The impact of percutaneous tracheostomy on intensive care unit practice and training

Simpson, Tom; Day, Charles; Jewkes, Claire; Manara, Alex

doi:10.1046/j.1365-2044.1999.00667.x

Cited by 64 publications

(42 citation statements)

References 13 publications

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“…In recent years, percutaneous tracheostomy has overtaken formal tracheostomy as the technique of choice in many intensive care units. Since the technique's introduction, the proportion of intensive care patients receiving tracheostomies has increased, in one study from 8.5 to 16.8% [100]. This has several implications.…”

Section: K R Stringer Et Al Ae Training In Airway Managementmentioning

confidence: 99%

Training in airway management

2002

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Section: K R Stringer Et Al Ae Training In Airway Managementmentioning

confidence: 99%

Training in airway management

2002

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“…The role of tracheostomy Tracheostomy has become an increasingly common intervention in ICUs [158] with the introduction of percutaneous techniques performed by the intensivist at the bedside [159]. It would now be unusual for clinicians to persist with orotracheal intubation in patients perceived as being difficult to wean, in the absence of contra-indications to tracheostomy.…”

Section: Question 5: How Should Patients With Prolonged Weaning Failumentioning

confidence: 99%

Weaning from mechanical ventilation

Boles

Bion

Connors³

et al. 2007

Eur Respir J

1,662

1,499

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Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Many controversial questions remain concerning the best methods for conducting this process. An International Consensus Conference was held in April 2005 to provide recommendations regarding the management of this process. An 11-member international jury answered five pre-defined questions. 1) What is known about the epidemiology of weaning problems? 2) What is the pathophysiology of weaning failure? 3) What is the usual process of initial weaning from the ventilator? 4) Is there a role for different ventilator modes in more difficult weaning? 5) How should patients with prolonged weaning failure be managed?The main recommendations were as follows. 1) Patients should be categorised into three groups based on the difficulty and duration of the weaning process. 2) Weaning should be considered as early as possible. 3) A spontaneous breathing trial is the major diagnostic test to determine whether patients can be successfully extubated. 4) The initial trial should last 30 min and consist of either T-tube breathing or low levels of pressure support. 5) Pressure support or assist–control ventilation modes should be favoured in patients failing an initial trial/trials. 6) Noninvasive ventilation techniques should be considered in selected patients to shorten the duration of intubation but should not be routinely used as a tool for extubation failure.

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“…Technically undertaking an awake surgical tracheostomy can be challenging, particularly in a patient who has airway obstruction and cannot lie flat, extend their head, or tolerate surgical manipulation in the neck. With fewer routine critical care tracheostomies being undertaken, current junior surgical staff inevitably have less experience than did their predecessors [36].…”

Section: Awake Tracheal Accessmentioning

confidence: 99%

Progress in management of the obstructed airway

Patel

Pearce

2011

Anaesthesia

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SummaryThere is no consensus as to the ideal approach for the anaesthetic management of the adult obstructed airway and there are advocates of awake fibreoptic intubation, inhalational induction and intravenous induction techniques. This review considers the different options available for obstruction at different anatomical levels. Decisions must also be made on the urgency of the required intervention. Particular controversies revolve around the role of inhalational vs intravenous induction of anaesthesia, the use or avoidance of neuromuscular blockade and the employment of cannula cricothyroidotomy vs surgical tracheostomy.

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The impact of percutaneous tracheostomy on intensive care unit practice and training

Cited by 64 publications

References 13 publications

Training in airway management

Training in airway management

Weaning from mechanical ventilation

Progress in management of the obstructed airway

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