Tracheostomy
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
- Prolonged ventilatory support
- Contraindications
- Absolute
- Percutaneous
- Inability to identify laryngeal and tracheal landmarks
- Percutaneous
- 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
- Percutaneous
- Absolute
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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 December 7, 2024.
Tracheostomy. (2010). In Pocket ICU Management. PocketMedicine.com, Inc. https://anesth.unboundmedicine.com/anesthesia/view/Pocket-ICU-Management/534021/all/Tracheostomy
Tracheostomy [Internet]. In: Pocket ICU Management. PocketMedicine.com, Inc; 2010. [cited 2024 December 07]. 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 -