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Tracheostomy before and during COVID-19 pandemic

Sara Jensterle

Sara Jensterle

Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre LjubljanaLjubljana, Slovenia
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Jensterle, Sara
, 
Janez Benedik

Janez Benedik

  • Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Benedik, Janez
 and 
Robert Sifrer

Robert Sifrer

  • Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Sifrer, Robert
  
Jun 12, 2024
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Article Category: Research Article
Published Online: Jun 12, 2024
Page range: 556 - 564
Received: Apr 04, 2024
Accepted: May 16, 2024
DOI: https://doi.org/10.2478/raon-2024-0034
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© 2024 Sara Jensterle et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

The main causes of upper airway obstruction

Causes of upper airway obstruction No. of patients Ratio (%)
All patients 82 100
Laryngeal cancer 24 29
Pharyngeal cancer 20 24
Cancer of other primary sites 7 9
Infections 16 20
Bilateral vocal cord paralysis 13 16
Laryngo-tracheal stenosis 2 2

A comparison of the risk factors in all patients before and during the COVID-19 outbreak in Slovenia

Risk factor Overall Before the outbreak of COVID-19 During the pandemic of COVID-19 p value
All patients 82 41 41
Patients
  Age (years) mean, range 66.8 (28–97) 64.8 (28–91) 68.8 (42–97) 0.172a
  Male sex 62 (76%) 31 (76%) 31 (76%) 1.00c
  Body weight (kg) mean, range 73.5 (35–143) 71.9 (35–143) 75.2 (43–110) 0.512 a
  Body height (cm) mean, range 172 (150–185) 172 (150–185) 173 (152–183) 0.933a
  Body mass index (kg/m2), mean, range 25.4 (12.7–37.6) 24.2 (12.7–37.6) 27.6 (19,4–35,5) 0.178a
The upper airway obstruction
Respiratory distress duration (days), median, range 6 (1–180) 10.5 (1–90) 3 (1–180) 0.373b
Causes of acute airway obstruction 0.826c
  Laryngeal cancer 24 (29%) 12 (29%) 12 (29%)
  Pharyngeal cancer 20 (24%) 8 (20%) 12 (29%)
  Other cancers 7 (9%) 5 (12%) 2 (5%)
  Inflammation 16 (20%) 8 (20%) 8 (20%)
  Vocal cord paralysis 13 (16%) 7 (17%) 6 (15%)
  Laryngotracheal stenosis 2 (2%) 1 (2%) 1 (2%)
  Multiple causes 22 (27%) 11 (27%) 11 (27%) 1.000c
  Respiration space (mm) mean, range 2.3 (1–5) 2.5 (1–4) 2.2 (1–5) 0.635a
Symptoms
  Dysphagia 26 (32%) 12 (29%) 14 (34%) 0.635c
  Trismus 6 (7%) 5 (12%) 1 (2%) 0.101d
  Pain 19 (23%) 8 (20%) 11 (27%) 0.432c
Stridor 0.504c
  Inspiratory 31 (38%) 17 (42%) 14 (34%)
  Biphasic 1 (1%) 0 1 (2%)
Previous treatment
  Surgery 14 (17%) 5 (12%) 9 (22%) 0.379d
  RT 11 (13%) 5 (12%) 6 (15%) 1.000d
  CRT 11 (13%) 5 (12%) 6 (15%) 1.000d
Surgery
  Re-TS 4 (5%) 0 4 (10%) 0.116d
  Cricothyrotomy 6 (7%) 3 (7%) 3 (7%) 1.000d
  Surgeon specialist 68 (83%) 34 (83%) 34 (83%) 1.000c
  Time-dependent aspect of TS 0.806c
  Emergent 59 (72%) 29 (71%) 30 (73%)
  Urgent 23 (28%) 12 (29%) 11 (27%)
  Duration (hour) median, range 0.75 (0.25–2.50) 0.75 (0.25–2.5) 0.88 (0.25–2) 0.546b
Anaesthesia 1.000d
  Local 5 (6%) 2 (5%) 3 (7%)
  General 77 (94%) 39 (95%) 38 (93%)
  Duration (hour) median, range 1.50 (0.75–3.25) 1.5 (0.75–3.25) 1.75 (1–3,25) 0.198b
ASA classification 0.952c
  II 6 (7%) 3 (7%) 3 (7%)
  III 44 (53%) 23 (56%) 21 (51%)
  IV 16 (20%) 9 (22%) 7 (17%)
  Unknown 10 (20%) 6 (15%) 10 (25%)
Mallampati classification 0.810 c
  I 7 (9%) 5 (12%) 2 (5%)
  II 10 (12%) 6 (15%) 4 (10%)
  III 13 (16%) 7 (17%) 6 (14%)
  IV 14 (17%) 7 (17%) 7 (17%)
  Unknown 38 (46%) 16 (39%) 22 (54%)
Mouth opening 0.207d
  Inadequate 7 (9%) 6 (15%) 1 (2%)
  Adequate 34 (41%) 18 (44%) 16 (39%)
  Unknown 41 (50%) 17 (41%) 24 (59%)
Hyo/thyromental distance 1.000c
  Insufficient 5 (6%) 3 (7%) 2 (5%)
  Sufficient 35 (43%) 21 (51%) 14 (34%)
  Unknown 42 (51%) 17 (42%) 25 (61%)
Endotracheal tube type 0.072c
  Wire 32 (39%) 18 (44%) 14 (34%)
  Straight 4 (5%) 4 (10%) 0
  Curved 7 (8%) 2 (5%) 5 (12%)
  Unknown 39 (48%) 17 (41%) 22 (54%)
Orotracheal intubation 0.043d*
  C-MAC laringoscope 7 (9%) 1 (3%) 6 (15%)
  Laryngoscope 60 (73%) 35 (85%) 25 (61%)
  Unknown 15 (18%) 5 (12%) 10 (24%)

