• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.129-135
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• 1995

The superiorly based flap tracheostomy(SBFT) has been advocated as an new technique of tracheostomy to manage a wide variety of causes of upper airway obstruction. This technique has particular applicability in patients who require long term tracheostomy such as in bilateral vocal cord paralysis and severe obstructive sleep apnea. SBFT has numerous advantages such as shortening of the gap between the skin and trachea : construction of a self-sustaining tract ; circumferential mucocutaneous junction to reduce infection, granulation tissue, bleeding, and stenosis of the tract : avoidance of the laryngotracheal damage : easy placement of a tracheostomal stent to promote speech, coughing and swallowing. Most of all, this technique can reduces the suprastomal buckling by the support of the superiorly based tracheal flap, and thus prevents the stenosis of suprastomal airway. The disadvantage of SBFT is more time-consuming procedure than the conventional tracheostomy, A retrospective analysis of 8 patients undergoing SBFT between June, 1994 and March, 1995 in Dankook University Hospital was performed to present the surgical technique and com-plication rates. The average duration of follow up was 11 months. The complications were consisted of a wound infection and a sternal granulation. The other complications including wound dehiscence, tracheitis, pneumonia, tracheal granulation, sternal narrowing and subglottic stenosis were not experienced.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.346-352
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• 2023

Background: A significant proportion of cardiac surgery intensive care unit (CSICU) patients require long-term ventilation, necessitating tracheostomy placement. The goal of this study was to evaluate the long-term postoperative outcomes and complications associated with percutaneous dilatational tracheostomy (PDT) in CSICU patients. Methods: All patients undergoing PDT after cardiac, thoracic, or vascular operations in the CSICU between January 1, 2013 and January 1, 2021 were identified. They were evaluated for mortality, decannulation time, and complications including bleeding, infection, and need for surgical intervention. Multivariable regression models were used to identify predictors of early decannulation and the complication rate. Results: Ninety-three patients were identified for this study (70 [75.3%] male and 23 [24.7%] female). Furthermore, 18.3% of patients had chronic obstructive pulmonary disease (COPD), 21.5% had history of stroke, 7.5% had end-stage renal disease, 33.3% had diabetes, and 59.1% were current smokers. The mean time from PDT to decannulation was 39 days. Roughly one-fifth (20.4%) of patients were on dual antiplatelet therapy and 81.7% had anticoagulation restarted 8 hours post-tracheostomy. Eight complications were noted, including 5 instances of bleeding requiring packing and 1 case of mediastinitis. There were no significant predictors of decannulation prior to discharge. Only COPD was identified as a negative predictor of decannulation at any point in time (hazard ratio, 0.28; 95% confidence interval, 0.08-0.95; p=0.04). Conclusion: Percutaneous tracheostomy is a safe and viable alternative to surgical tracheostomy in cardiac surgery ICU patients. Patients who undergo PDT have a relatively short duration of tracheostomy and do not have major post-procedural complications.

• Journal of Korean Neurosurgical Society
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• v.54 no.3
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• pp.220-224
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• 2013

Objective : This study aimed to determine the optimal time for tracheostomy by evaluating the benefits and safety of early versus late tracheostomy in spinal cord injury (SCI) patients. Methods : We retrospectively reviewed a total of 254 patients with spinal cord injury. Of them, we selected 21 spinal cord injury patients who required tracheostomy due to long-term mechanical ventilation and analyzed their medical records. The patients were categorized into two groups. Early tracheostomy was performed day 1-10 from intubation in 10 patients and the late tracheostomy was performed after day 10 in 11 cases. We also evaluated the duration of mechanical ventilation, stay in the ICU and complications related to tracheostomy, the injury level of and clinical severity. All data was analyzed using SPSS 18.0/WIN. Results : The early tracheostomy offered clear advantages for shortening the total ICU stay (20.8 day vs. 38.0 day, p=0.010). There was also statistically significant reduction in the total length of time on mechanical ventilation (5.2 day vs. 29.2 day, p=0.009). However, the reductions in the incidence of pneumonia (40% vs. 82%) and the length of ICU stay post to tracheostomy (6 day vs. 15 day) were found to be statistically not significant. There were also no statistically significant differences in the injury level and clinical severity between the groups. Conclusion : We concluded that the early tracheostomy (at least 10 days) is beneficial for SCI patients who are likely to require prolonged mechanical ventilation.

