Jaeger J Michael, Littlewood Keith A, Durbin Charles G
Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA.
Respir Care. 2002 Apr;47(4):469-80; discussion 481-2.
A common clinical observation is that patients wean more rapidly from mechanical ventilation following tracheotomy. Expected changes in tube resistance and dead space are not adequate to explain this observation in adult patients. Theoretical considerations are too complicated to allow evaluation of expected changes in work of breathing following tracheotomy. The resistance of the upper airway is about the same as breathing quietly through an 8.0 mm endotracheal tube; however, many patients experience a higher work of breathing following extubation. This is not true in infants, in whom the reduction in airway diameter is profound and a marked reduction in resistance is seen following extubation. The other benefits of tracheostomy include better secretion removal, improved oral hygiene, less laryngeal damage, and ability to eat and speak. These should be considered when proposing this procedure. There may be less late ventilator-associated pneumonia following early tracheotomy. The assumed better safety of tracheostomy has been questioned. That patients appear to wean more rapidly is probably accounted for by the variety of factors mentioned above.
一个常见的临床观察结果是，气管切开术后患者从机械通气中撤机的速度更快。气管导管阻力和死腔的预期变化不足以解释成年患者的这一观察结果。理论上的考量过于复杂，无法评估气管切开术后呼吸功的预期变化。上气道阻力与通过8.0毫米气管内导管安静呼吸时大致相同；然而，许多患者在拔管后呼吸功更高。婴儿并非如此，婴儿气道直径显著减小，拔管后阻力明显降低。气管造口术的其他益处包括更好地清除分泌物、改善口腔卫生、减少喉部损伤以及能够进食和说话。在提议进行此手术时应考虑这些因素。早期气管切开术后可能较少发生晚期呼吸机相关性肺炎。气管造口术假定的更高安全性受到了质疑。患者似乎撤机更快可能是由上述多种因素导致的。
