The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Christian Debry - One of the best experts on this subject based on the ideXlab platform.
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laryngeal replacement with an artificial larynx after total laryngectomy the possibility of restoring larynx functionality in the future
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2014Co-Authors: Christian Debry, Agnes Dupretbories, Nihal Engin Vrana, Patrick Hemar, Philippe Lavalle, Philippe SchultzAbstract:BACKGROUND: Most patients perceive total laryngectomy as a mutilation carrying with it a loss of physical and psychological integrity. Thus, an artificial larynx system that can replace the laryngeal functions would significantly improve the quality of life for the afflicted patients. METHODS: This report, with accompanying video, presents the first case in an ongoing clinical trial of laryngeal rehabilitation using an artificial larynx after total laryngectomy for squamous cell carcinoma, for an 8-month follow-up period. We depict the prosthesis' features, our 2-step surgical procedure, and the outcome. The prosthesis is formed of 2 parts: (1) a tracheal prosthesis with a porous titanium junction with trachea, which was implanted in the first step to ensure its colonization, and (2) a removable part composed of concentric valves that enable inhalation and exhalation. The second part was implanted endoscopically. The implant was monitored with a retrograde nasofibroscopy of the tracheal prosthesis lumen and CT scans over a course of 8 months. RESULTS: The patient's functioning in the relevant postoperative problem areas, such as swallowing, breathing, and smelling, has significantly improved. The patient was able to talk in a whispering fashion while the Tracheostomy was temporarily closed. The implant's porous part was in the process of being colonized by the surrounding tissue and no fistulas were observed as evidenced by barium swallow. CONCLUSION: As the current case shows, tracheotomy closure can be performed, and laryngeal functions are restored, by means of an implant. With further improvements, this system can alleviate the need for a permanent Tracheostomy after total laryngectomy, while maintaining important larynx functions intact.
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laryngeal replacement with an artificial larynx after total laryngectomy the possibility of restoring larynx functionality in the future
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2014Co-Authors: Christian Debry, Agnes Dupretbories, Nihal Engin Vrana, Patrick Hemar, Philippe Lavalle, Philippe SchultzAbstract:Background Most patients perceive total laryngectomy as a mutilation carrying with it a loss of physical and psychological integrity. Thus, an artificial larynx system that can replace the laryngeal functions would significantly improve the quality of life for the afflicted patients. Methods This report, with accompanying video, presents the first case in an ongoing clinical trial of laryngeal rehabilitation using an artificial larynx after total laryngectomy for squamous cell carcinoma, for an 8-month follow-up period. We depict the prosthesis' features, our 2-step surgical procedure, and the outcome. The prosthesis is formed of 2 parts: (1) a tracheal prosthesis with a porous titanium junction with trachea, which was implanted in the first step to ensure its colonization, and (2) a removable part composed of concentric valves that enable inhalation and exhalation. The second part was implanted endoscopically. The implant was monitored with a retrograde nasofibroscopy of the tracheal prosthesis lumen and CT scans over a course of 8 months. Results The patient's functioning in the relevant postoperative problem areas, such as swallowing, breathing, and smelling, has significantly improved. The patient was able to talk in a whispering fashion while the Tracheostomy was temporarily closed. The implant's porous part was in the process of being colonized by the surrounding tissue and no fistulas were observed as evidenced by barium swallow. Conclusion As the current case shows, tracheotomy closure can be performed, and laryngeal functions are restored, by means of an implant. With further improvements, this system can alleviate the need for a permanent Tracheostomy after total laryngectomy, while maintaining important larynx functions intact. © 2014 Wiley Periodicals, Inc. Head Neck 36: 1669–1673, 2014
Henry T Stelfox - One of the best experts on this subject based on the ideXlab platform.
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Tracheostomy tube malposition in patients admitted to a respiratory acute care unit following prolonged ventilation
Chest, 2008Co-Authors: Ulrich Schmidt, Dean R Hess, Jean Kwo, Susan Lagambina, Elise Gettings, Farah Khandwala, Luca M Bigatello, Henry T StelfoxAbstract:Background Tracheostomy tube malposition is a barrier to weaning from mechanical ventilation. We determined the incidence of Tracheostomy tube malposition, identified the associated risk factors, and examined the effect of malposition on clinical outcomes. Methods We performed a retrospective study on 403 consecutive patients with a Tracheostomy who had been admitted to an acute care unit specializing in weaning from mechanical ventilation between July 1, 2002, and December 31, 2005. Bronchoscopy reports were reviewed for evidence of Tracheostomy tube malposition (ie, > 50% occlusion of lumen by tissue). The main outcome parameters were the incidence of Tracheostomy tube malposition; demographic, clinical, and Tracheostomy-related factors associated with malposition; clinical response to correct the malposition; the duration of mechanical ventilation; the length of hospital stay; and mortality. Results Malpositioned Tracheostomy tubes were identified in 40 of 403 patients (10%). The subspecialty of the surgical service physicians who performed the Tracheostomy was most strongly associated with malposition. Thoracic and general surgeons were equally likely to have their patients associated with a malpositioned Tracheostomy tube, while other subspecialty surgeons were more likely (odds ratio, 6.42; 95% confidence interval, 1.82 to 22.68; p=0.004). Malpositioned Tracheostomy tubes were changed in 80% of cases. Malposition was associated with prolonged mechanical ventilation postTracheostomy (median duration, 25 vs 15 d; p=0.009), but not with increased hospital length of stay or mortality. Conclusion Tracheostomy tube malposition appears to be a common and important complication in patients who are being weaned from mechanical ventilation. Surgical expertise may be an important factor that impacts this complication.
