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The Role of Tracheotomy in Weaning
Section snippets
Improved Patient Comfort
No prospective outcome studies in general populations of ventilator-dependent patients using validated measurement tools have established that tracheotomy results in greater patient comfort or mobility compared with prolonged translaryngeal intubation. Astrachan and coworkers3 interviewed ICU caregivers, however, and found that they believed that patients receiving mechanical ventilation were more comfortable after a tracheotomy. General consensus exists that patients supported with long-term
Effect of Tracheotomy on Decreasing Airway Resistance
The shorter length of a tracheostomy tube compared to an endotracheal tube is associated with less airway resistance when measured in vitro during constant flow and oscillatory conditions.16 Although the small radius of curvature of tracheostomy tubes increases turbulent airflow and airway resistance,1718 the short length of tracheostomy tubes more than compensates for airflow turbulence. The overall lower airway resistance may decrease the loads imposed on the respiratory system and thereby
Outcome Studies: The Impact of Tracheotomy on the Duration of Mechanical Ventilation
The impact of tracheotomy on the duration of mechanical ventilation has been examined by several different study designs. Most studies are retrospective, although a few prospective studies have been performed. Most studies have assigned patients to treatment groups on the basis of physician practice patterns rather than random assignment. Those studies that used random assignment frequently used quasi-randomization methods (eg, every other patient, every other day, hospital record number, or
Impact of Tracheotomy on Ventilator-Associated Pneumonia
Early tracheotomy and, alternatively, the avoidance of tracheotomy by maintaining a translaryngeal endotracheal tube in place have both been proposed as strategies to promote successful weaning from mechanical ventilation by avoiding ventilator-associated pneumonia. The occurrence of pneumonia is considered to be a cause of delayed weaning from ventilator support.
Few data support the conclusion, however, that the timing of tracheotomy alters the risk of pneumonia. Three prospective studies142830
Effects on Weaning of the Technique for Tracheotomy
The advent of PDT has created the impression that tracheotomy may provide greater support of weaning from mechanical ventilation because it can be performed at lower costs, and also because it might be associated with fewer complications than a standard surgical tracheotomy.
Observational studies31323334 using hospital charge data have indicated that PDT performed in the ICU has lower associated charges (cost range, $l,742 to $1,370) than standard surgical tracheotomy performed in the operating
Future Investigations
It is probable that the timing of tracheotomy promotes weaning from mechanical ventilation in some, but not all, ventilator-dependent patients. The quality of existing studies, however, does not establish this clinical impression. Because of the difficulty in blinding caregivers to the presence or absence of tracheotomy, studies should use explicit weaning protocols to control for different levels of approaches toward weaning that the presence of a tracheotomy may invoke. Studies also could be
Conclusion
Insufficient data support the impression that tracheotomy provides universal benefit in promoting weaning from mechanical ventilation in all ventilator-dependent patients. Subsets of patients, however, may benefit from the procedure.
Patients requiring sedation to assist their toleration of translaryngeal endotracheal tubes may be more comfortable after tracheotomy (level III) and may be weaned more rapidly from mechanical ventilation with the discontinuation of treatment with sedative drugs
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Safety and efficacy of high tracheostomy with inferior retraction of the thyroid isthmus
2024, Auris Nasus LarynxEarly vs. late tracheostomy in ventilated COVID-19 patients – A retrospective study
2021, American Journal of Otolaryngology - Head and Neck Medicine and SurgerySurgical strategy and optimal timing of tracheostomy in patients with COVID-19: Early experiences in Japan
2021, Auris Nasus LarynxCitation Excerpt :Despite the efficiency of tracheostomy in COVID-19 patients, the optimal timing of tracheostomy remains controversial. Traditionally, a tracheostomy is performed to accelerate ventilator weaning, to enhance clearance of secretions, to improve patient mobility, to reduce VAP, and to increase potential for speech, ability to eat orally [16]. In randomized controlled trials that compared early and late tracheostomies, the timing of tracheostomy was divided as follows: very early (< 4 days), moderately early (< 10 days) and late (> 10 days) tracheotomies [17–20].
When To Do a Tracheostomy?
2021, Encyclopedia of Respiratory Medicine, Second EditionTiming of percutaneous tracheotomies in intensive care unit
2017, Brazilian Journal of Anesthesiology