International Journal of Otorhinolaryngology and Head and Neck Surgery

Gupta A et al. Int J Otorhinolaryngol Head Neck Surg. 2020 May;6(5):826-829

http://www.ijorl.com

pISSN 2454-5929 | eISSN 2454-5937

Original Research Article

DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20201532

Tracheostomy in a tertiary care hospital: epidemiology, indications and complications

Anchal Gupta1*, Palak Gupta2, Vikrant Mahajan3, Padam Singh Jamwal1

1Department of ENT, Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir, India

2Department of Ophthalmology, 3Department of Radiodiagnosis, Government Medical College, Jammu, Jammu and Kashmir, India

Received: 14 March 2020

Revised: 29 March 2020

Accepted: 31 March 2020

*Correspondence:

Dr. Anchal Gupta,

E-mail: anchalsachit@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Tracheostomy is one of the most frequently performed surgeries in the emergency department, Intensive care units and at bedside in the present scenario. The aim of our study is to outline the frequent indications, to analyse various complications and to evaluate the outcomes of tracheostomy in our setting in our Institution.

Methods: This retrospective study was conducted in the Department of ENT and Head & Neck Surgery, SMGS Hospital, Jammu from January 2018 to January 2020. The cases were recorded from ENT Department and also intensive medical care, intensive neonatal and pediatric care, intensive respiratory care, surgical intensive care units of our institution. We included all the emergency, elective and prophylactic tracheostomies in this group.

Results: Out of 100 patients included in our study, male: female ratio was 2.7:1. 61 (61%) patients were in the age group of 41 to 60 years. The mean age was 43 years. In our study 58 (58%) tracheostomies were done on emergency. 38 (38%) were done electively whereas rest 4 (4%) were done prophylactically. 37 (37%) tracheostomies were done for upper airway obstruction, followed by artificial ventilation done in 36 (36%) patients. The most indication was carcinoma seen in 17 (17%) patient followed by head injury seen in 16 (16%) patients. The most common complication was surgical emphysema seen in 8(8%) tracheostomies followed by haemorrhage in 6 (6%) tracheostomies.

Conclusions: Tracheostomy still remains a life saving procedure in the surgical management of airway if performed timely despite its few complications.

Keywords: Airway, Complication, Tracheostomy

INTRODUCTION

Tracheostomy is a procedure to perform a persistent opening in trachea for better airway. Brasovala in 1546 AD done first tracheostomy successfully. Armand Trousseau improvised the technique in order to treat diphtheria patients with dyspnea.1,2 The most common indication for doing tracheostomy initially was to relieve the upper airway obstruction. The indications have evolved gradually and it is being used increasingly as a temporary procedure for airway access especially for anesthetic purpose and artificial ventilation. Similarly, the indication of long term or permanent tracheostomy as in cases of severe respiratory distress, sleep apnoea syndrome and terminal malignant neoplasm are also increasing.3

Tracheostomy being a simple procedure is not free from risks. Mortality rate from procedure-related complications is approximately 0.6%.

Various modifications in techniques of tracheostomy has reduced complications and deaths due to tracheostomy. The use of multidisciplinary teams and protocols for tracheostomy care can improve the quality of life of tracheostomy patients.4 Aim of our study is to present an analysis of various indications and complications encountered in tracheostomized patients in our Institution.

METHODS

This retrospective study was conducted in the Department of ENT and Head & Neck Surgery, SMGS Hospital, Jammu from January 2018 to January 2020. The cases were recorded from ENT Department and also intensive medical care, intensive neonatal and pediatric care, intensive respiratory care, surgical intensive care units of our institution. We included all the emergency, elective and prophylactic tracheostomies in this group.

Most of the cases were performed under local anesthesia except prophylactic and preoperative tracheostomies. We preferred a vertical incision from thyroid notch to suprasternal notch in emergency conditions and horizontal incision in elective cases. After reflecting skin and deep fascia, the ribbon muscles i.e., sternohyoid and sternothyroid and isthmus of thyroid were identified and either reflected or cut in midline and ligated. Trachea was identified and opened from below upwards 4,3,2 rings. Using Trousseau’s tracheal dilator, the opening was dilated and tube was inserted. In temporary tracheostomy, we preferred horizontal incision in the trachea.

Inclusion criteria

All patients who underwent tracheostomy during the study period, willing to be included in the study.

Exclusion criteria

Patients not willing for the study and not available for follow up.

Statistical analysis

Data was analysed with a statistical software program (SPSS Statistics for Windows version 20, Chicago, IL). All p values were calculated with one tail. P values below 0.05 were considered significant.

RESULTS

Hundred patients were included in the study. The following observations were made.

Age and sex distribution of patients

Out of 100 patients included in our study, 73 were male patients and 27 were females. The male:female ratio was 2.7:1 (Figure 1).

61 (61%) patients were in the age group of 41 to 60 years. 19 (19%) patients were in the age group 21 to 40 years. The mean age was 43 years. The youngest patient was 6 months old child in whom tracheostomy was done as the child presented with subglottic stenosis (Figure 2).

Figure 1: Gender wise distribution of patients. | 73 27 males females
Figure 1: Gender wise distribution of patients.
Figure 2: Age wise distribution of patients. | 3 1 4 15 33 28 12 4 0 5 10 15 20 25 30 35 0--10 11--20 21--30 31--40 41--50 51--60 61--70 71--80 no.ofpatients Age group (in years) no. of patients
Figure 2: Age wise distribution of patients.
Figure 3: Type of tracheostomy. | 58 38 4 emergency elective prophylactic
Figure 3: Type of tracheostomy.

