Urgent surgical airway intervention: A 3 year county hospital experience

Kenneth W. Altman*, Joshua D. Waltonen, Robert C. Kern

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Scopus citations

Abstract

OBJECTIVES: To review the indications, complications, and outcomes of patients undergoing urgent surgical airway intervention. METHODS: The inpatient and outpatient charts of patients who underwent awake tracheostomy or were converted from cricothyrostomy to tracheostomy at our institutional-affiliated County Hospital over a 3 year period were reviewed. RESULTS: Ninety patients underwent awake tracheotomy, and seven were converted from cricothyrostomy to tracheostomy. Indications for awake tracheotomy included impending airway obstruction from malignancy of the aerodigestive tract or that causing extrinsic compression of the airway in 72 (80%) patients, neck abscess in 4 (4.4%), subglottic stenosis in 3 (3.3%), and a variety of other etiologies in 11 (12.2%). Thirty-eight (42%) patients were noted to have stridor. On fiberoptic laryngoscopy, 66 (80%) patients had moderate or severe airway obstruction, whereas 17 (20%) had mild or no obstruction. Of the 72 patients with squamous cell carcinoma, only 6 (8%) have been subsequently decannulated. Among the remainder, 13 of 18 (72%) have been decannulated. Complications occurred in seven (7.8%) patients after awake tracheotomy, none with untoward sequelae. Three severe complications occurred among the seven patients converted from cricothyrostomy to tracheostomy: anoxic brain injury in each, leading to death in two. CONCLUSIONS: Awake tracheostomy should be considered in any patient with impending or ongoing airway obstruction or with potential for difficult intubation. This should be performed in a timely manner before an emergent situation arises because the complications of emergency surgical airway can be devastating.

Original languageEnglish (US)
Pages (from-to)2101-2104
Number of pages4
JournalLaryngoscope
Volume115
Issue number12
DOIs
StatePublished - Dec 2005

Keywords

  • Airway emergency
  • Awake tracheostomy
  • Cricothyroidotomy
  • Upper airway obstruction

ASJC Scopus subject areas

  • Otorhinolaryngology

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