Early tracheostomy for primary airway management in the surgical critical care setting

Abstract

MECHANICAL VENTILATION REQUIRING cannulation of the trachea is an integral part of the therapy provided to patients in the surgical critical care setting. In the 1950s and early 1960s, airway management consisted of a short period of translaryngeal intubation quickly converted to tracheostomy. In the late 1960s and 1970s the time of translaryngeal intubation before tracheostomy gradually increased with the development of improved endotracheal tube design and construction. This concept became the standard of care in critical care units,'-6 irrespective of the type of patient cared for. In the late 1970s and early 1980s Dane and King; El Naggar et a1.,8 and Stauffer et al.9 compared translaryngeal intubation with tracheostomy in critically ill patients. Outcome analyses centered solely on the complications of tracheostomy and risk of tracheal stenosis. These studies have frequently been cited to demonstrate the dangers of tracheostomy and the high incidence of morbidity and death as a result of the procedure and supported prolonged translaryngeal intubation to avoid tracheostomy until absolutely necessary. In several well-performed prospective studies,"-12 the controversy concerning perioperative morbidity and death and timing of tracheostomy after translaryngeal intubation were addressed. These reports demonstrated that morbidity and mortality rates of tracheostomy were low and translaryngeal intubation of less than 7 days was associated with a risk of transient laryngeal injury of less than 10%. Tracheostomy after 7 days of translaryngeal intubation had a significant incidence of irreversible laryngeal and tracheal stenosis. On the other hand, in a prospective,

Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury

“…Patients with C-SCI are at increased risk of respiratory failure that may lead to the need for tracheostomy [6,11,13,15,21]. Pulmonary complications are the most common complications in patients with C-SCI [7,9].…”

“…Patients with respiratory failure after C-SCI will require intubation and mechanical ventilation, leading to tracheostomy. It has been reported that 21-77 % of patients with C-SCI have undergone tracheostomy [6,11,13,15,21].…”

“…When patients with C-SCI are taken to hospital, doctors must judge those requiring tracheostomy and then perform the tracheostomy as soon as possible [4,5,13,16,20,21]. The benefits of tracheostomy have been discussed previously: improved secretion control, lower rates of pulmonary infection and laryngeal injury, the ability to be given oral nutrition, and shorter hospital/intensive care unit stays [4,13,16,20].…”

“…Tracheostomy provides a secure airway, facilitates secretion control and decreases the risk of pulmonary complications in C-SCI patients [4,5,6,11,13,15,16,20,21]. It has been reported that 21-77 % of patients with C-SCI require tracheostomy [6,11,13,15,21].…”

“…It has been reported that 21-77 % of patients with C-SCI require tracheostomy [6,11,13,15,21]. Early tracheostomy has been advocated from the viewpoint of medical economics and the patient's prognosis because it decreases the length of the hospital/intensive care unit stay and the rate of infectious complications, and increases the patient's ventilation tolerance [4,5,13,16,20,21]. However, quick identification of the risk factors associated with tracheostomy for each patient is necessary for early tracheostomy, but the identification process is difficult.…”