06-30-TracheHandbook(2017).pdf

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Hope that helps. Tomorrow we'll take a look into Awake Intubation Techniques. See you then! #JanuAirway @AirwayFirst @AirwayInfo @dastrainees @Dasairway @UniversalAirway @Theairwaysite @GAMCLondon2020 @elboghdadly

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