Department of Anesthesiology, University of Virginia, Box 800710, Charlottesville, VA 22908, USA.
Respir Care. 2010 Aug;55(8):1056-68.
Tracheostomy is one of the most frequent procedures performed in intensive care unit (ICU) patients. Of the many purported advantages of tracheostomy, only patient comfort, early movement from the ICU, and shorter ICU and hospital stay have significant supporting data. Even the belief of increased safety with tracheostomy may not be correct. Various techniques for tracheostomy have been developed; however, use of percutaneous dilation techniques with bronchoscopic control continue to expand in popularity throughout the world. Tracheostomy should occur as soon as the need for prolonged intubation (longer than 14 d) is identified. Accurate prediction of this duration by day 3 remains elusive. Mortality is not worse with tracheotomy and may be improved with earlier provision, especially in head-injured and critically ill medical patients. The timing of when to perform a tracheostomy continues to be individualized, should include daily weaning assessment, and can generally be made within 7 days of intubation. Bedside techniques are safe and efficient, allowing timely tracheostomy with low morbidity.
气管切开术是重症监护病房（ICU）患者最常进行的手术之一。在气管切开术的众多所谓优点中，只有患者舒适度、早期从 ICU 移动以及 ICU 和住院时间缩短具有确凿的数据支持。即使认为气管切开术更安全的观点也可能不正确。已经开发了多种气管切开术技术；然而，在全世界范围内，经支气管镜控制的经皮扩张技术的使用继续普及。一旦确定需要长时间插管（超过 14 天），就应进行气管切开术。第 3 天准确预测这一持续时间仍然难以捉摸。气管切开术不会增加死亡率，并且可能会通过更早地提供来改善，特别是在头部受伤和重症监护的内科患者中。进行气管切开术的时间继续因人而异，应包括每日脱机评估，通常可以在插管后 7 天内进行。床边技术安全有效，可及时进行气管切开术，且发病率低。
