Emergent Awake tracheostomy—The five‐year experience at an urban tertiary care center. (24th June 2015)

• Record Type: Journal Article
• Authors: Fang, Christina H.; Friedman, Remy; White, Priscilla E.; Mady, Leila J.; Kalyoussef, Evelyne
• Is Part Of: Laryngoscope. Volume 125:Number 11(2015:Nov.)
• Page Start: 2476
• Page End: 2479
• Publication Date: 2015-06-24
• Subjects: Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.25348
• Languages: English
• ISSNs: 0023-852X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="lary25348-sec-0001" sec-type="section"> <title>Objectives/Hypothesis</title> <p>There are few studies that discuss the issues surrounding emergent awake tracheostomy. We aim to review the indications, anesthesia used, complications, and outcomes of patients undergoing urgent awake tracheostomy.</p> </sec> <sec id="lary25348-sec-0002" sec-type="section"> <title>Study Design</title> <p>Chart review.</p> </sec> <sec id="lary25348-sec-0003" sec-type="section"> <title>Methods</title> <p>Medical charts of patients who underwent an emergent awake tracheostomy at our institution‐affiliated tertiary care center over a 5‐year period from 2009 to 2014 were reviewed. Data were collected from inpatient, outpatient, and operative records.</p> </sec> <sec id="lary25348-sec-0004" sec-type="section"> <title>Results</title> <p>Sixty‐eight patients underwent emergent awake tracheostomy. Over half presented with hoarseness (n = 37, 54.4%) and/or stridor (n = 37, 54.4%). Acute upper airway obstruction secondary to malignancy was the most common indication and accounted for 58 cases (85.3%). Thirty‐nine (70.1%) of the 55 patients with squamous cell carcinoma presented with advanced disease (stage III or IV). Other indications included glottic or subglottic stenosis (4.4%), failure to intubate (2.9%), and other (7.4%). Local anesthesia was used alone in 35.3% of cases and in combination with conscious sedation in 64.7% of cases. Mild bleeding occurred postoperatively in five patients (7.4%). There were no other postoperative complications. Nineteen patients were lost to follow‐up. The mean follow‐up of 49 patients was 7.2 weeks, ranging from 2 to 261 weeks. Long‐term complications occurred in three patients and included tracheitis 7.4% and suprastomal granuloma 2.9%. Eleven patients (22%) were decannulated at a mean of 11.8 months following tracheostomy.</p> </sec> <sec id="lary25348-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Emergent awake tracheostomy should be considered in patients with impeding airway obstruction and is a safe and effective method to secure an airway in these patients.</p> </sec> <sec id="lary25348-sec-0006" sec-type="section"> <title>Level of Evidence</title> <p>4 <italic>Laryngoscope</italic>, 125:2476–2479, 2015</p> </sec> </abstract>