REVIEWTracheostomy in Critically Ill Patients
Section snippets
INDICATIONS AND TIMING OF TRACHEOSTOMY IN PATIENTS WITH ACUTE RESPIRATORY FAILURE
Tracheostomy is performed primarily in critically ill patients with acute respiratory failure who require prolonged mechanical ventilation and/or in whom multiple attempts to wean from mechanical ventilation have been unsuccessful for 14 to 21 days.10 Tracheostomy facilitates weaning by decreasing the work of breathing in patients with limited reserve.11, 12 However, the effect on dead space ventilation is marginal.13 Tracheostomy decreases the requirement for sedation and may allow for earlier
TRACHEOSTOMY TECHNIQUES
Tracheostomy can be performed with the open technique in the operating room, with the open technique at the bedside, or with the percutaneous approach at the bedside. In the open technique, a small transverse incision is made between the lower border of the cricoid cartilage and the suprasternal notch. The strap muscles are retracted laterally to expose the underlying thyroid gland and the trachea. The thyroid isthmus is retracted in a cephalad direction or divided, exposing the tracheal rings.
WHICH TECHNIQUE IS SUPERIOR?
Numerous studies40, 41, 42, 43, 44, 45 and 2 meta-analyses in 199946 and 200047 have tried to determine which technique is superior. Dulguerov et al,46 in their meta-analysis, included all study designs (retrospective, observational, and prospective) and all studies of percutaneous tracheostomy irrespective of techniques analyzed. The surgical technique studies were grouped according to the historical period: 1960–1984 (17 studies including 4185 patients) and 1985–1996 (21 studies including
CONCLUSIONS
Many critically ill patients require prolonged mechanical ventilation and tracheostomy. In patients with high risk of mortality and morbidity based on the presence of shock at onset of mechanical ventilation and high severity of illness scores and in whom no evidence of improvement can be shown during the first few days of mechanical ventilation, the option of early tracheostomy (within the first week from initiation of mechanical ventilation) should be discussed with the patient and/or family
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Cited by (62)
Evidence-based airway management protocol for a critical ill patient in medical intensive care unit: Systematic review
2022, Annals of Medicine and SurgeryCitation Excerpt :Performing tracheostomy at an earlier stage for the critically ill adult patients who require prolonged mechanical ventilation than is currently practiced may shorten the duration of artificial ventilation and length of stay in the intensive care unit [18]. Patients with high risk of mortality and morbidity based on the presence of shock at onset of mechanical ventilation and high severity of illness scores and in whom no evidence of improvement can be shown during the first few days of mechanical ventilation, the option of early tracheostomy (within the first week from initiation of mechanical ventilation) should be discussed with the patient and/or family members [19]. Tracheal intubation in ICU is often life saving, however, life threatening events could happen in a significant proportion, making TI the most common but underappreciated airway emergency in ICU.
Comparison of clinical outcomes of tracheotomy in patients with acute cervical spinal cord injury at different timing
2021, Clinical Neurology and NeurosurgeryCitation Excerpt :The endotracheal intubation is a common procedure in first aid, but prolonged intubation may cause discomfort and a sequence of complications, such as laryngeal edema, iatrogenic pneumonia [5]. Tracheotomy is an alternative procedure in the airway management in the intensive care unit, suitable for patients requiring prolonged mechanical ventilation [6,7]. It can keep the respiratory tract unobstructed, conducive to airway care, avoid respiratory complications and is more comfortable than endotracheal intubation [8,9].
Association Between Early Tracheostomy and Delirium in Older Adults in the United States
2021, Journal of Cardiothoracic and Vascular AnesthesiaFactors influencing intracranial pressure (ICP) during percutaneous tracheostomy
2020, Clinical Neurology and NeurosurgeryEarly vs. late tracheostomy in intensive care settings: Impact on ICU and hospital costs
2018, Journal of Critical CareCitation Excerpt :In prolonged mechanically ventilated patients, tracheostomy can improve lung mechanics, improve oral hygiene, decrease pain, decrease need for sedatives and improve communication [6,9]. It is also associated with a number of adverse side effects, including procedural risks and cosmetic concerns [10-12]. Changes in technology have allowed for a more liberal use of tracheostomies [6].
Factors Associated with Otolaryngologists Performing Tracheotomy
2023, JAMA Otolaryngology - Head and Neck Surgery
- 1
Dr Rana is now with Mercy Medical Center, Des Moines, Iowa.
- 2
Dr Pendem is now with St. Alexius Medical Center, Bismarck, ND.
- 3
Dr Pogodzinski is now with the US Air Force, Yokota, Japan.