Kumar Sanjay, Patra Arun, Deepthi Sangineedi, Biradar Kashiroygoud
Department of ENT, Command Hospital Airforce Bangalore, Rajiv Gandhi University of Health Sciences, India.
Department of Anaesthesia, Command Hospital Bangalore, Rajiv Gandhi University of Health Sciences, India.
Iran J Otorhinolaryngol. 2024 Jul;36(4):559-565. doi: 10.22038/IJORL.2024.75652.3533.
Tracheostomy is a life-saving surgical intervention commonly performed in patients requiring prolonged mechanical ventilation. However, the decannulation process is associated with various complications that can affect patient outcomes. This study aimed to assess complications and their management during decannulation in a cohort of tracheostomy patients at a tertiary care hospital, considering the complexities introduced by prior intubation.
A retrospective cohort study was conducted involving 450 patients who underwent tracheostomy during a stipulated timeframe. Data regarding demographic characteristics, complications, and management strategies during decannulation were analysed. Special attention was given to distinguishing between complications directly related to the tracheostomy procedure and those potentially influenced by previous intubation.
Out of the 450 patients, 250 experienced minor complications such as localized bleeding, oxygen desaturation, and minor infections. Another 40 faced major complications including severe haemorrhage, tracheal damage, and stenosis. Increasing age and tracheostomy duration were identified as significant predictors of complications. Pharmacological treatments, surgical interventions, and respiratory therapy were among the management strategies employed. The differentiation between complications arising from tracheostomy and prior intubation highlighted the need for comprehensive patient evaluation.
Complications associated with decannulation occur frequently with varying severity. Efficient recognition and management of these complications are vital for improving patient outcomes. The study provides important insights into the challenges experienced during the decannulation process and highlights the necessity of considering prior intubation history in the management of tracheostomy decannulation to refine patient care protocols.
气管切开术是一种挽救生命的外科手术，常用于需要长期机械通气的患者。然而，拔管过程会引发各种并发症，可能影响患者的预后。本研究旨在评估一家三级医院中一组气管切开术患者在拔管期间的并发症及其处理情况，同时考虑既往插管带来的复杂性。
进行了一项回顾性队列研究，纳入了在规定时间段内接受气管切开术的450例患者。分析了有关人口统计学特征、并发症以及拔管期间处理策略的数据。特别关注区分与气管切开术直接相关的并发症和那些可能受既往插管影响的并发症。
在450例患者中，250例出现了轻微并发症，如局部出血、氧饱和度下降和轻度感染。另外40例面临严重并发症，包括严重出血、气管损伤和狭窄。年龄增长和气管切开术持续时间被确定为并发症的重要预测因素。所采用的处理策略包括药物治疗、手术干预和呼吸治疗。区分气管切开术和既往插管引起的并发症凸显了全面评估患者的必要性。
与拔管相关的并发症频繁发生，严重程度各异。有效识别和处理这些并发症对于改善患者预后至关重要。该研究为拔管过程中遇到的挑战提供了重要见解，并强调在气管切开术拔管管理中考虑既往插管史以完善患者护理方案的必要性。
