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World Journal of Surgery

, Volume 42, Issue 9, pp 2792–2799 | Cite as

Awake Tracheostomy: Indications, Complications and Outcome

  • Doron Sagiv
  • Yuval Nachalon
  • Jobran Mansour
  • Eran Glikson
  • Eran E. Alon
  • Arkadi Yakirevitch
  • Gideon Bachar
  • Michael Wolf
  • Adi Primov-Fever
Original Scientific Report
  • 214 Downloads

Abstract

Background

Awake tracheostomy (AT) is aimed at securing the airway of patients with upper airway obstruction when other means are not feasible or have failed. Reports on AT in the literature are scarce. The goal of this study was to review our experience with the indications, complications and outcome of AT.

Methods

A retrospective chart review was conducted on all ATs performed between 2010 and 2016 in two university-affiliated, tertiary medical centers. Data on demographics, indications, techniques, urgency and postoperative complications were retrieved from the medical charts.

Results

The 37 of the 1023 recorded tracheostomies (3.62%) that were ATs comprised the study group (mean age of the patients 60.3 years, 32 [86.5%] males). The most common indication was head and neck (HN) malignancy (oncologic group, 70.3%), with the larynx (53.8%) being the most commonly involved site. Patients in the non-oncologic group (n = 11) were significantly younger (P = 0.048) and had a significantly higher prevalence of urgent surgery compared to the oncologic group (P = 0.0009). Major postoperative complications included tube dislodgement (n = 2) and pneumothorax (n = 1) that were managed successfully. One of the two patients with severe hypoxia and arrhythmia that necessitated cardiopulmonary resuscitation died.

Conclusion

Whether the etiology of the AT was related to HN oncological disease or not was the most important clinical factor in our cohort. The non-oncologic group was significantly younger, suffered from more urgent events and tended to have more complications (nonsignificant). ATs had a 97.3% rate of immediate survival, a 5.4% risk of major irreversible complications and a 2.7% risk of mortality.

Notes

Compliance with ethical standards

Conflict of interest

There are no financial or personal conflicts of interest to declare.

Ethical standard

The study was approved by the medical centers’ Institutional Review Boards.

References

  1. 1.
    Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG (2013) Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 118:251–270CrossRefPubMedGoogle Scholar
  2. 2.
    Asai T (2015) Emergency cricothyrotomy toward a safer and more reliable rescue method in “cannot intubate, cannot oxygenate” situation. Anesthesiology 123:995–996CrossRefPubMedGoogle Scholar
  3. 3.
    Bradely PJ (1999) Treatment of the patient with upper airway obstruction caused by cancer of the larynx. Otolaryngol Head Neck Surg 120:737–741CrossRefGoogle Scholar
  4. 4.
    Goldenberg D, Golz A, Netzer A, Joachims HZ (2002) Tracheotomy: changing indications and a review of 1130 cases. J Otolaryngol 31:211–215CrossRefPubMedGoogle Scholar
  5. 5.
    Gillespie MB, Eisele DW (1999) Outcomes of emergency surgical airway procedures in a hospital-wide setting. Laryngoscope 109:1766–1769CrossRefPubMedGoogle Scholar
  6. 6.
    Altman KW, Waltonen JD, Kern RC (2005) Urgent surgical airway intervention: a 3 year county hospital experience. Laryngoscope 115:2101–2104CrossRefPubMedGoogle Scholar
  7. 7.
    Fang CH, Friedman R, White PE, Mady LJ, Kalyoussef E (2015) Emergent awake tracheostomy—the five-year experience at an urban tertiary care center. Laryngoscope 125:2476–2479CrossRefPubMedGoogle Scholar
  8. 8.
    Yuen HW, Loy AH, Johari S (2007) Urgent awake tracheotomy for impending airway obstruction. Otolaryngol Head Neck Surg 136:838–842CrossRefPubMedGoogle Scholar
  9. 9.
    Rashid AO, Islam S (2017) Percutaneous tracheostomy: a comprehensive review. J Thorac Dis 9(Suppl 10):S1128–S1138CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ravi PR, Vijai MN, Shouche S (2017) Realtime ultrasound guided percutaneous tracheostomy in emergency setting: the glass ceiling has been broken. Disaster Mil Med 28:3–7Google Scholar
  11. 11.
    Langvad S, Hyldmo PK, Nakstad AR, Vist GE, Sandberg M (2013) Emergency cricothyrotomy—a systematic review. Scand J Trauma Resusc Emerg Med 21:43CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Bair AE, Panacek EA, Wisner DH, Bales R, Sakles JC (2003) Cricothyrotomy: a 5-year experience at one institution. J Emerg Med 24:151–156CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  1. 1.Department of Otolaryngology and Head and Neck Surgery, Sheba Medical CenterTel HashomerRamat GanIsrael
  2. 2.Department of Otolaryngology and Head and Neck SurgeryRabin Medical CenterPetah-TikvaIsrael
  3. 3.Sackler Faculty of MedicineTel-Aviv UniversityTel AvivIsrael

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