Early translaryngeal tracheostomy in patients with severe brain damage

Abstract

Translaryngeal tracheostomy, performed in selected patients when the risk of intracranial hypertension was reduced to the minimum, was well tolerated in the majority of cases and did not induce persistent intracranial disorders. However, ICP is affected by tracheostomy, and careful monitoring and patient selection is necessary. At follow-up no severe anatomical or functional damage was detected.

Safety and Feasibility of Percutaneous Tracheostomy Performed by Neurointensivists

“…Percutaneous dilational tracheostomy was performed through a 1.5-cm transverse incision at the second of third cartilaginous interspace using a modification [23] of the procedure initially described by Ciaglia et al [24], with the Cook Ciaglia Blue Rhino PT kit. Because of concern for hypoventilation and elevated ICP [13,[17][18][19] associated with bronchoscopy, capnography was routinely used to verify tracheal positioning of the tube [25], with bronchoscopy available for evaluation of the airway or tracheostomy placement, if necessary. All patients received assist control mode ventilation and FiO 2 1.0 throughout the procedure.…”

“…The frequency of tracheostomy is high among the population served by neurocritical care physicians, including a significant number of patients with ischemic stroke [11], intracerebral hemorrhage [12], subarachnoid hemorrhage [13], traumatic brain injury [14][15][16], hypoxic-ischemic encephalopathy, and status epilepticus. Neurointensivists may be more vigilant in recognizing and managing subtle dangers to brain injured patients that may occur during the procedure, such as hypoventilation, head-down positioning, hypoxia, hypotension, and elevated intracranial pressure (ICP) [13,[17][18][19].…”

“…The frequency of tracheostomy is high among the population served by neurocritical care physicians, including a significant number of patients with ischemic stroke [11], intracerebral hemorrhage [12], subarachnoid hemorrhage [13], traumatic brain injury [14][15][16], hypoxic-ischemic encephalopathy, and status epilepticus. Neurointensivists may be more vigilant in recognizing and managing subtle dangers to brain injured patients that may occur during the procedure, such as hypoventilation, head-down positioning, hypoxia, hypotension, and elevated intracranial pressure (ICP) [13,[17][18][19]. Finally, tracheostomy decreases the work of breathing [20], and early tracheostomy is increasingly recognized as a potential method for reducing the duration of mechanical ventilation (DMV), the frequency of ventilator-associated pneumonia (VAP), intensive care unit length of stay (ICU LOS), and mortality [21,22] among patients who require prolonged mechanical ventilation.…”

Long-Term Outcome Following Tracheostomy in Critical Care

“…For studies evaluating STD, the Ciaglia Blue Rhino Percutaneous Tracheostomy Introducer set (Cook Critical Care) was used in six (9,11,33,35,43,52), and the Portex Ultraperc (Smith Medical, Hythe, Kent, United Kingdom ) was used in one (40). For the TLT technique, two studies did not specify the equipment used (42,53) and in the third the Mallinckrodt kit (Mallinckrodt Medical, Mirandola, Italy) was used (55). The study evaluating the BD technique (43) used the Ciaglia Blue Dolphin Percutaneous Tracheotomy Introducer Kit (Cook Critical Care), whereas the PercuTwist Set (Rüsch GmbH, Kennen, Germany) was used for the SSRD study (32).…”

Liberation of neurosurgical patients from mechanical ventilation and tracheostomy in neurocritical care

“…The procedure, however, is not without risk, and potential complications include surgical site infection, hemorrhage, pneumomediastinum, pneumothorax, and death [34]. Tracheostomy should be deferred in patients with unstable ICP/CPP [35]. Furthermore, the appropriate timing for the most benefit is not well defined and may differ in different patient populations.…”