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Trachea Mark Perna Sunday, May 02, 2010. Introduction  Anatomy  Discuss emergent and elective surgical Airways  Discuss complications of surgical airways.

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Presentation on theme: "Trachea Mark Perna Sunday, May 02, 2010. Introduction  Anatomy  Discuss emergent and elective surgical Airways  Discuss complications of surgical airways."— Presentation transcript:

1 Trachea Mark Perna Sunday, May 02, 2010

2 Introduction  Anatomy  Discuss emergent and elective surgical Airways  Discuss complications of surgical airways  Review repair of tracheal trauma  Review tracheoinnominate fistula  Discuss tracheoesophageal fistula  Foreign Body

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7 Emergent Surgical Airway  When  Sooner than you think Usually three strikes and your out Usually three strikes and your out Knife, Clamp, 4 or 6 ET tube, Betadine Knife, Clamp, 4 or 6 ET tube, Betadine Cricothyroidotomy Cricothyroidotomy Tracheotomy Tracheotomy Crushed LarynxCrushed Larynx

8 Elective Surgical Airway  When  Sooner than you think 7 days or less on ventilator 7 days or less on ventilator Early weaning of vent Early weaning of vent Patient comfort Patient comfort Improved Pulmonary Toilet Improved Pulmonary Toilet

9 Elective Surgical Airway  Tracheostomy Percutaneous Percutaneous Blue Rhino Kit, Selindger Technique, Use BronchBlue Rhino Kit, Selindger Technique, Use Bronch Open Open Define anatomy visually, stay sutures, T incision in trach or Bjork flapDefine anatomy visually, stay sutures, T incision in trach or Bjork flap Semi Open Semi Open Define anatomy visually, Blue Rhino KitDefine anatomy visually, Blue Rhino Kit

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12 Early Complications  Loss of Airway  False Passage  Decannulation  Bleeding  Mucus Plug  Pneumomediasteum  Pneumothorax  Infection  Negative Pressure Pulmonary Edema

13 Late Complications  Tracheomalacia Dynamic obstruction Dynamic obstruction  Stenosis Obstructive symptoms Obstructive symptoms  Tracheoinnominate Fistula Herald Bleed Herald Bleed  Granulation Tissue Bleeding Bleeding

14 Tracheal Trauma  Tracheobronchial injury generally very appearent  Blunt tracheal trauma 22% have concomitant esophageal injuries 22% have concomitant esophageal injuries 16% have major vessel injury 16% have major vessel injury 40% have hemothorax 40% have hemothorax

15 Repair of Tracheal Trauma  Small defect or 4-0 absorbable sutures transversely including two tracheal rings 3-0 or 4-0 absorbable sutures transversely including two tracheal rings  Large anterior defect- Convert to tracheostomy Convert to tracheostomy  Large lateral or posterior defect- Moblize and repair primarily and protect with tracheostomy Moblize and repair primarily and protect with tracheostomy  Drains?  Only if esophageal injury

16 Tracheoinnominate Fistula  Late complication of tracheostomy  Low lying tracheal Rings 3-4 Rings 3-4 Herald Bleeds Herald Bleeds Bronch can rule out Bronch can rule out

17 Plan for initial management  Decannulate  Quickly reintubate from above Get ET past the bleeding site Get ET past the bleeding site Blow up the cuff Blow up the cuff  Insert finger and tamponade the innominate artery  Call OR and for help

18 Definitive Management  Sternotomy and likely neck incision  Proximal and distal control  Leave trachea alone  Resect artery with autologous bypass  Protect with sternohyoid flap

19 Tracheosophageal Fistula  Classically pediatric surgery issue Enteral feeding access and electively repair Enteral feeding access and electively repair  Adults with prolong intubation High cuff pressures High cuff pressures

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23 Bronchoscopy (Rigid)

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25 Esophagoscopy (Rigid or Flexible)

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27 Bronchoscopy

28 Summary   Anatomy  Complicated   Emergent Airways  Be ready and do it quickly   Elective Airways  Be prepared   Tracheal Trauma  Look for other injuries   Tracheoinnomiate Fistula  Prevention is best treatment   Tracheoesophageal Fistula  Close defects and protect with muscle flap   Foreign Body - Think Rigid Scope


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