Yendrapalli, U.

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.

Objectives: The goal of this study was to evaluate the benefit of sublesional bevacizumab injection for recurrent respiratory papillomatosis (RRP) as used in a typical clinical practice. Methods: A retrospective review of patients with RRP treated between 2011 and 2016 was undertaken. All patients were treated with in-office potassium titanyl phosphate (KTP) laser photoablation. Sublesional bevacizumab injection was used based on joint patient-physician decision making. Papilloma burden was objectively measured on prior recordings by 2 blinded reviewers and described as vocal fold segments affected (VFSA) by papilloma. Each patient served as their own control by comparing times when bevacizumab was or was not used. Mixed model for longitudinal data was used to determine if the previous use of bevacizumab decreased the disease burden. Results: A total of 19 patients met inclusion criteria and all prior laryngoscopic exams were reviewed for VFSA as described above. The mean (SD) number of VFSA when bevacizumab was not used at the prior procedure was 15 (14) as compared to 8 (11) when bevacizumab was used. When adjusted for age, time from initial presentation and baseline disease burden, mixed model showed a decrease of 11 VFSA (95% CI 6.5, 15.5, P < .0001) when bevacizumab was used as compared to when bevacizumab was not used at the prior procedure. In mixed model analysis, there was not a significant association between bevacizumab dose used and VFSA at the subsequent visit ( P = .8). Conclusion: Using sublesional bevacizumab intermittently based on clinical findings appears to be effective in improving disease control. Papilloma burden is significantly decreased at the subsequent clinical follow-up following injection of sublesional bevacizumab. The beneficial effect of sublesional bevacizumab may be not be dose-dependent.