Heffner John E
Division of Pulmonary and Critical Care Medicine, 812 CSB, Medical University of South Carolina, 96 Jonathan Lucas Street, Post Office Box 250623, Charleston, SC 29425, USA.
Clin Chest Med. 2003 Sep;24(3):389-98. doi: 10.1016/s0272-5231(03)00044-3.
Tracheotomy is one of the most commonly performed surgical procedures among critically ill patients. In the past, tracheotomy was delayed as long as possible in ventilator-dependent patients because of concerns regarding injury to the airway from the surgical procedure. Greater recognition of the benefits of tracheotomy in terms of greater patient comfort and mobility has promoted its earlier performance. No data identify an ideal time for tracheotomy. The decision to convert a patient from translaryngeal intubation to a tracheostomy requires anticipation of the duration of expected mechanical ventilation and the weighing of the expected benefits and risks of the procedure. The convenience of percutaneous tracheotomy performed in the ICU by critical care specialists without formal surgical training has further promoted the adoption of tracheotomy for ventilator-dependent patients. Regardless of the method for performing tracheotomy, meticulous surgical technique and careful postoperative management are necessary to maintain the excellent safety record of tracheotomy for critically ill patients.
气管切开术是重症患者中最常施行的外科手术之一。过去，由于担心手术操作会损伤气道，对于依赖呼吸机的患者，气管切开术会尽可能推迟进行。随着人们越来越认识到气管切开术在提高患者舒适度和活动能力方面的益处，该手术得到了更早期的施行。目前尚无数据确定气管切开术的理想时机。决定将患者从经喉插管转换为气管造口术需要预估预期机械通气的持续时间，并权衡该手术的预期益处和风险。由没有正规外科培训的重症监护专家在重症监护病房（ICU）进行经皮气管切开术的便利性，进一步推动了依赖呼吸机患者采用气管切开术。无论采用何种气管切开术方法，都需要精细的手术技巧和精心的术后管理，以保持气管切开术对重症患者出色的安全记录。
