- Percutaneous tracheostomy
Link:www.tracheostomy.org.uk/
- Contraindications
- Children
- CV instability
- High O₂/PEEP requirements
- High airway pressures
- Presence of coagulopathy
- Anatomical abnormalities
- Indications
- Prolongued mechanical ventilation
- Anticipated difficulty in weaning
- Airway protection in comatose patients
- Major head and neck surgery
- Benefits
- Increased patient comfort
- Less need for sedation
- Improved oral hygeine
- Possibility of oral hygeine
- Bronchial toilet aided
- Reduced dead space
- Reduced airway resistance
- Reduced risk of glottic trauma
- Procedure
- Advantages
- Better cosmetic results
- No need to transport from ITU
- Less likely to dislodge
- Less infection rate
- Lower rate of tracheal stenosis
- Disadvantages
- More difficult to reinsert if dislodged
- Requires 2 doctors
- One for tracheostomy
- One for bronchoscopy
- Perioperative complications
- Posterior tracheal wall damage
- Hypoxaemia due to loss of PEEP
- Haemorrhage (usually mild)
- Surgical emphysema
- Pneumothorax
- Para-tracheal placement
- Tracheal tears
- Laryngeal nerve damage
- Early post-op complications
- Blockage
- Infection
- Vessel erosion
- Late complications
- Voice changes
- Tracheal stenosis
- Use a smaller ETT if had tracheostomy
- CEACCP
Link:ceaccp.oxfordjournals.org/content/8/1/31.full.pdf
- CEACCP
Link:ceaccp.oxfordjournals.org/content/3/5/139.full.pdf?frame=sidebar
Link:www.youtube.com/results?search_query=percutaneous+tracheostomy