David H Rothstein - One of the best experts on this subject based on the ideXlab platform.
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gastrostomy tube placement in neonates undergoing Tracheostomy an opportunity to coordinate care
Journal of Perinatology, 2020Co-Authors: Jane Zhao, Sarah B Cairo, Yao Tian, Timothy B Lautz, Sara K Berkelhamer, Michael Pizzuto, Mehul V Raval, David H RothsteinAbstract:To describe variations in timing of gastrostomy tube (GT) placement for neonates undergoing Tracheostomy. Database study of neonates undergoing Tracheostomy and GT placement using the Pediatric Health Information System (2012–2015). The primary outcome was timing of GT relative to Tracheostomy. Logistic regression evaluated associations of patient- and hospital-level characteristics with GT timing. Of 1156 patients undergoing GT and Tracheostomy placement, 42.4% had concurrent GT placement, 23.3% GT placement prior to Tracheostomy, and 34.3% GT placement after Tracheostomy. The proportion of patients undergoing concurrent placement ranged from 0 to 80% among 47 hospitals. Neonates born at 31–35 weeks, having cardiovascular comorbidities, history of diaphragmatic hernia repair, or gastroesophageal reflux disorder were more likely to receive GT placement prior to Tracheostomy. Significant variability exists in the timing of neonatal Tracheostomy and GT placement. Opportunities may exist to optimize coordination of care for neonates and reduce anesthetic exposure and hospital resource utilization.
Philippe Schultz - One of the best experts on this subject based on the ideXlab platform.
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laryngeal replacement with an artificial larynx after total laryngectomy the possibility of restoring larynx functionality in the future
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2014Co-Authors: Christian Debry, Agnes Dupretbories, Nihal Engin Vrana, Patrick Hemar, Philippe Lavalle, Philippe SchultzAbstract:BACKGROUND: Most patients perceive total laryngectomy as a mutilation carrying with it a loss of physical and psychological integrity. Thus, an artificial larynx system that can replace the laryngeal functions would significantly improve the quality of life for the afflicted patients. METHODS: This report, with accompanying video, presents the first case in an ongoing clinical trial of laryngeal rehabilitation using an artificial larynx after total laryngectomy for squamous cell carcinoma, for an 8-month follow-up period. We depict the prosthesis' features, our 2-step surgical procedure, and the outcome. The prosthesis is formed of 2 parts: (1) a tracheal prosthesis with a porous titanium junction with trachea, which was implanted in the first step to ensure its colonization, and (2) a removable part composed of concentric valves that enable inhalation and exhalation. The second part was implanted endoscopically. The implant was monitored with a retrograde nasofibroscopy of the tracheal prosthesis lumen and CT scans over a course of 8 months. RESULTS: The patient's functioning in the relevant postoperative problem areas, such as swallowing, breathing, and smelling, has significantly improved. The patient was able to talk in a whispering fashion while the Tracheostomy was temporarily closed. The implant's porous part was in the process of being colonized by the surrounding tissue and no fistulas were observed as evidenced by barium swallow. CONCLUSION: As the current case shows, tracheotomy closure can be performed, and laryngeal functions are restored, by means of an implant. With further improvements, this system can alleviate the need for a permanent Tracheostomy after total laryngectomy, while maintaining important larynx functions intact.
