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Percutaneous Tracheostomy
Ziyad Al-Shathri1, Irawan Susanto1
1Division of Pulmonary, Critical Care Medicine, Allergy and Clinical Immunology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Seminars in Respiratory and Critical Care Medicine
|January 15, 2019
Summary
Percutaneous tracheostomy (PT) is a safe and cost-effective alternative to surgical tracheostomy (ST) in intensive care units. Ultrasound guidance offers a viable option when bronchoscopy is limited, though careful technique and planning are crucial.
Area of Science:
- Critical Care Medicine
- Surgical Procedures
- Airway Management
Background:
- Tracheostomy is a frequent ICU procedure, with percutaneous tracheostomy (PT) increasingly favored over surgical tracheostomy (ST) due to bedside accessibility and cost-effectiveness.
- PT offers benefits over translaryngeal intubation for anticipated prolonged airway support, but optimal timing remains debated.
- While PT is well-established, data on its safety in patients on dual antiplatelet therapy or anticoagulation is limited.
Purpose of the Study:
- To review the safety and efficacy of percutaneous tracheostomy (PT) in intensive care units (ICUs).
- To compare percutaneous tracheostomy (PT) with surgical tracheostomy (ST).
- To discuss the role of ultrasound (US)-guided PT as an alternative to bronchoscopy-guided PT.
Main Methods:
- Review of existing literature on percutaneous tracheostomy (PT) techniques and outcomes.
- Comparison of safety and cost-effectiveness between PT and surgical tracheostomy (ST).
- Evaluation of ultrasound (US) guidance as an adjunct or alternative to bronchoscopy in PT.
Main Results:
- Percutaneous tracheostomy (PT) is demonstrated to be as safe as surgical tracheostomy (ST) when performed by trained clinicians.
- Bedside PT is more accessible than ST in ICUs and offers significant cost savings.
- Ultrasound (US)-guided PT is emerging as a valuable technique, particularly where bronchoscopy access is limited.
Conclusions:
- Percutaneous tracheostomy (PT) is a safe, cost-effective, and readily available alternative to surgical tracheostomy (ST) in the ICU setting.
- Ultrasound (US)-guided PT provides a viable alternative or adjunct to bronchoscopic guidance.
- Careful technique, adequate training, and meticulous planning are paramount to minimize complications associated with PT, especially in high-risk patients.
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