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Related Experiment Videos

Percutaneous tracheostomy--special considerations.

Armin Ernst1, Jonathan Critchlow

  • 1Pulmonary and Critical Care Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. Aernst@caregroup.harvard.edu

Clinics in Chest Medicine
|October 11, 2003
PubMed
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Percutaneous tracheostomy (PT) is a safe and effective method for creating artificial airways. Many perceived contraindications are not absolute prohibitions but depend on operator skill and patient selection.

Area of Science:

  • Critical Care Medicine
  • Surgical Procedures
  • Airway Management

Background:

  • Percutaneous tracheostomy (PT) is a widely used technique for establishing long-term artificial airways.
  • Early PT trials focused on "perfect candidates," leading to perceived contraindications.
  • These perceived contraindications often reflect operator skill rather than absolute limitations.

Purpose of the Study:

  • To evaluate the safety and effectiveness of percutaneous tracheostomy (PT).
  • To reassess the validity of traditional contraindications for PT.
  • To highlight the importance of operator expertise in patient selection for PT.

Main Methods:

  • Review of clinical experience with percutaneous tracheostomy (PT).
  • Application of PT in selected patients with coagulopathies and superior vena cava syndromes.

Related Experiment Videos

  • Emphasis on operator skill and judgment in patient and procedure selection.

    • Main Results:

    • PT is safe and highly effective when performed by well-trained practitioners.
    • PT can be beneficial in patients with coagulopathies, venous congestion, and thyroid cancers.
    • Operator expertise is crucial for maintaining PT's excellent safety record.

    Conclusions:

    • Most contraindications for PT are relative and depend on operator skill.
    • Absolute contraindications for PT are limited to active infections, uncontrollable bleeding, and extreme ventilatory/oxygenation needs.
    • Fewer than 5% of intensive care unit patients requiring tracheostomy undergo open procedures at our institution, reflecting the broad applicability of PT.