• Tuberculosis and Respiratory Diseases
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• v.62 no.5
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• pp.437-440
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• 2007

Tracheostomy is one of the oldest surgical procedures in medical history. The indications for a tracheostomy include the relief of an upper airway obstruction, long-term mechanical ventilation, and decreased airway resistance to help wean the patient from mechanical ventilator support. Unfortunately, tracheostomy is also associated with a number of problems including, bleeding, infection, pneumothorax, and tracheal stenosis. A pneumothorax is an uncommon complication of a tracheostomy, and can result from direct injury to the pleura or positive pressure ventilation through a dislocation of the tracheostomy tube. We report an uncommon case of a tracheostomy-induced bilateral tension pneumothorax with a review of the literature.

• Journal of Korean Public Health Nursing
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• v.24 no.1
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• pp.5-18
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• 2010

Purpose: The purpose of this study is to understand nurses' perception of visiting nursing services of long-term care insurance. Method: The descriptive survey study involved 188 nurses selected by the convenient sampling of visiting nurses who participated in professional education sessions. Results: Of the 188 participants, 149 (79.3%) were aware of long-term care insurance. Awareness of aspects of long-term care services was 78.7% for facility service, 77.7% for ordinary visiting care service, 85.1% for visiting nursing service and 77.7% for visiting bathing service. Concerning visiting nursing service provision, the majority of the study subjects considered nurse-aid not to be the appropriate route for delivery of services including nasogastric tube exchange, tracheostomy tube management and stitch removal. Conclusion: Continuous evaluation and research on the standards and requirements of the nursing workforce is needed to secure and maintain the high quality of visiting nursing services. Exhaustive studies concerning task division and workforce separation according to nursing services type and level of difficulty should be done to develop the appropriate job description for visiting nursing service staff.

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.27-34
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• 1998

Despite improvement in respiratory care, including use of low pressure and high volume cuffed tubes, tracheal stenosis remains a serious complication after a long-term tracheal intubation and tracheostomy. In such patients, tracheal resection and primary anastomosis is still considered ideal therapeutic modality. Between 1989 and 1997, we performed tracheal resections with end-to-end anastomosis on 14 patients with no operative mortality and some morbidity. Tracheal stenosis was caused by tracheostomy in nine patients, by endotracheal intubation in three patients and by thyroid carcinoma in two patients. The length of stenosis was various from 2cm to 4.5cm. All patient underwent segmental tracheal resection and primary anastomosis(14 patients) and additional procedures were cricoid cartilage reconstruction(2 patients), suprahyoid laryngeal release(3patients), carinal release technique(2 patients) and arytenoidectomy(2 patients). We have nine complications: granulona at anastomosis site in four patients, vocal cord palsy in two patients and restenosis, pneumonia, skin necrosis in each of those patients. The granuloma was removed by bronchoscopic forceps(4 patients). Vocal cord palsy was treated by arytenoidectorny(2 patients), restenosis by T-tube insertion, pneumonia by antibiotics and skin necrosis was treated by skin graft. We reviews our expenence of clinical features of tracheal stenosis and surgical treatment by tracheal one-to-end anastomosis with additional procedures to avoid postoperative complications for sucessful results.

• Journal of Chest Surgery
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• v.54 no.3
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• pp.206-213
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• 2021

