Engels Paul T, Bagshaw Sean M, Meier Michael, Brindley Peter G
Department of Surgery, Division of Critical Care Medicine, University of Alberta, Edmonton, Alta.
Can J Surg. 2009 Oct;52(5):427-33.
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.
气管切开术是一种常见的外科手术，与手术室相比，越来越多地在重症监护病房（ICU）进行。操作知识至关重要，因此在本综述中进行了概述。我们还回顾了几项比较经皮扩张气管切开术和开放性外科气管切开术的高质量研究。与开放性手术方法相比，经皮方法具有相当（如果不是更优）的安全性和更低的成本；因此，经皮方法越来越受到青睐。比较早期与晚期气管切开术的研究表明，其在发病率方面具有益处，包括较少的医院获得性肺炎、更短的机械通气时间和更短的ICU住院时间。然而，我们讨论了关于气管切开术最佳时机仍存在的问题。我们概述了气管切开术潜在的急性和慢性并发症及其处理方法，并且回顾了不同的气管切开套管、其适应证以及何时拔除。
