Noninvasive positive pressure ventilation in the management of post-thyroidectomy tracheomalacia

Shun Yu Chi, Shih Chung Wu, Kun Chou Hsieh, Shyr Ming Sheen-Chen, Fong Fu Chou

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1977-1983
Number of pages7
JournalWorld Journal of Surgery
Volume35
Issue number9
DOIs
Publication statusPublished - Sep 1 2011
Externally publishedYes

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Tracheomalacia
Positive-Pressure Respiration
Thyroidectomy
Intensive Care Units
Respiratory Sounds
Recovery Room
Airway Management
Oximetry
Intratracheal Intubation
Tracheostomy
Taiwan
Respiratory Insufficiency

ASJC Scopus subject areas

  • Surgery

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Noninvasive positive pressure ventilation in the management of post-thyroidectomy tracheomalacia. / Chi, Shun Yu; Wu, Shih Chung; Hsieh, Kun Chou; Sheen-Chen, Shyr Ming; Chou, Fong Fu.

In: World Journal of Surgery, Vol. 35, No. 9, 01.09.2011, p. 1977-1983.

Research output: Contribution to journalArticle

Chi, Shun Yu ; Wu, Shih Chung ; Hsieh, Kun Chou ; Sheen-Chen, Shyr Ming ; Chou, Fong Fu. / Noninvasive positive pressure ventilation in the management of post-thyroidectomy tracheomalacia. In: World Journal of Surgery. 2011 ; Vol. 35, No. 9. pp. 1977-1983.
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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.",
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