Use of postoperative chest x-ray after elective adult tracheotomy
| Autor: | Nabil S. Fuleihan, Daniel K. Smith, Gregory A. Grillone |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Tachycardia
Adult Male medicine.medical_specialty Radiography medicine.medical_treatment Respiratory Tract Diseases 03 medical and health sciences 0302 clinical medicine Tracheotomy Postoperative Complications medicine Humans Postoperative Period 030223 otorhinolaryngology Aged Retrospective Studies Aged 80 and over business.industry Incidence (epidemiology) Pneumothorax Retrospective cohort study medicine.disease Surgery Otorhinolaryngology Elective Surgical Procedures 030220 oncology & carcinogenesis Anesthesia Female medicine.symptom business Elective Surgical Procedure Complication |
| Zdroj: | Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery. 120(6) |
| ISSN: | 0194-5998 |
| Popis: | Surgeons have been creating tracheotomies since at least 124 AD, when first reported by Asclepiades (Price HC, Postma DS. Ear Nose Throat J 1983;62:44-59). Intraoperative and postoperative complications specifically associated with this procedure have been well established. The incidence of pneumothorax ranges from 0% to 17%, depending on the age group studied. To evaluate this complication, it is generally accepted that a postoperative chest film should routinely be obtained after a tracheotomy in adult patients. In adult nonemergent tracheotomies, the routine use of a postoperative chest film has a low yield for detecting a pneumothorax in patients without clinical findings of pneumothorax. To evaluate the use of postoperative chest x-ray in adult tracheotomy patients, a retrospective review of tracheotomies performed at the Boston Medical Center from January 1994 to June 1996 was undertaken. Data examined consisted of age, sex, surgical indication, urgency, operating service, intraoperative and postoperative complications, difficulty of procedure, anesthetic technique, findings on postoperative chest film, signs and symptoms of pneumothorax, and specific treatment of pneumothorax if present. In total, 250 patients were identified. The main indication for tracheostomy in this study was ventilator dependence, accounting for 77% of the procedures. A complication rate of 11.6% was encountered, with no deaths. Postoperative hemorrhage was the most common complication (3.6%). Pneumothorax was documented by chest x-ray in 3 (1.2%) patients, 1 of whom had bilateral pneumothoraces. The most common symptom of a pneumothorax was tachycardia, with 8.8% of the patients exhibiting at least 1 episode. Of the 3 cases of pneumothorax in this study, only 1 was clinically relevant and required treatment. Furthermore, the clinical signs and symptoms in this patient clearly supported the diagnosis of pneumothorax before a postoperative chest film was obtained. Thus postoperative chest radiographs did not change the treatment or outcome of any of the patients undergoing a tracheotomy. This suggests that postoperative chest x-ray after adult tracheotomy is not required in routine cases. Chest radiographs should be obtained after emergent procedures, after difficult procedures, or in patients exhibiting signs or symptoms of pneumothorax. |
| Databáze: | OpenAIRE |
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