title: Noninvasive positive pressure ventilation in the management of post-thyroidectomy tracheomalacia.
abstract: BACKGROUND
  Post-thyroidectomy tracheomalacia is a rare but complicated problem. It has often been treated with tracheostomy or prolonged endotracheal intubation. However, noninvasive positive pressure ventilation (NPPV) has been successfully employed with increasing frequency in patients with respiratory failure from other causes. In the present study we describe the use of NPPV in the management of respiratory distress in patients with post-thyroidectomy tracheomalacia.
  
  
  METHODS
  All 606 patients who underwent thyroidectomy in Chung Gung Memorial Hospital - Kaohsiung Medical Center, Taiwan, from January 2009 to August 2010 were reviewed. If tracheomalacia was diagnosed intraoperatively, the patients were left intubated and taken to the intensive care unit (ICU) (n = 5). If tracheomalacia was diagnosed in the recovery room (stridor and airway compromise not from other causes), the patient was reintubated promptly and taken to the ICU (n = 4). When subsequently re-extubated in the ICU (24-72 h later), NPPV was used to treat recurrent stridor and airway compromise.
  
  
  RESULTS
  A total of nine patients (1.5 %) were diagnosed with post-thyroidectomy tracheomalacia, five intraoperatively and four postoperatively. The patients were intubated with an endotracheal tube and then taken to the ICU. After early re-extubation in the ICU, three of the patients with intraoperatively diagnosed tracheomalacia were found not to have respiratory problems, whereas the other six patients developed stridor and airway compromise, which resolved immediately with the initiation of NPPV. Hemoglobin oxygen saturation on pulse oximetry was also elevated. No further respiratory support was required and no complications occurred in these patients.
  
  
  CONCLUSIONS
  Noninvasive positive pressure ventilation is effective and appears safe in the management of stridor and airway compromise following early extubation in patients with post-thyroidectomy tracheomalacia.
authors: Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Ta Pei Road, 833 Niao Sung Hsiang, Kaohsiung Hsien, Taiwan, ROC.
authors: Shun-Yu
authors: SY
authors: Chi
authors: Shih-Chung
authors: SC
authors: Wu
authors: Kun-Chou
authors: KC
authors: Hsieh
authors: Shyr-Ming
authors: SM
authors: Sheen-Chen
authors: Fong-Fu
authors: FF
authors: Chou
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000628:therapy; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D055090:Tracheomalacia / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome