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Purpose To assess the effectiveness of a new suturing technique called Dragonfly for the closure of temporary tracheotomies. This technique involves placing two sutures during the tracheotomy procedure and leaving them loose and unknotted until the day of skin closure. Methods Retrospective case control study. Monocentric study at a department of Otolaryngology and head and neck surgery at a tertiary centre in Italy. A total of 50 patients who underwent temporary tracheotomy between January 2017 and December 2021. Patients were divided into two groups based on the trachea closure method: traditional closure with sutures placed during the skin closure procedure (Group A) and the Dragonfly technique (Group B). The incidence of tracheal stenosis by Computed Tomography (CT), granulation tissue formation, bleeding, procedure duration, patient discomfort were evaluated. Results The incidence of tracheal complications and tracheal stenosis was reduced in Group B (6%) compared to Group A (24%). Procedure times (3 min vs. 6 min) durations was significantly shorter. No patients had symptoms of tracheal stenosis at the end of the procedures. Conclusion The Dragonfly suturing technique is effective and safe for tracheotomy closure, reducing the incidence of tracheal stenosis and shortening hospitalization duration compared to the traditional method.

IntroductionAneurysmal subarachnoid hemorrhage (aSAH) has a high rate of morbidity. However, the ability to predict tracheostomy/gastrostomy tube requirement during hospital admission and long-term rates of tracheostomy/gastrostomy tube decannulation are not well understood.MethodsWe performed a retrospective study of patients with aSAH treated at a single center between 2015 and 2023, examining rates of tracheostomy and gastrostomy tube placement. Both univariate analysis and multivariate logistic regressions (MLR) were used to analyze predictors of tracheostomy/PEG placement, using characteristics present on hospital arrival such as age and Hunt and Hess [HH] grades. Additionally, rates and predictors post-discharge tracheostomy decannulation and PEG removal were also analyzed.ResultsOf 434 patients with aSAH reviewed, with 322 patients surviving to discharge (mean age, 56.7 ± 13.7; 62.7% female; 69.9% white), 17 (5.3%) had tracheostomy placement and 45 (13.9%) had gastrostomy tube placement. MLR showed that strong prediction of tracheostomy and PEG Placement (AUROC 0.87 and 0.82, respectively). On MLR, HH grade was predictive of both tracheostomy and G-tube placement (OR 2.9 95%CI [1.69, 5.4] and OR 2.2. 95%CI 1.5 and 3.2, respectively), with modified Fisher Score not associated with either tracheostomy but trending towards significance with gastrostomy tube placement (OR 2.3, 95% CI [0.9, 9.32] and OR 1.57, 95%CI [0.99, 2.69], p=0.07, respectively). Aneurysm re-rupture was predictive of PEG placement (OR 4.55, 95%CI [1.72, 11.9], p=0.002), while not tracheostomy (OR 1.67, 95% [0.32, 6.70], p=0.5). Age was not a predictor of either tracheostomy or PEG placement (OR 0.97, 95%CI [0.94, 1.01] and OR 0.99, 95%CI [0.97, 1.02], respectively).Tracheostomy decannulation was achieved in 52.9% (9/17), with 77.8% (7/9) of decannulations occurring within 3 months of discharge. Gastrostomy tube removal was achieved in 51.1% (23/45) of patients, with 56.5% (13/23) occurring with 3 months of discharge. On univariate analysis, age was not associated with tracheostomy decannulation (mean: 58.3 years [SD 13.] vs. 48.3 [?], p=0.3) or PEG removal (54 years [14.9] vs. 59.8 [13.6], p=0.19) but lower arrival HH grades and lower mRS at discharge follow-up were associated with PEG removal (HH grade median [IQR]: 3, [3, 4] vs. 4, [3, 5], p=0.03 and mRS at discharge median [IQR]: 5, [4, 5] vs. 5, [5, 5], p=0.05, respectively).ConclusionsTracheostomy or gastrostomy tube requirement could be accurately predicted using characteristics present on hospital arrival. Over half of patients with tracheostomies or gastrostomy tubes in our cohort were able to successfully have tracheostomy decannulation/gastrostomy tube removal, with half of those achieving this by 3 months of discharge. Neurologic status on arrival played a larger role than age in predicting tracheostomy/gastrostomy tube requirement and long-term tracheostomy decannulation/gastrostomy tube removal.DisclosuresC. Chuck: None. M. Taman: None. J. Oldam: None. J. Feler: None. K. Moldovan: None. R. Torabi: None. A. Mahta: None.

