Petrossian, R.

Abstract Rationale: Tracheostomies are commonly placed to facilitate weaning from ventilators in ICU patients who fail extubation. Once these patients are successfully weaned from mechanical ventilation and transferred out of the ICU however, management of the tracheostomies are frequently left to the floor teams that are less experienced in managing them. This can delay downsizing/removing tracheostomies when appropriate or in exchanging them when they cannot be safely removed. This report details the number and type of patients with tracheostomies and describes their tracheostomy management after placement.in a small university hospital that did not have a dedicated tracheostomy team. Methods: We reviewed the charts of all patients with tracheostomies who were in the hospital on a single day (7/22/2024). Patients were categorized based on which service placed the initial trach, the reason for the tracheostomy placement, the time from the initial trach placement, and the most recent exchange date. Results: Twelve patients with tracheostomies were in the hospital on that day (4% of all hospitalized patients); six were still in the ICU and 6 were on the floor. The time from initial tracheostomy placement ranged from 10 days to 2.5 years. The primary indications for tracheostomy included respiratory failure (n=5), cerebrovascular accidents (CVA) (n=4), and trauma (n=3). Eight tracheostomies were placed by the Surgery/Trauma service, three by the ENT service, and one by an outside hospital. At the time of data collection 5 of the 12 patients had not yet received a first trach exchange with an average time from tracheostomy placement of >20 days. Three of the 12 patients had had their trach downsized at least once. At least 4 patients had not had a documented tracheostomy exchange for at least 2 months. Conclusion: Our findings emphasize the diverse clinical situations requiring tracheostomy and their impact on patient care in and out of the ICU. The study highlights the importance of continuous assessment throughout a patient's hospital stay. In at least four cases, tracheostomy exchange intervals exceeded the recommended monthly timeframe. Research indicates that tracheostomy teams improve patient safety and outcomes through standardized protocols, suggesting a need for further investigation into team dynamics and their role in recovery.

Background: CO2 Laser (CO2L) technology deployable through flexible endoscopes now allows for their use throughout the airway, although published data are limited. Methods: Retrospective analysis of CO2L bronchoscopic procedures, excluding glottic and subglottic interventions. Procedural success was defined as >50% visual reduction in airway obstruction in the area treated or resolution of the procedural indication. Results: Seventy-two procedures were performed on 36 patients. Nonmalignant indications comprised 66%: stent-associated granulation tissue (28%), granulomatosis with polyangiitis lesions (23%), and lung transplant-related granulation tissue (16%) were the most common. Bronchoscopic access was flexible only in 81% and primarily rigid (combined with flexible) in 18%. The site of intervention was the trachea at 19%, the mainstem at 56%, and lobar/segmental airways at 45%. Procedural success was 89%. CO2L was used exclusively in 19%; in 81%, additional techniques were required, most commonly balloon dilation (59%), cryo-debulking (23%), and rigid dilation (16%). Malignant indications had a nonsignificant trend toward requiring adjuvant techniques (P=0.05). Seventy-six percent of the patients required more than 1 procedure. CO2L exclusive cases had no statistically different needs for subsequent therapeutic bronchoscopies (P=0.10) or time to reintervention (109 vs. 41 days, P=0.07), and reintervention-free survival was similar (P=0.10) and difficult to predict. The complication rate attributable to CO2L was 2.7%. Conclusion: CO2L is a safe and useful tool when precise cutting and vaporization are desired. Its use in multi-modality approaches has high levels of success in adequately selected lesions, adding an ablative potential to dilation techniques. Vasculitis-associated scars/webs and granulation tissue (including stent-associated) appear to be ideal targets.