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Techniques of surgical tracheostomy
Peter A Walts1, Sudish C Murthy, Malcolm M DeCamp
1Department of Thoracic and Cardiovascular Surgery, Section of General Thoracic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F24, Cleveland, OH 44195, USA.
Clinics in Chest Medicine
|October 11, 2003
Summary
Tracheostomy is a common procedure for critically ill patients. Surgical tracheostomy offers a favorable risk-benefit ratio compared to prolonged intubation, especially after ten days.
Area of Science:
- Critical Care Medicine
- Surgical Procedures
- Respiratory Management
Background:
- Tracheostomy is frequently performed in critically ill patients.
- Variations in technique and expertise contribute to a wide range of procedural complications.
- Lack of controlled trials and physician bias complicate decisions regarding tracheostomy timing.
Purpose of the Study:
- To evaluate the risk-benefit ratio of tracheostomy versus prolonged translaryngeal intubation.
- To provide guidance on the optimal timing for surgical tracheostomy.
Main Methods:
- Review of existing literature and clinical practice regarding tracheostomy procedures.
- Analysis of complication rates associated with different techniques.
- Comparison of risks associated with prolonged intubation versus surgical tracheostomy.
Main Results:
- With meticulous technique, operative complication rates for tracheostomy should be below 1%.
- The risk-benefit balance favors surgical tracheostomy over prolonged translaryngeal intubation.
- This balance shifts significantly by the tenth day of intubation if extubation is not imminent.
Conclusions:
- Surgical tracheostomy is a safe procedure with low complication rates when performed by experienced teams.
- Prolonged translaryngeal intubation carries increasing risks beyond ten days.
- Consideration for surgical tracheostomy should be made by day ten if extubation is not anticipated.