Introduction : Over the years, pediatric tracheotomy has evolved significantly, and ongoing debates regarding its indications, timing, surgical techniques, and decannulation protocols persist. In most cases, management decisions are based on the medical team’s clinical experience and existing literature, as there are no universally accepted guidelines. Aim : This study aims to present our experience with pediatric tracheostomies and compare our results with those reported in the international literature. Patients and methods : Over the past few years, 18 pediatric tracheotomies were performed at the ENT Clinic at St George University Hospital in Plovdiv due to various chronic conditions. All procedures were planned due to disease progression. Results : The surgical interventions were completed without complications in all cases. Eight patients underwent permanent tracheostomy, while ten underwent temporary tracheostomy. Three children were successfully decannulated. Conclusion : Pediatric tracheotomy is a relatively rare surgical procedure with an estimated incidence rate of 6.6 per 100,000, according to the literature. Despite extensive research on the topic, several aspects of planned pediatric tracheotomy remain under discussion and require further clarification.

IntroductionTracheostomy care in hospitals has historically been suboptimal, contributing to increased morbidity and mortality.1 These patients require complex, multidisciplinary care delivered by appropriately trained staff. Simulation-based training improves both knowledge and confidence in tracheostomy care. We conducted a national survey to assess training, exposure, and confidence among respiratory trainees in the UK.MethodsA web-based survey was designed to evaluate tracheostomy training and exposure among UK respiratory trainees. Respondents were asked about training grade, deanery, ICU rotation completion, and whether they were dual training in Intensive Care Medicine (ICM). The survey included questions on theoretical and practical training, use of simulation, confidence levels, and suggestions for improving training. It was distributed via the Dual Respiratory & ICM trainees WhatsApp group between November 2024 and February 2025.ResultsSeventy-one trainees responded, including 12 dual ICM trainees, from 10 deaneries. Of all respondents, 32% had not received any tracheostomy training, while 41% had received both theoretical and practical instruction. Among 59 non-ICM trainees, only 31% had received both.Confidence in tracheostomy care was associated with seniority, dual ICM training, ICU experience, and access to a tracheostomy weaning unit. Trainees with simulation experience or frequent exposure to tracheostomy patients reported higher confidence levels figure 1).A total of 94% expressed interest in attending practical or simulation-based training. Suggested improvements included mandatory e-learning modules, annual simulation sessions, and dedicated tracheostomy teaching at regional training events.Abstract P60 Figure 1Trainee Confidence Ratings[Image Omitted. See PDF.]ConclusionThis national survey highlights a clear mismatch between the clinical expectations of respiratory trainees and their current training in tracheostomy care. Gaps in structured teaching and simulation access are common, but trainees identified practical, achievable improvements. There is strong interest in better training opportunities. It is now the responsibility of training bodies and educators to implement meaningful changes.ReferenceWilkinson KA, et al. On the right trach? A review of the care received by patients who underwent a tracheostomy. A report by NCEPOD. 2014, London.

Pediatric tracheotomy became established as a valuable procedure when Galloway reported its successful use to assist breathing in polio patients during the polio pandemic of the 1950s. Examination of the history of the procedure from its inception to the present day reveals a significant change in the indications for its execution. This is due to the achievements of neonatal and pediatric intensive care medicine, which in recent years have been able to shift the emphasis from performing it as an emergency procedure to solve an acute asphyxia problem to performing it in children, representing a complex group of patients with permanent dependence on tracheostomy and medical technologies for long-term survival related to it. These undisputed successes have created new groups of small patients in need of tracheotomy – children with diseases requiring a multidisciplinary approach to treatment, in whom, until not so long ago, performing a tracheotomy for the purpose of maintaining life was considered pointless. The main difference in the modern planned pediatric tracheotomy is noticeable in the reasons for its performance – congenital or acquired upper respiratory tract stenosis, neurological, cardiological and other conditions bilateral insufficiency of the vocal cords and infections of the upper respiratory tract. The indications for its implementation, on the other hand, remain unchanged – overcoming obstruction of the upper respiratory tract, need for long-term mechanical ventilation, performing a tracheobronchial lavage. Most of the children who require tracheostomy are under 1 year of age, with a higher incidence in males compared to females.

