Effects of tracheotomy on respiratory mechanics in spontaneously breathing patients

Abstract

Tracheotomy is a method of intubating the trachea, which is employed in several clinical settings, including the treatment of head and neck neoplasms. Tracheotomy is believed to facilitate weaning through changes in respiratory mechanics. Existing information concerning functional changes associated with tracheotomy are limited to comparisons with orotracheal intubation.In this study, respiratory mechanics were monitored in seven spontaneously breathing patients, before and after an elective tracheotomy was performed for surgical treatment of cancer. Campbell diagrams were constructed by plotting pressure, obtained with an oesophageal balloon catheter, against volume, obtained from a pneumotachograph placed at the airway opening. Work of breathing was calculated as the internal area of the Campbell diagram and was partitioned into its elastic and inspiratory and expiratory resistive components. Oesophageal pressure was also used to quantify intrinsic positive end-expiratory pressure (PEEPi) and the pressure-time product (PTP), which is considered to be proportional to the oxygen cost of breathing. PTP was divided into its resistive and elastic components.Inspiratory resistive work, PEEPi, inspiratory PTP, as well as its resistive and elastic components were significantly reduced by tracheotomy.Tracheotomy significantly reduces work of breathing and pressure-time product in spontaneously breathing patients.

Feasibility of a single-stage tracheostomy decannulation protocol with endoscopy in adult patients

“…Few studies have examined the physiological effect of mouth-breathing versus tracheostomy breathing. 15,16 Even fewer studies have examined the physiological effects of reduced-size tracheotomy tube or capped tube. Haberth€ ur et al 17 investigated the work of breathing in 10 tracheostomized, spontaneously breathing patients in the ICU.…”

“…The APACHE II score of our study group was found to be significantly lower (15/35 vs. 16/35, P 5 0.027) than that of the control group. The difference of a single score point is not associated with a higher risk for morbidity or mortality because both scores are within the same subgroup (15)(16)(17)(18)(19), which predicts a 24% approximate mortality. 13 Our study group demonstrated a significantly shorter hospitalization period than the control group, following the decannulation process (5 vs. 20 days, P < 0.001), even though the general condition of the patients prior to and following decannulation (represented by the APACHE II and SOFA scores, respectively) was similar.…”

Tracheostoma

“…Das Tracheostoma hilft, F den Sedierungsbedarf des Patienten zu reduzieren bzw. aufzuheben; F Traumatisierungen des Kehlkopfes und des NasenRachenRaums zu minimieren, F durch Reduzierung der Atemarbeit, der "resistance", des Spitzendrucks, des "intrinsic positive endexpiratory pressure" (intrinsic PEEP) und durch ein verbessertes Triggern des Beatmungs gerätes das "weaning" günstig zu beeinflussen [2,4,14,16]; F einen Wechsel zwischen assistierter Beatmung und reiner Spontanatmung (mit prolongierten Beatmungspausen) durchzuführen; F die Schluck und Kommunikationsrehabilitation des Patienten zu ermöglichen; F durch effiziente Bronchialtoilette bronchopulmonalen Infektionen vorzubeugen und F die Pflegbarkeit des NasenRachenRaums zu verbessern. …”

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“…The role of tracheostomy in this setting, however, has yet to be clearly defined. Tracheostomy has been shown to decrease the work of breathing [14], but this is not the issue in this scenario. Aspiration of oropharyngeal contents is common in neurologically impaired patients, but tracheostomy may not protect against aspiration [15].…”