A comparison of the risk factors in patients with HNC before and during the COVID-19 outbreak in Slovenia

Risk Factor Overall Before the Outbreak of COVID-19 During the Pandemic of COVID-19 p value
All Patients 51 25 26
Patients
  Age (years) mean, range 66.2 (28–88) 64.6 (28–88) 67.8 (42–87) 0.374 a
  Male sex 44 (86%) 22 (88%) 22 (85%) 1.000d
Primary site 0.365 c
  Laryngeal cancer 24 (47%) 12 (48%) 12 (46%)
  Pharyngeal cancer 20 (39%) 8 (32%) 12 (46%)
  Other cancers 7 (14%) 5 (20%) 2 (8%)
Invasion of subsites
  Glottis 21 (42%) 13 (52%) 8 (31%) 0.124c
  Supraglottis 32 (63%) 16 (64%) 16 (62%) 0.856c
  Subglottis 11 (22%) 6 (24%) 5 (19%) 0.743d
  Trachea 2 (4%) 1 (4%) 1 (4%) 1.000d
  Hypopharynx 13 (26%) 3 (12%) 10 (39%) 0.052d
  Oropharynx 16 (31%) 10 (40%) 6 (23%) 0.193c
  Oral cavity 8 (16%) 4 (16%) 4 (15%) 1.000d
  Respiration Space (mm), mean, range 2.4 ± 1.5 (1–5) 3 ± 1.7 (1–4) 2.2 ± 1.5 (1–5) 0.714 b
Previous treatment
  Surgery 8 (16%) 3 (12%) 5 (19%) 0.703d
  RT 10 (20%) 4 (16%) 6 (23%) 0.726d
  CRT 8 (16%) 4 (16%) 4 (15%) 1.000d
Surgery
  Time-dependent aspect of TS 0.806 c
  Emergent 34 (67%) 16 (64%) 18 (69%)
  Urgent 17 (33%) 9 (36%) 8 (31%)
  Orotracheal intubation 0.047d*
  C-MAC 7 (14%) 1 (4%) 6 (23%)
  Laryngoscope 38 (74%) 22 (88%) 16 (62%)
  Unknown 6 (12%) 2 (8%) 4 (15%)
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