We assessed the effects of tracheostomy timing (early vs. late) on outcomes among adult patients receiving mechanical ventilation. PubMed, Embase, Web of Science and Cochrane Library were searched to identify relevant RCTs of tracheotomy timing on patients receiving mechanical ventilation. Two reviewers independently screened the literature, extracted data. Outcomes in patients with early tracheostomy and late tracheostomy groups were compared and analyzed. Meta-analysis was performed using Stata14.0 and RevMan 5.4 software. This study is registered with PROSPERO (CRD42022360319). Twenty-one RCTs were included in this Meta-analysis. The Meta-analysis indicated that early tracheotomy could significantly shorten the duration of mechanical ventilation (MD: -2.77; 95% CI -5.10~ -0.44; P = 0.02) and the length of ICU stay (MD: -6.36; 95% CI -9.84~ -2.88; P = 0.0003), but it did not significantly alter the all-cause mortality (RR 0.86; 95% CI 0.73~1.00; P = 0.06), the incidence of pneumonia (RR 0.86; 95% CI 0.74~1.01; P = 0.06), and length of hospital stay (MD: -3.24; 95% CI -7.99~ 1.52; P = 0.18). In patients requiring mechanical ventilation, the tracheostomy performed at an earlier stage may shorten the duration of mechanical ventilation and the length of ICU stay but cannot significantly decrease the all-cause mortality and incidence of pneumonia.

Introduction and objectivesThere are many benefits to one-way valve use including restoring physiological PEEP, improving postural tone, vocalisation and re-sensitisation of the upper airway. Our organisation adopts a multidisciplinary pathway to establish appropriateness for one-way valve assessment. Our clinical experience shows that a small proportion of our caseload do not tolerate closed bias valves. We present 8 paediatric cases and evaluate the tolerance and patient experience in terms of vocalisation/communication, tracheobronchial secretion management and feeding/swallowing when wearing the Atos Medical TRACOE® Phon Assist I one-way valve.MethodsData was collected for 8 paediatric patients, demographics are detailed in table 1. Additional data was collated from the clinical assessment including Transtracheal pressure (TTP)manometry. TTP was compared between the two valve types. Likert rating scales and a semi structured parent/carer interview followed by thematic analysis.ResultsOf the 8 sets of data for children using the TRACOE® Phon Assist I one-way valve, one was excluded from full analysis as they were transferred to a different tertiary hospital. Our data showed where a closed bias-valve resulted in high TTP and non-tolerance, use of the TRACOE® Phon Assist I one-way valve resulted was well tolerated (table 1).All parent/carer responses reported a positive change in communication/vocalisation. The top ranking theme (86%) was that the vocalisation was louder with the valve on. Six (86%) responses reported a positive change in tracheobronchial secretion management. No (0%) responses reported a change in oral feeding. The top ranking theme stated by 6 (86%) was that the child was tube fed.Abstract P147 Table 1Demographic and Transtracheal Pressure measurements: TRACOE® Phon Assist I one-way valve vs closed bias ValveConclusionsThe findings of this study show that for paediatric patients who do not tolerate closed bias one-way valve, that the TRACOE® Phon Assist I one-way valve provides a safe and well tolerated alternative. The infinitely adjustable side openings allow adjustment of breathing resistance which facilitates airflow through the upper airway and out the side openings aiding tolerance. Our small but complex population of paediatric tracheostomy patients who do not tolerate closed bias one-way valves, can now to gain the benefits associated with use of one-way valves by using the TRACOE® Phon Assist I one-way valve.

Background Percutaneous dilatational tracheostomy (PDT) is a common procedure for mechanically ventilated patients in the intensive care unit (ICU). This study compared the real-time ultrasound-guided PDT using a laryngeal mask airway (LMA) with the standard bronchoscopy-guided PDT technique in ICU patients requiring elective tracheostomy. Methods This randomized controlled study was conducted at Ain Shams University Hospital’s Critical Care Department from December 4th, 2021, to December 3rd, 2022. The study population included 60 critically ill patients admitted to the ICU. Thirty patients were randomly assigned to the real-time ultrasound-guided LMA-assisted group, and 30 patients were randomly assigned to the bronchoscopy-guided technique. The primary study outcome was the procedure time, and the secondary outcomes included procedure-related complications rate and cost-effectiveness. Results The real-time ultrasound-guided LMA-assisted group had significantly shorter procedure time (median 17 [IQR: 15–20] min vs. 35 [IQR: 28–39] min, p  < 0.001) and lower equipment damage (0% vs. 20%, p  = 0.024) during the procedure compared to the bronchoscopy-guided group. Additionally, the cost of tracheostomy was significantly lower in the real-time ultrasound-guided LMA-assisted group (median: 300 vs. 800 USD, p  < 0.001). The real-time ultrasound-guided LMA group had a lower major complications rate than the bronchoscopy-guided group (36.7%) vs. 3.3%, p  = 0.002). Conclusions The study demonstrated that real-time ultrasound-guided LMA-assisted PDT had shorter procedure time, reduced equipment damage, lower costs, and was associated with lower complications when compared to the bronchoscopy-guided technique. These findings suggest that ultrasound guidance can enhance the efficiency and cost-effectiveness of PDT procedures.