We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
Published online by Cambridge University Press: 12 January 2010
Historically, tracheostomy has been performed for relief of obstruction of the upper airway (trauma, epiglottitis); when prolonged ventilatory support for respiratory failure is likely; for control of secretions in patients with bulbar lesions or closed head injuries; or for sleep apnea. In many centers, open surgical tracheostomy has been replaced with bedside percutaneous dilational tracheostomy. In patients with acute airway obstruction, cricothyroidotomy (“high tracheostomy”) is a better choice than tracheostomy, especially if the individual performing the procedure has little or no surgical training, if the procedure is being performed under less than ideal conditions in the emergency center or intensive care unit, or if there is impending asphyxiation. The delay until tracheostomy is performed in patients with prolonged endotracheal intubation varies from center to center, but prospective data demonstrate the advantage of doing the procedure after 7 to 10 days. Recent evidence also indicates that patients who cannot be weaned with endotracheal tubes in place can often be weaned rapidly after a tracheostomy is performed. Finally, newer devices are available that enable patients with sleep apnea to be managed without tracheostomies.
After instituting the delivery of 100% oxygen by mask, endotracheal tube, or ventilating bronchoscope, open tracheostomy is best performed in the operating room under local anesthesia supplemented by intravenous sedation. The patient's neck is hyperextended and a transverse incision is made over the second tracheal cartilage.
To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.
