A Comparative Study on Elective and Emergency Tracheostomies in a Tertiary Hospital of Andhra Pradesh

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A Comparative Study on Elective and Emergency Tracheostomies in a Tertiary Hospital of Andhra Pradesh

Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 8

Abstract

Introduction: Tracheostomy (TR) is a lifesaving procedure, routinely performed in upper airway obstruction and in intensive care unit (ICU) where there is need for prolonged mechanical ventilation (MV). The mortality rates in TR are between 0.5% and 3%. Complication rates quoted in the literature range between 4% and 31% for percutaneous TR and between 6 and 66% for surgical TR. In our country percutaneous endoscopically guided TR is not yet routinely practiced, conventional TR is practiced in the vast majority of cases to manage airway problems. Aim of the Study: The aim of the study was to study the changing trends in indications of elective and emergency tracheostomies and compare the rate and pattern of their complications. Materials and Methods: The study was conducted in ICUs and Department of Otolaryngology-Head and Neck Surgery of Government General Hospital, Kurnool. 100 cases of tracheostomies from November 2012 to October 2014 were included in this study. Both indications of TR; elective and emergency types were included in this study. Selected patients were subjected to investigations preoperatively and postoperatively: X-ray soft tissue neck lateral view, X-ray chest PA view, routine blood, and urine examination, indirect laryngoscopy, video laryngoscopy, DL scopy and biopsy, and CT scans neck with contrast were done. The indications for emergency and elective tracheostomies were noted and compared with other studies. Complications encountered were also compared with other studies. Observations and Results: Overall, data of 100 patients undergoing TR were collected. The most common indication of elective TR was head injury with prolonged MV in 27 cases, OP poisoning in 20 cases, and GB syndrome in 2 cases. The most common indications of emergency TR were SV poisoning in 18 cases, malignancies in 18 cases other indications including diphtheritic tonsillitis, cut throat, hanging, tracheal stenosis, post-RT, and juvenile laryngeal papillomatosis. Out of 100 tracheostomies performed, 20 complications were encountered. The most common complication was tubal blockade in 5 cases, tubal granulation in 3 cases, infection in 3 cases, surgical emphysema in 3 cases, bleeding in 2 cases, tracheal stenosis in 3 cases, and difficulty in decannulation in 1 case. In our study, 51 tracheostomies were performed as an emergency, of which 15 complications were encountered. 49 cases were performed electively of which only 5 complications were encountered. Conclusions: TR is a life surgical procedure that is not devoid of complications; however, most of the complications can be avoided with meticulous technique, adequate, and appropriate post-operative care.

Authors and Affiliations

K Sreelakshmi

Keywords

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