Awake tracheostomy in a patient with acute upper airway obstruction: an emergency application of an elective percutaneous procedure
Pierluigi Fusco, Angela Iuorio, Mirco Della Valle, Fausto FerraroDipartimento Della Donna, Del Bambino, Della Chirurgia Generale e Specialistica, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, IT 80138, ItalyAbstract: Since its introduction in 1985 with Ciaglia, percutane...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2019-07-01
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| Series: | Open Access Emergency Medicine |
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| Online Access: | https://www.dovepress.com/awake-tracheostomy-in-a-patient-with-acute-upper-airway-obstruction-an-peer-reviewed-article-OAEM |
| _version_ | 1811198095480848384 |
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| author | Fusco P Iuorio A Della Valle M Ferraro F |
| author_facet | Fusco P Iuorio A Della Valle M Ferraro F |
| author_sort | Fusco P |
| collection | DOAJ |
| description | Pierluigi Fusco, Angela Iuorio, Mirco Della Valle, Fausto FerraroDipartimento Della Donna, Del Bambino, Della Chirurgia Generale e Specialistica, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, IT 80138, ItalyAbstract: Since its introduction in 1985 with Ciaglia, percutaneous tracheostomy (PT) was contraindicated in emergency settings and obesity. However, several case series in the last 20 years have documented the use of PT in life-threatening airway emergencies. We present a case of severe acute airway obstruction in a 66-year-old woman successfully treated with a placement of an awake PT. The woman’s glottic obstruction was caused by a recurrent laryngeal neoplasia and revealed by nasoendoscopy. This acute condition required a serious effort from the patient to oxygenate and therefore prevented orotracheal intubation as well as the use of any supraglottic device and/or sedation. Blood aspiration after a first attempt to make a quick access to the tracheal lumen with an emergency cricothyroidotomy, and difficulties in the exact identification of tumor infiltration, led us to perform an awake tracheostomy. Due to elevated risk of airway bleeding, we started with a surgical approach to better identify anatomical structures. After the correct inter-tracheal ring space identification, sudden worsening of clinical symptoms required that we complete the procedure quickly with the aid of a Ciaglia Blue Rhino™-Cook (CBR) tracheostomy kit. At the tracheostomy tube placement, the patient quickly resolved her dyspnea and physiological breathing was restored.Keywords: emergency, hypoxia, tracheostomy |
| first_indexed | 2024-04-12T01:25:02Z |
| format | Article |
| id | doaj.art-1f02ebbd4a494d1389a981de8f53ec24 |
| institution | Directory Open Access Journal |
| issn | 1179-1500 |
| language | English |
| last_indexed | 2024-04-12T01:25:02Z |
| publishDate | 2019-07-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Open Access Emergency Medicine |
| spelling | doaj.art-1f02ebbd4a494d1389a981de8f53ec242022-12-22T03:53:40ZengDove Medical PressOpen Access Emergency Medicine1179-15002019-07-01Volume 1116717047372Awake tracheostomy in a patient with acute upper airway obstruction: an emergency application of an elective percutaneous procedureFusco PIuorio ADella Valle MFerraro FPierluigi Fusco, Angela Iuorio, Mirco Della Valle, Fausto FerraroDipartimento Della Donna, Del Bambino, Della Chirurgia Generale e Specialistica, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, IT 80138, ItalyAbstract: Since its introduction in 1985 with Ciaglia, percutaneous tracheostomy (PT) was contraindicated in emergency settings and obesity. However, several case series in the last 20 years have documented the use of PT in life-threatening airway emergencies. We present a case of severe acute airway obstruction in a 66-year-old woman successfully treated with a placement of an awake PT. The woman’s glottic obstruction was caused by a recurrent laryngeal neoplasia and revealed by nasoendoscopy. This acute condition required a serious effort from the patient to oxygenate and therefore prevented orotracheal intubation as well as the use of any supraglottic device and/or sedation. Blood aspiration after a first attempt to make a quick access to the tracheal lumen with an emergency cricothyroidotomy, and difficulties in the exact identification of tumor infiltration, led us to perform an awake tracheostomy. Due to elevated risk of airway bleeding, we started with a surgical approach to better identify anatomical structures. After the correct inter-tracheal ring space identification, sudden worsening of clinical symptoms required that we complete the procedure quickly with the aid of a Ciaglia Blue Rhino™-Cook (CBR) tracheostomy kit. At the tracheostomy tube placement, the patient quickly resolved her dyspnea and physiological breathing was restored.Keywords: emergency, hypoxia, tracheostomyhttps://www.dovepress.com/awake-tracheostomy-in-a-patient-with-acute-upper-airway-obstruction-an-peer-reviewed-article-OAEMEmergencyHypoxiaTracheostomy |
| spellingShingle | Fusco P Iuorio A Della Valle M Ferraro F Awake tracheostomy in a patient with acute upper airway obstruction: an emergency application of an elective percutaneous procedure Open Access Emergency Medicine Emergency Hypoxia Tracheostomy |
| title | Awake tracheostomy in a patient with acute upper airway obstruction: an emergency application of an elective percutaneous procedure |
| title_full | Awake tracheostomy in a patient with acute upper airway obstruction: an emergency application of an elective percutaneous procedure |
| title_fullStr | Awake tracheostomy in a patient with acute upper airway obstruction: an emergency application of an elective percutaneous procedure |
| title_full_unstemmed | Awake tracheostomy in a patient with acute upper airway obstruction: an emergency application of an elective percutaneous procedure |
| title_short | Awake tracheostomy in a patient with acute upper airway obstruction: an emergency application of an elective percutaneous procedure |
| title_sort | awake tracheostomy in a patient with acute upper airway obstruction an emergency application of an elective percutaneous procedure |
| topic | Emergency Hypoxia Tracheostomy |
| url | https://www.dovepress.com/awake-tracheostomy-in-a-patient-with-acute-upper-airway-obstruction-an-peer-reviewed-article-OAEM |
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