tracheostomy
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Introduction
Surgery to make an opening into the trachea.
Indications
Contraindications
- routine early tracheostomy for mechanically ventilation
- results in many unneeded procedures
- does not confer any clear benefit[3]
Adverse effects
- interferes with speech
- interferes with exercise
- interferes with social interactions
- interferes with mucociliary clearance
Procedure
- open surgery
- dissection of the anterior pretracheal tissue
- insertion of a tracheostomy tube under direct visualization
- percutaneous dilation
- can be performed quickly & safely at the bedside
- bronchoscopic guidance
- associated with less bleeding & similar long-term morbidity vs open surgery[6]
* video of percutaneous tracheostomy[6]
Management
- early tracheostomy of no significant benefit over prolonged endotracheal intubation & late tracheotomy[2]
- capping trials slow removal of tracheostomy tubes[5]
More general terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 258
- ↑ 2.0 2.1 Trouillet J-L et al. Early percutaneous tracheotomy versus prolonged intubation of mechanically ventilated patients after cardiac surgery: A randomized trial. Ann Intern Med 2011 Mar 15; 154:373 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21403073
Patel SB and Kress JP. Early tracheotomy after cardiac surgery: Not ready for prime time. Ann Intern Med 2011 Mar 15; 154:434. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21403080 - ↑ 3.0 3.1 Young D et al. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: The TracMan randomized trial. JAMA 2013 May 22; 309:2121. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23695482
Angus DC. When should a mechanically ventilated patient undergo tracheostomy? JAMA 2013 May 22; 309:2163 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23695486 - ↑ Higgs A, McGrath BA, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018 Feb;120(2):323-352. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29406182 <Internet> http://bjanaesthesia.org/article/S0007-0912(17)54060-X/fulltext
- ↑ 5.0 5.1 Hernandez Martinez G et al. High-flow oxygen with capping or suctioning for tracheostomy decannulation. N Engl J Med 2020 Sep 10; 383:1009. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32905673 https://www.nejm.org/doi/10.1056/NEJMoa2010834
- ↑ 6.0 6.1 6.2 Hashimoto DA, Axtell AL, Auchincloss HG. Videos in Clinical Medicine. Percutaneous Tracheostomy. N Engl J Med 2020. Oct 28. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33113296 https://www.nejm.org/doi/full/10.1056/NEJMvcm2014884