Type of tracheostomy (in relation to time of surgery)

In our study 58 (58%) tracheostomies were done on emergency basis in ENT, surgery emergency and pediatric emergency wings of our hospital. 38 (38%) tracheostomies were done electively whereas rest 4 (4%) tracheostomies were done prophylactically prior to major surgeries of larynx and oral cavity (Figure 3).

Indication of tracheostomy

Table 1 shows distribution of patients according to indication of tracheostomy. 37 (37%) tracheostomies were done for upper airway obstruction, followed by artificial ventilation done in 36 (36%) patients, tracheobronchial toilet done in 23 (23%) patients. The most common indication in our study was carcinoma seen in 17 (17%) patients. The most common patients were those with carcinoma larynx, carcinoma tongue and carcinoma buccal mucosa. The next most common indication for tracheostomy was in head injury patients done in 16 (16%) patients. Most of these patients were in ICU and tracheostomy was done for tracheobronchial toileting in these patients.

Table 1: Distribution of patients according to indication of tracheostomy.
Table reproduced from source PDF page 3

Complications after tracheostomy

Table 2 shows distribution of patients according to complications after tracheostomy. The most common complication in our study was surgical emphysema seen in 8 (8%) tracheostomies followed by haemmorhage seen in 6 (6%) tracheostomies.

Statistical analysis showed no significant difference in the incidence of complication between males and females, adult and paediatric patients and emergency and elective procedure.

Table 2: Distribution of patients according to complications after tracheostomy.
Table reproduced from source PDF page 3

DISCUSSION

Since it was originally described in the first century B.C, tracheostomy is currently one of the most commonly performed operations in the critically ill patients.

Out of 100 patients included in our study, 73 were male patients and 27 were females. The male: female ratio was 2.7: 1.61 (61%) patients were in the age group of 41 to 60 years. 19 (19%) patients were in the age group 21 to 40 years. The mean age was 43 years. Costa et al, male female ratio 3.66:1 is almost equal to ours 2.7:1.5 Rashid et al has shown male preponderance too.6 Male preponderance in this age group may be due to their increased susceptibility to trauma and increased incidence of malignancy in males than females owing to their habits of smoking and alcohol consumption.

In our study 58 (58%) tracheostomies were done on emergency basis in ENT, surgery emergency and pediatric emergency wings of our hospital. 38 (38%) tracheostomies were done electively whereas rest 4 (4%) tracheostomies were done prophylactically prior to major surgeries of larynx and oral cavity.

37 (37%) tracheostomies were done for upper airway obstruction, followed by artificial ventilation done in 36 (36%) patients, tracheobronchial toilet done in 23 (23%) patients. The most common indication in our study was carcinoma seen in 17 (17%) patients. The next most common indication for tracheostomy was in head injury patients done in 16 (16%) patients which is comparable with studies by few other workers.7-9

The most common complication in our study was surgical emphysema seen in 8 (8%) tracheostomies followed by haemmorhage seen in 6 (6%) tracheostomies. Similar findings were observed by Goldenberg et al and Yellon in their studies.10,11

CONCLUSION

Tracheostomy still remains a life saving procedure in the surgical management of airway if performed timely despite its few complications.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

  1. 1. Van Heurn LW, Brink PR. The history of percutaneous tracheostomy. J Laryngol Otol. 1996;110(8):723-6.
  2. 2. Peumery JJ. Armand Trousseau (1801-1867) French physician par excellence. Hist Sci Med. 2003;37(2):151-6.
  3. 3. Bradley PJ. Management of the obstructed airway and Tracheostomy. In Editor: Scott-Brown’s otorhinolaryngology, Head Neck Surg. 6th ed. Butterworth-Heinemann; 1997.
  4. 4. Kraft SM, Schindler J. Tracheotomy. Chapter 7. Cummings Otolaryngology Head and Neck Surgery, 6th edition. Saunders, Elsevier Inc; 2015: 95-103.
  5. 5. Costa L, Matos R. Urgent tracheostomy: fosur year experience in a tertiary hospital, World J Emerg Med. 2016;7(3):227-30.
  6. 6. Rashid MH, Taous A. Comparative study on complications of emergency and elective tracheostomy, Bangladesh J Otorhinolaryngol. 2015;21(2):69-75
  7. 7. Chandrika A, Somaraj S, Karat A; A descriptive study on complications of tracheostomy. J Evid Based Med Healthc. 2016;3(99):5451-7.
  8. 8. Cohen D, Gurvitz Y, Friedman P, Raveh D, Perez R. Self-retaining T-incision for difficult tracheotomy. J Laryngol Otol. 2007;121(7):664-7.
  9. 9. Crysalde WS, Fieldman RI, Natio K. Tracheostomies: 10 year experience in 319 children Ann Otol Rhinol Laryngol. 1988;97:439-43.
  10. 10. Goldenberg D, Ari EG, Golz A, Danino J, Netzer A, Joachims HZ. Tracheostomy complications: A retrospective study of 1130 cases. Otolaryngol Head Neck Surg. 2000;123(4):495-500.
  11. 11. Yellon RF. Totally obstructing tracheostomy associated suprastomal granulation tissue. Int Jour Pead Otorhinolaryngol. 2000;53(1):49-55.