Journal Reading

Mini Tracheostomy for Obstructive Sleep Apnea: An Evidence

Based Proposal

By:
Sunny
RSUD KOJA
November 12 December 16, 2016

OBJECTIVE
To search for articles evaluating
the use of tracheostomies in adult
OSA patients and to evaluate the
potential for the use of minitracheostomies as treatment for
OSA.

STUDY DESIGN
Systematic Review
METHODS
Nine databases were searched from inception through
July 21, 2015
RESULTS
Overall studies yielded 516 articles
No study was identified for the use of minitracheostomy for treating OSA
6 Articles described the use of mini-tracheostomies as
a temporary procedure for upper airway obstruction.
Additional research is still needed.

INTRODUCTION

Sign &
Symptoms

TREATMENT
1. Surgery : Somnoplasty,
Tracheostomy
2. Changing Life Style
3. CPAP & Cervical collars/pillow

Tracheostomy
A tracheostomy is an
opening
into
the
trachea through the
neck just below the
larynx through which
the indwelling tube is
placed and thus an
artificial airway is
created.

Mini-Tracheostomy
A mini tracheostomy
involves the insertion
of a small 4 mm noncuffed tracheostomy
tube through the
cricothyroid
membrane.
primarily inserted to
facilitate the
removal of secretions.

Study Selection
Study inclusion criteria:
1. Patients: adults with OSA
2. Intervention:
Tracheostomy or Minitracheostomy
3. Comparison: qualitative
data or quantitative
polysomnographic,
sleepiness, or quality of
life data before and after
mini-tracheostomy.

Study exclusion
criteria:
1. Study on children
2. Study for patients
with central sleep
apnea.

RESULTS
3.1 516 articles
18 studies that
reported OSA
polysomnography,
sleepiness and
quality of life before
and after
tracheostomy
None of the studies
discussed minitracheostomy as a
technique used for
OSA treatment.

RESULTS

3.2 Tubed vs Tubeless

Tracheostomies
Increase tube length
Increase distance from the skin
edge to lumen of trachea.
Tube-free permanent
tracheostomies
3.3 Suction Liposectomy and
Deffating Techniques
3.4 Tracheostomy
Concealment
Affect patients socially and
phsycollogically

3.5 Complications of
tracheostomy
Repeated obstruction
secondary to neck adiposity
occluding the tube
Displacement
Formation of granulation
tissue
Infection
3.6 Tracheostomy tube sizes
Obese adult patients 8mm
Neonatus 3,5 mm
3.7 Mini Tracheostomies

Conclusion
Mini tracheostomies have been
successfully used as small as 4 mm
in the short term to relieve upper
airway obstruction.
Given that polysomnography data
are lacking, additional studies are
needed.