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Research ArticleConference Proceedings

Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion

Nora H Cheung and Lena M Napolitano
Respiratory Care June 2014, 59 (6) 895-919; DOI: https://doi.org/10.4187/respcare.02971
Nora H Cheung
Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Lena M Napolitano
Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Abstract

Tracheostomy is a common procedure performed in critically ill patients requiring prolonged mechanical ventilation for acute respiratory failure and for airway issues. The ideal timing (early vs late) and techniques (percutaneous dilatational, other new percutaneous techniques, open surgical) for tracheostomy have been topics of considerable debate. In this review, we address general issues regarding tracheostomy (epidemiology, indications, and outcomes) and specifically review the literature regarding appropriate timing of tracheostomy tube placement. Based on evidence from 2 recent large randomized trials, it is reasonable to wait at least 10 d to be certain that a patient has an ongoing need for mechanical ventilation before consideration of tracheostomy. Percutaneous tracheostomy with flexible bronchoscopy guidance is recommended, and optimal percutaneous techniques, indications, and contraindications and results in high-risk patients (coagulopathy, thrombocytopenia, obesity) are reviewed. Additional issues related to tracheostomy diagnosis-related groups, charges, and procedural costs are reviewed. New advances regarding tracheostomy include the use of real-time ultrasound guidance for percutaneous tracheostomy in high-risk patients. New tracheostomy tubes (tapered with low-profile cuffs that fit better on the tapered dilators, longer percutaneous tracheostomy tubes) are discussed for optimal use with percutaneous dilatational tracheostomy. Two new percutaneous techniques, a balloon inflation technique (Dolphin) and the PercuTwist procedure, are reviewed. The efficacy of tracheostomy teams and tracheostomy hospital services with standardized protocols for tracheostomy insertion and care has been associated with improved outcomes. Finally, the UK National Tracheostomy Safety Project developed standardized resources for education of both health care providers and patients, including emergency algorithms for tracheostomy incidents, and serves as an excellent educational resource in this important area.

  • tracheostomy
  • timing
  • percutaneous dilatational
  • open
  • outcomes
  • complications

Footnotes

  • Correspondence: Lena M Napolitano MD, Department of Surgery, University of Michigan Health System, Room 1C340A-UH, University Hospital, 1500 East Medical Drive, Ann Arbor, MI 48109-0033. E-mail: lenan{at}umich.edu.
  • Dr Napolitano presented a version of this paper at the 52nd Respiratory Care Journal Conference, “Adult Artificial Airways and Airway Adjuncts” held June 14 and 15, 2013, in St Petersburg, Florida.

  • The authors have disclosed no conflicts of interests.

  • Copyright © 2014 by Daedalus Enterprises

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Respiratory Care: 59 (6)
Respiratory Care
Vol. 59, Issue 6
1 Jun 2014
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Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion
Nora H Cheung, Lena M Napolitano
Respiratory Care Jun 2014, 59 (6) 895-919; DOI: 10.4187/respcare.02971

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Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion
Nora H Cheung, Lena M Napolitano
Respiratory Care Jun 2014, 59 (6) 895-919; DOI: 10.4187/respcare.02971
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  • Article
    • Abstract
    • Introduction
    • Overview of Tracheostomy
    • Timing of Tracheostomy
    • Charges and Compensation for Tracheostomy
    • Patients Who Would Benefit From Early Tracheostomy?
    • Tracheostomy Technique
    • Procedural Cost of Tracheostomy
    • Tracheostomy Decannulation
    • Additional Recent Advances in Tracheostomy
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  • tracheostomy
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  • percutaneous dilatational
  • open
  • outcomes
  • complications

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