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tracheostomy

Surgery to make an opening into the trachea. Indications: - upper airway obstruction 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] Contraindications: - routine early tracheostomy for mechanically ventilation - results in many unneeded procedures - does not confer any clear benefit [3] Adverse effects: 1) interferes with speech 2) interferes with exercise 3) interferes with social interactions 4) interferes with mucociliary clearance Management: - early tracheostomy of no significant benefit over prolonged endotracheal intubation & late tracheotomy [2] - capping trials slow removal of tracheostomy tubes [5]

General

tracheal procedure ostomy

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 258
  2. 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: 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: 21403080
  3. 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: 23695482 - Angus DC. When should a mechanically ventilated patient undergo tracheostomy? JAMA 2013 May 22; 309:2163 PMID: 23695486
  4. 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. PMID: 29406182 http://bjanaesthesia.org/article/S0007-0912(17)54060-X/fulltext
  5. 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: 32905673 https://www.nejm.org/doi/10.1056/NEJMoa2010834
  6. Hashimoto DA, Axtell AL, Auchincloss HG. Videos in Clinical Medicine. Percutaneous Tracheostomy. N Engl J Med 2020. Oct 28. PMID: 33113296 https://www.nejm.org/doi/full/10.1056/NEJMvcm2014884