Urgent surgical airway intervention: a 3 year county hospital experience.
OBJECTIVE
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.
Altman
Kenneth W
KW
Department of Surgery, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA.
Waltonen
Joshua D
JD
Kern
Robert C
RC
D000402:Airway Obstruction / Q000175:diagnosis / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006766:Hospitals, County / Q000706:statistics & numerical data*; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014139:Tracheostomy / Q000706:statistics & numerical data*