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Tracheostomy

Tracheostomy is a topic covered in the Pocket ICU Management.

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Anesthesia Central

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First Things First (assess & treat for the following)

  • Overview
    • Once used primarily for emergency mgt of upper airway obstruction; has evolved into an elective, bedside procedure in patients requiring prolonged ventilatory support
    • Open tracheostomy (OT): open procedure performed at bedside or in OR. Allows direct visualization of trachea during cannulation.
    • Percutaneous dilational tracheostomy (PDT): alternative to OT; can be performed at bedside or in OR. Seldinger technique used for tracheal dilatation & tracheostomy tube placement.
  • Indications
    • Prolonged ventilatory support
      • Ventilatory support >10-14 days
      • Early tracheostomy (< 3 days) in patients with suspected devastating injuries (neurologic or multi-system trauma)
        • May decrease risk of pneumonia, number of ventilator days & length of ICU stay
    • Upper airway obstruction or trauma
    • Excessive and difficult-to-manage secretions
  • Contraindications
    • Absolute
      • Percutaneous
        • Inability to identify laryngeal and tracheal landmarks
    • Relative
      • Percutaneous
        • Difficult airway
        • Small ETT (< 7 mm); will make bronchoscopy and ventilation difficult
        • Previous neck surgery including tracheostomy
      • Both open and percutaneous
        • PEEP >15 cm of water
        • FiO2 >80%
        • Patient requiring non-conventional ventilation mode to maintain oxygenation or ventilation
        • Coagulopathy
        • Active neck infection

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Last updated: May 13, 2010

Citation

"Tracheostomy." Pocket ICU Management, PocketMedicine.com, Inc, 2010. Anesthesia Central, anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534021/all/Tracheostomy.
Tracheostomy. Pocket ICU Management. PocketMedicine.com, Inc; 2010. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534021/all/Tracheostomy. Accessed April 21, 2019.
Tracheostomy. (2010). In Pocket ICU Management. Available from https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534021/all/Tracheostomy
Tracheostomy [Internet]. In: Pocket ICU Management. PocketMedicine.com, Inc; 2010. [cited 2019 April 21]. Available from: https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534021/all/Tracheostomy.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tracheostomy ID - 534021 Y1 - 2010/05/13/ BT - Pocket ICU Management UR - https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534021/all/Tracheostomy PB - PocketMedicine.com, Inc DB - Anesthesia Central DP - Unbound Medicine ER -