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laryngeal replacement with an artificial larynx after total laryngectomy the possibility of restoring larynx functionality in the future
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2014Co-Authors: Christian Debry, Agnes Dupretbories, Nihal Engin Vrana, Patrick Hemar, Philippe Lavalle, Philippe SchultzAbstract:Background Most patients perceive total laryngectomy as a mutilation carrying with it a loss of physical and psychological integrity. Thus, an artificial larynx system that can replace the laryngeal functions would significantly improve the quality of life for the afflicted patients. Methods This report, with accompanying video, presents the first case in an ongoing clinical trial of laryngeal rehabilitation using an artificial larynx after total laryngectomy for squamous cell carcinoma, for an 8-month follow-up period. We depict the prosthesis' features, our 2-step surgical procedure, and the outcome. The prosthesis is formed of 2 parts: (1) a tracheal prosthesis with a porous titanium junction with trachea, which was implanted in the first step to ensure its colonization, and (2) a removable part composed of concentric valves that enable inhalation and exhalation. The second part was implanted endoscopically. The implant was monitored with a retrograde nasofibroscopy of the tracheal prosthesis lumen and CT scans over a course of 8 months. Results The patient's functioning in the relevant postoperative problem areas, such as swallowing, breathing, and smelling, has significantly improved. The patient was able to talk in a whispering fashion while the Tracheostomy was temporarily closed. The implant's porous part was in the process of being colonized by the surrounding tissue and no fistulas were observed as evidenced by barium swallow. Conclusion As the current case shows, tracheotomy closure can be performed, and laryngeal functions are restored, by means of an implant. With further improvements, this system can alleviate the need for a permanent Tracheostomy after total laryngectomy, while maintaining important larynx functions intact. © 2014 Wiley Periodicals, Inc. Head Neck 36: 1669–1673, 2014
Ulrich Schmidt - One of the best experts on this subject based on the ideXlab platform.
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Tracheostomy tube change before day 7 is associated with earlier use of speaking valve and earlier oral intake
Respiratory Care, 2012Co-Authors: Daniel F Fisher, Dean R Hess, Dhimiter Kondili, June Williams, Edward A Bittner, Ulrich SchmidtAbstract:BACKGROUND: Presence of a Tracheostomy tube often decreases the patient9s ability to communicate and to tolerate oral intake. The initial Tracheostomy tube change is often recommended between day 7 and 14 post insertion. Local guidelines permit Tracheostomy tube change 5 days after insertion. OBJECTIVE: We hypothesized that changing Tracheostomy tubes before day 7 is associated with earlier use of a speaking valve as well as earlier oral intake, compared to changing Tracheostomy tubes after 7 days. METHODS: We prospectively enrolled 130 admitted subjects, after Tracheostomy placement to a respiratory care unit between July 2008 and May 2010. Subject data were recorded from the electronic medical record. The primary end point was the time from Tracheostomy tube placement to tolerating speaking valve. The secondary end point was the time from Tracheostomy tube placement to tolerating oral intake. Complications of Tracheostomy tube change were recorded. RESULTS: Thirty-eight subjects had the first Tracheostomy tube change before 7 days (early group), and 92 subjects had the first Tracheostomy tube change after 7 days (late group). The early group tolerated a speaking valve significantly sooner than the late group (7 d vs 12 d, P = .001). The early group also tolerated oral intake significantly sooner (10 d vs 20 d, P = .04). After change of the Tracheostomy tube, the time to tolerating oral feeding was 5.5 days in both groups. There was no significant difference in time to decannulation between the groups. The early group had a shorter respiratory care unit stay (11 d vs 17 d, P = .001) and a shorter hospital stay (P = .05) than the late group. There was no difference in survival. There were no complications associated with Tracheostomy tube change. CONCLUSIONS: Tracheostomy tube change before day 7 is associated with earlier ability to tolerate speaking valve and oral intake. In this series, early Tracheostomy tube change was not associated with an increased rate of complications.
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Tracheostomy tube malposition in patients admitted to a respiratory acute care unit following prolonged ventilation
Chest, 2008Co-Authors: Ulrich Schmidt, Dean R Hess, Jean Kwo, Susan Lagambina, Elise Gettings, Farah Khandwala, Luca M Bigatello, Henry T StelfoxAbstract:Background Tracheostomy tube malposition is a barrier to weaning from mechanical ventilation. We determined the incidence of Tracheostomy tube malposition, identified the associated risk factors, and examined the effect of malposition on clinical outcomes. Methods We performed a retrospective study on 403 consecutive patients with a Tracheostomy who had been admitted to an acute care unit specializing in weaning from mechanical ventilation between July 1, 2002, and December 31, 2005. Bronchoscopy reports were reviewed for evidence of Tracheostomy tube malposition (ie, > 50% occlusion of lumen by tissue). The main outcome parameters were the incidence of Tracheostomy tube malposition; demographic, clinical, and Tracheostomy-related factors associated with malposition; clinical response to correct the malposition; the duration of mechanical ventilation; the length of hospital stay; and mortality. Results Malpositioned Tracheostomy tubes were identified in 40 of 403 patients (10%). The subspecialty of the surgical service physicians who performed the Tracheostomy was most strongly associated with malposition. Thoracic and general surgeons were equally likely to have their patients associated with a malpositioned Tracheostomy tube, while other subspecialty surgeons were more likely (odds ratio, 6.42; 95% confidence interval, 1.82 to 22.68; p=0.004). Malpositioned Tracheostomy tubes were changed in 80% of cases. Malposition was associated with prolonged mechanical ventilation postTracheostomy (median duration, 25 vs 15 d; p=0.009), but not with increased hospital length of stay or mortality. Conclusion Tracheostomy tube malposition appears to be a common and important complication in patients who are being weaned from mechanical ventilation. Surgical expertise may be an important factor that impacts this complication.
