[Percutaneous tracheostomy in the ventilated patient]

Area of Science:

• Critical Care Medicine
• Pulmonology
• Surgical Procedures

Background:

• Tracheostomy is indicated for upper airway obstruction, preventing airway damage from prolonged intubation, and facilitating secretion removal.
• Percutaneous tracheostomy (PT) has become a widely accepted alternative to surgical tracheostomy since 1985 for long-term ventilated patients.
• Comparative trials and technique advancements have increased the popularity of PT, particularly percutaneous dilatation under bronchoscopic control.

Purpose of the Study:

• To review the current state of percutaneous tracheostomy (PT) in mechanically ventilated patients.
• To analyze the advantages and evolving techniques of PT in critical care settings.
• To discuss the indications and individualized timing of tracheostomy.

Main Methods:

• Review of comparative trials evaluating PT versus surgical tracheostomy.
• Analysis of developments in PT techniques, including percutaneous dilatation under bronchoscopic guidance.
• Examination of the role of PT in managing critically ill, mechanically ventilated patients.

Main Results:

• Percutaneous tracheostomy (PT) is increasingly favored globally, especially percutaneous dilatation techniques under bronchoscopic control.
• PT is considered the technique of choice for tracheostomy in many critically ill patients requiring mechanical ventilation.
• While tracheostomy should be timely, a validated model for predicting prolonged mechanical ventilation is lacking, necessitating individualized timing.

Conclusions:

• Percutaneous tracheostomy (PT) is a highly accepted and often preferred method for airway management in prolonged mechanical ventilation.
• Ongoing advancements in PT techniques continue to enhance its safety and efficacy in critically ill patients.
• Individualized assessment is crucial for determining the optimal timing of tracheostomy.