Background Acute respiratory failure is a rare life threatening complication following thyroid surgery and its incidence is reported as high as 0.9%. Clinical presentation of severe acute respiratory failure is characterized by dyspnea, inspiratory airways distress, hypoxia and its standard current management is the orotracheal intubation and safe extubation. In case of persistent distress, tracheotomy is mandatory. The Authors, analysing a large acute respiratory failure clinical series, describe an innovative treatment of this severe condition: the nasotracheal prolonged safe extubation. Methods Patients treated at our Intensive Care Unit for acute respiratory failure following thyroid surgery from January 2004 to December 2013, were reviewed. Demographic data including gender, age, clinical presentation, laryngoscopic findings, management and outcome during a 24-months follow-up after treatment were collected and evaluated. Moreover, the strategy for prolonged nasotracheal safe extubation was carefully described. Results Nineteen out of the 2853 patients scheduled for thyroid surgery (0.66%) at our University Hospital, developed post-operative acute respiratory failure. All of them were treated by nasotracheal prolonged safe extubation. The success rate in avoiding highly invasive treatment was of 84.2%, since only 3 patients needed definitive tracheotomy (15.7%). Conclusions In our series, the prolonged safe extubation reduced the almost totality of expected tracheotomies in patients with acute respiratory failure following thyroid surgery (84.2%), demonstrating its feasibility and efficacy. It was a well tolerated and minimal invasive procedure that allowed a good respiratory ability and a fast clinical resolution of the laryngeal functional impairment.

Nasotracheal prolonged safe extubation in acute respiratory failure post-thyroidectomy: An efficacious technique to avoid tracheotomy? A retrospective analysis of a large case series / Ferraro, F.; Gambardella, C.; Testa, D.; Santini, L.; Marfella, R.; Fusco, P.; Lombardi, C. P.; Polistena, A.; Sanguinetti, A.; Avenia, N.; Conzo, G.. - In: INTERNATIONAL JOURNAL OF SURGERY. - ISSN 1743-9191. - 41:Suppl. 1(2017), pp. S48-S54. [10.1016/j.ijsu.2017.03.082]

Nasotracheal prolonged safe extubation in acute respiratory failure post-thyroidectomy: An efficacious technique to avoid tracheotomy? A retrospective analysis of a large case series

Polistena A.
Membro del Collaboration Group
;
2017

Abstract

Background Acute respiratory failure is a rare life threatening complication following thyroid surgery and its incidence is reported as high as 0.9%. Clinical presentation of severe acute respiratory failure is characterized by dyspnea, inspiratory airways distress, hypoxia and its standard current management is the orotracheal intubation and safe extubation. In case of persistent distress, tracheotomy is mandatory. The Authors, analysing a large acute respiratory failure clinical series, describe an innovative treatment of this severe condition: the nasotracheal prolonged safe extubation. Methods Patients treated at our Intensive Care Unit for acute respiratory failure following thyroid surgery from January 2004 to December 2013, were reviewed. Demographic data including gender, age, clinical presentation, laryngoscopic findings, management and outcome during a 24-months follow-up after treatment were collected and evaluated. Moreover, the strategy for prolonged nasotracheal safe extubation was carefully described. Results Nineteen out of the 2853 patients scheduled for thyroid surgery (0.66%) at our University Hospital, developed post-operative acute respiratory failure. All of them were treated by nasotracheal prolonged safe extubation. The success rate in avoiding highly invasive treatment was of 84.2%, since only 3 patients needed definitive tracheotomy (15.7%). Conclusions In our series, the prolonged safe extubation reduced the almost totality of expected tracheotomies in patients with acute respiratory failure following thyroid surgery (84.2%), demonstrating its feasibility and efficacy. It was a well tolerated and minimal invasive procedure that allowed a good respiratory ability and a fast clinical resolution of the laryngeal functional impairment.
2017
Acute respiratory failure; Laryngoscopy; Nasotracheal safe extubation; Nasotracheal tube; Prolonged safe extubation; Total thyroidectomy; Adult; Aged; Airway Extubation; Feasibility Studies; Female; Follow-Up Studies; Humans; Intensive Care Units; Intubation, Intratracheal; Laryngoscopy; Male; Middle Aged; Postoperative Complications; Postoperative Period; Respiratory Insufficiency; Retrospective Studies; Thyroidectomy; Time Factors; Tracheotomy
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Nasotracheal prolonged safe extubation in acute respiratory failure post-thyroidectomy: An efficacious technique to avoid tracheotomy? A retrospective analysis of a large case series / Ferraro, F.; Gambardella, C.; Testa, D.; Santini, L.; Marfella, R.; Fusco, P.; Lombardi, C. P.; Polistena, A.; Sanguinetti, A.; Avenia, N.; Conzo, G.. - In: INTERNATIONAL JOURNAL OF SURGERY. - ISSN 1743-9191. - 41:Suppl. 1(2017), pp. S48-S54. [10.1016/j.ijsu.2017.03.082]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1452893
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