Article Figures & Data
Figures
- Fig. 1.
Fused vocal cords were seen after only 3 days of intubation in this patient. This lesion resolved several days after the tracheostomy was placed and the endotracheal tube removed.
- Fig. 2.
Approach to the timing of tracheostomy in patients receiving mechanical ventilation. APACHE = Acute Physiology and Chronic Health Evaluation. (Adapted from Reference 30, with permission.)
- Fig. 3.
Creating a surgical tracheostomy. After incising the skin and dividing the strap muscles of the neck, the thyroid isthmus is mobilized with a hemostat. (From Reference 44.)
- Fig. 4.
Creating a surgical tracheostomy. If the thyroid cannot be retracted either superiorly or inferiorly to reveal the 2nd and 3rd tracheal rings, a small incision in the gland may be created to allow access to the trachea. (From Reference 44.)
- Fig. 5.
Creating a surgical tracheostomy. If the thyroid isthmus remains in the way of the site of the tracheostomy, it may be completely divided, carefully ensuring there is no bleeding. This is the most common approach and gives the greatest access to the trachea. (From Reference 44.)
- Fig. 6.
Creating the tracheal portal. There are 2 basic approaches to tracheal entry. As illustrated here, the 2nd tracheal ring is divided laterally and the anterior portion removed. Lateral sutures are used to provide counter-traction during tracheostomy-tube insertion. These are left uncut to provide assistance should the tube be accidentally dislodged later. (From Reference 44.)
- Fig. 7.
The trachea is entered between the appropriate tracheal rings with an intravenous catheter, with aspiration of air to confirm correct location. The needle is withdrawn and the catheter left in place as a conduit for the guide wire. (From Reference 44.)
- Fig. 8.
The guide wire is threaded through the catheter to act as a guide for the dilators that follow. It also helps protect the tracheal wall by directing the pointed dilator tips down the trachea. (From Reference 44.)
- Fig. 9.
Through the fiberoptic bronchoscope the wire is seen entering between the 2nd and 3rd tracheal rings, directly in the center or the trachea.
- Fig. 10.
The tip of the dilator is seen entering the trachea over the wire. After the stoma is created, a loading dilator with the tracheostomy tube is used to deliver the tube to its final position. (From Reference 44.)
- Fig. 11.
Specially designed intubating supraglottic airway, which is useful as a conduit for fiberoptic bronchoscope insertion during percutaneous dilational tracheostomy. The patient can continue to breath (or be ventilated) through the large-diameter connecter with the bronchoscope in the larynx during the entire procedure.
