Traqueostomia na UTI: vale a pena realizá-la?

Abstract

Objective: To determine the feasibility of performing tracheostomy in the intensive care unit (ICU) environment and to assess procedurerelated complications and mortality. Methods: The medical records of the 73 patients submitted to tracheostomy in the ICU of the Federal University of São Paulo Hospital São Paulo between January and November of 2003 were evaluated retrospectively. All operations were performed by surgical residents, under the supervision of a thoracic surgeon, using the open technique standardized at the facility. Results: The mean age of the patients was 55.2 years. Of the 73 patients evaluated, 47 (64.4%) were male and 26 (35.6%) were female. The most common indication was prolonged orotracheal intubation (76.7%). There was no procedure-related mortality, and, in all patients, the procedure was successfully performed in the ICU. Early complications occurred in 2 patients (2.7%), who presented increased local bleeding, which was controlled using compression. The late complication was infection at the incision site, which occurred in 2 patients (2.7%) and was treated by applying local dressings, without further clinical repercussions. Conclusions: Based on the results of our analysis, which are comparable to those found in the literature regarding tracheostomy performed in the operating room, we concluded that tracheostomy in the ICU is feasible and presents a low rate of complications, even when performed in critically ill patients and by surgeons in training. Therefore, in our view, it is possible to state that performing tracheostomy in the ICU is worthwhile.

Atuação do fisioterapeuta no gerenciamento de risco para pacientes com traqueostomia / Physicotherapist performance in risk management for patients with tracheostomy

“…Taxa de incidência complicações relacionadas ao pós operatório são relativamente baixas (2,7-4,3%) (18) e raramente levam os pacientes a óbito, porém quando ocorre deslocamento acidental da cânula na fase precoce após a cirurgia (incidência de 0,8-1,5% dentre todas as complicações (19) a taxa de letalidade pode chegar a 100% (20,21) .…”

Bedside conventional tracheostomy

“…Many of these patients have injuries that make their mobilization very dangerous or they have venous accesses (sometimes vasoactive drugs), drainages or more invasive monitoring that can be displaced during transportation, complicating or threatening their lives. Tracheostomy at the bedside can be performed sometimes earlier since it does not depend on the availability of a room in the operating theater, often overloaded 7 .…”

Resultados de enfermagem para padrão respiratório ineficaz e ventilação espontânea prejudicada em terapia intensiva

“…The indicators "Integrity of skin impaired at the site of tracheostomy" and "Difficulty communicating needs" obtained scores below 0.50, and were discarded. The literature suggests that tracheostomy is a surgical procedure that occurs in intensive care units and is associated to patients who require prolonged mechanical ventilation (17,18) . It is also a procedure that requires constant nursing care, in order to ensure that the patient's airway remains clear to prevent infections, particularly of the operative wound (17) .…”