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An overview of complications associated with open and percutaneous tracheostomy procedures.

Cipriano A, Mao ML, Hon HH, Vazquez D, Stawicki SP, Sharpe RP, Evans DC - Int J Crit Illn Inj Sci (2015 Jul-Sep)

Bottom Line: Tracheostomy, whether open or percutaneous, is a commonly performed procedure and is intended to provide long-term surgical airway for patients who are dependent on mechanical ventilatory support or require (for various reasons) an alternative airway conduit.Due to its invasive and physiologically critical nature, tracheostomy placement can be associated with significant morbidity and even mortality.This article provides a comprehensive overview of commonly encountered complications that may occur during and after the tracheal airway placement, including both short- and long-term postoperative morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States.

ABSTRACT
Tracheostomy, whether open or percutaneous, is a commonly performed procedure and is intended to provide long-term surgical airway for patients who are dependent on mechanical ventilatory support or require (for various reasons) an alternative airway conduit. Due to its invasive and physiologically critical nature, tracheostomy placement can be associated with significant morbidity and even mortality. This article provides a comprehensive overview of commonly encountered complications that may occur during and after the tracheal airway placement, including both short- and long-term postoperative morbidity.

No MeSH data available.


Schematic representation of properly placed tracheostomy positioning
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Figure 4: Schematic representation of properly placed tracheostomy positioning

Mentions: Percutaneous tracheostomy is becoming the method of choice in many ICUs. The benefits include performance at the bedside, reduction of operating room (OR) costs, limiting patient travel, and improved healing. There are different kits available to perform a percutaneous tracheostomy, but the general steps remain consistent. First, a small incision is made about 1 cm below the cricoid cartilage and dissection is carried down bluntly with a hemostat (of note, this step is sometimes performed after the placement of the guidewire and prior to serial tract dilatations – see below). An assistant at the head of the bed then performs the bronchoscopy. The bronchoscope is advanced to the tip of the endotracheal tube, which is then slowly withdrawn as a single unit until just proximal to the level of the first or second tracheal ring. From here on, all steps of the procedure should proceed under direct bronchoscopic visualization. The introducer needle is advanced through the incision and into the trachea. Once proper placement is confirmed, a guide wire is advanced. The needle is then removed while leaving the guide wire in place. A series of dilatations are performed over the guide wire. Once dilatation is deemed satisfactory, the tracheostomy is then inserted over the guide wire or the dilator.[24] The tracheostomy is then connected to the ventilator and placement is confirmed. Similar to an open tracheostomy, it is then secured in place with sutures. There is an option to perform the procedure without the use of bronchoscopic visualization, however, this requires more thorough dissection in order to directly palpate the trachea. Step-by-step pictorial representation of percutaneous tracheostomy is shown in Figure 3. Finally, proper tracheostomy positioning is schematically represented in Figure 4.


An overview of complications associated with open and percutaneous tracheostomy procedures.

Cipriano A, Mao ML, Hon HH, Vazquez D, Stawicki SP, Sharpe RP, Evans DC - Int J Crit Illn Inj Sci (2015 Jul-Sep)

Schematic representation of properly placed tracheostomy positioning
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4613417&req=5

Figure 4: Schematic representation of properly placed tracheostomy positioning
Mentions: Percutaneous tracheostomy is becoming the method of choice in many ICUs. The benefits include performance at the bedside, reduction of operating room (OR) costs, limiting patient travel, and improved healing. There are different kits available to perform a percutaneous tracheostomy, but the general steps remain consistent. First, a small incision is made about 1 cm below the cricoid cartilage and dissection is carried down bluntly with a hemostat (of note, this step is sometimes performed after the placement of the guidewire and prior to serial tract dilatations – see below). An assistant at the head of the bed then performs the bronchoscopy. The bronchoscope is advanced to the tip of the endotracheal tube, which is then slowly withdrawn as a single unit until just proximal to the level of the first or second tracheal ring. From here on, all steps of the procedure should proceed under direct bronchoscopic visualization. The introducer needle is advanced through the incision and into the trachea. Once proper placement is confirmed, a guide wire is advanced. The needle is then removed while leaving the guide wire in place. A series of dilatations are performed over the guide wire. Once dilatation is deemed satisfactory, the tracheostomy is then inserted over the guide wire or the dilator.[24] The tracheostomy is then connected to the ventilator and placement is confirmed. Similar to an open tracheostomy, it is then secured in place with sutures. There is an option to perform the procedure without the use of bronchoscopic visualization, however, this requires more thorough dissection in order to directly palpate the trachea. Step-by-step pictorial representation of percutaneous tracheostomy is shown in Figure 3. Finally, proper tracheostomy positioning is schematically represented in Figure 4.

Bottom Line: Tracheostomy, whether open or percutaneous, is a commonly performed procedure and is intended to provide long-term surgical airway for patients who are dependent on mechanical ventilatory support or require (for various reasons) an alternative airway conduit.Due to its invasive and physiologically critical nature, tracheostomy placement can be associated with significant morbidity and even mortality.This article provides a comprehensive overview of commonly encountered complications that may occur during and after the tracheal airway placement, including both short- and long-term postoperative morbidity.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania, United States.

ABSTRACT
Tracheostomy, whether open or percutaneous, is a commonly performed procedure and is intended to provide long-term surgical airway for patients who are dependent on mechanical ventilatory support or require (for various reasons) an alternative airway conduit. Due to its invasive and physiologically critical nature, tracheostomy placement can be associated with significant morbidity and even mortality. This article provides a comprehensive overview of commonly encountered complications that may occur during and after the tracheal airway placement, including both short- and long-term postoperative morbidity.

No MeSH data available.