Background: Tracheoesophageal fistula (TEFs) is a rare condition that requires complex surgical treatment. We analyzed the surgical outcomes of TEF reported in the literature and at Pusan National University Yangsan Hospital using standardized techniques. Methods: This retrospective study included 8 patients diagnosed with acquired benign TEF between March 2010 and December 2019. The surgical method was determined based on the size of the fistula observed within the endoscope. Results: TEF occurred in 7 patients (87.5%) after intubation or tracheostomy and in 1 patient (12.5%) after esophageal surgery due to conduit necrosis. For tracheal management, 5 and 2 patients underwent tracheal resection and end-to-end anastomosis and primary repair, respectively. The median length of resection was 2.5 cm (range, 1.3-3.4 cm). For esophageal management, 6 patients underwent primary repair and 1 patient underwent esophageal diversion. One patient underwent TEF division with a stapler. Interposition of a muscle flap was performed in 2 patients. TEF recurrence, esophageal stenosis, and dehiscence or granulation occurred in 1, 1, and 2 patients, respectively. A long-term tracheostomy tube or T-tube was used in 2 patients for >2 months. Conclusion: Although TEF surgery is complex and challenging, good results can be achieved if surgical standards are established and experience is accumulated.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.32 no.1
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• pp.29-34
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• 2021

Background and Objectives Tracheostomy lead to persistent bacterial colonization of the respiratory tract. Surgical site infection and restenosis by the pathogenic bacteria is the most fatal complication after open airway surgery. The aim of this study is to describe the culture results of larynx and tracheostoma in patients with tracheostomy and the preoperative, intraoperative culture results in patients underwent open airway surgery. Materials and Method A retrospective review was performed on 18 patients who underwent culture between 2017 and 2019. Results Pseudomonas or antibiotic resistance bacteria were identified in 11 patients out of 18 patients (61.1%); Ceftriaxone-resistant Streptococcus (38.9%), Pseudomonas (33.3%), Methicillin-resistant Staphylococcus aureus (16.7%), extended-spectrum β-lactamases (ESBL) producing Klebsiella pneumoniae (11.1%). Among 18 patients, 6 patients showed the different culture result between larynx and tracheostoma. In 4 out of 10 patients who underwent open airway surgery, the bacteria were not identified before surgery, but the bacteria were isolated in the intraoperative culture. In one patient, the bacteria detected intraoperatively were different from those detected before surgery. Conclusion Preoperative respiratory tract culture and usage of perioperative antibiotics according to the culture are necessary. It is crucial to verify the bacterial culture in both tracheostoma and larynx. And it should be performed immediately before open airway surgery.

• Tuberculosis and Respiratory Diseases
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• v.75 no.1
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• pp.1-8
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• 2013

Several papers on respiratory and critical care published from March 2012 to February 2013 were reviewed. From these, this study selected and summarized ten articles, in which the findings were notable, new, and interesting: effects of high-frequency oscillation ventilation on acute respiratory distress syndrome (ARDS); safety and efficacy of hydroxyethyl starch as a resuscitation fluid; long-term psychological impairments after ARDS; safety and efficacy of dexmedetomidine for sedation; B-type natriuretic peptide-guided fluid management during weaning from mechanical ventilation; adding of daily sedation interruptions to protocolized sedations for mechanical ventilation; unassisted tracheostomy collar of weaning from prolonged mechanical ventilations; and effects of nighttime intensivist staffing on the hospital mortality rates.

• Sleep Medicine and Psychophysiology
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• v.4 no.2
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• pp.129-139
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• 1997

The data collected to date indicate that sleep-related breathing disorders, including sleep-disordered breathing(sleep apnea) and underlying respiratory system diseases, are one of the important risk factors for cardiovascular dysfunction. Sleep-disordered breathing(sleep apnea) is now recognized as one of the leading causes of systemic hypertension, cardiac arrhythmias, coronary heart disease, pulmonary hypertension, right heart failure, and stroke. Sleep may exert a profound effect on breathing in patients with underlying respiratory system disease including bronchopumonary diseases, chest wall abnormalities, central alveolar hypoventilation syndromes or respiratory neuromuscular disorders. Chronic hypoxia and hypercapnia in these patients may accelerate the development of long term cardiovascular complications such as cardiac arrhythmias, pulmonary hypertension, and right heart failure(cor pulmonale). Several recent studies reported that sleep-related breathing disorders are associated with long-term cardiovascular morbidity and mortality. Careful assessment of respiratory and cardiovascular function in these patients is critical. Aggressive and highly effective treatment of sleep-related breathing disorders using tracheostomy, mechanical ventilation, nasal continuous positive airway pressure therapy(nCPAP), intercurrent oxygen therapy or other interventions can reduce the prevalence of cardiovascular dysfunction and the long-term mortality.