Techniques of surgical tracheostomy.
Tracheostomy has become one of the most commonly performed procedures in the critically ill patient. Variations in technique and expertise have led to a wide range of reported procedural related morbidity and rarely mortality. The lack of prospective, controlled trials, physician bias and patient comorbidities further confound the decisions regarding the timing of tracheostomy. With careful attention to anatomy and technique, the operative complication rate should be less than 1%. In such a setting, the risk-benefit ratio of prolonged translaryngeal intubation versus tracheostomy begins to weight heavily in favor of surgical tracheostomy. At exactly what point this occurs remains undefined, but certainly by the tenth day of intubation, if extubation is not imminent, arrangements should be made for surgical tracheostomy by a team experienced with the chosen technique.
Walts
Peter A
PA
Department of Thoracic and Cardiovascular Surgery, Section of General Thoracic Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F24, Cleveland, OH 44195, USA.
Murthy
Sudish C
SC
DeCamp
Malcolm M
MM
D003413:Cricoid Cartilage / Q000473:pathology; D006801:Humans; D007442:Intubation, Intratracheal; D009334:Neck Muscles / Q000601:surgery; D013536:Suture Techniques; D014132:Trachea / Q000033:anatomy & histology; D014135:Tracheal Stenosis / Q000601:surgery; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*