RT Journal Article
SR Electronic
T1 Tracheostomy: from insertion to decannulation
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP 427
OP 433
VO 52
IS 5
A1 Paul T. Engels
A1 Sean M. Bagshaw
A1 Michael Meier
A1 Peter G. Brindley
YR 2009
UL http://canjsurg.ca/content/52/5/427.abstract
AB Tracheostomy is a common surgical procedure, and is increasingly performed in the intensive care unit (ICU) as opposed to the operating room. Procedural knowledge is essential and is therefore outlined in this review. We also review several high-quality studies comparing percutaneous dilational tracheostomy and open surgical tracheostomy. The percutaneous method has a comparable, if not superior, safety profile and lower cost compared with the open surgical approach; therefore the percutaneous method is increasingly chosen. Studies comparing early versus late tracheostomy suggest morbidity benefits that include less nosocomial pneumonia, shorter mechanical ventilation and shorter stay in the ICU. However, we discuss the questions that remain regarding the optimal timing of tracheostomy. We outline the potential acute and chronic complications of tracheostomy and their management, and we review the different tracheostomy tubes, their indications and when to remove them.