Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
Curr Opin Anaesthesiol. 2011 Apr;24(2):188-94. doi: 10.1097/ACO.0b013e328344527f.
Trauma is a common predisposing condition in patients developing acute respiratory failure. Selection criteria for tracheostomy use in trauma remain poorly defined. The purpose of this review is to discuss contemporary knowledge regarding the benefits and risks of tracheostomy and to highlight potential strategies to standardize practice.
A number of studies have examined the effects of tracheostomy timing on clinically important end points. In general, these studies have produced conflicting findings, and are difficult to apply clinically. As a result, tracheostomy practice varies considerably. An approach to standardizing tracheostomy practice is presented, whereby decision for tracheostomy is based, in part, on a patient's clinical trajectory. The attractiveness of such an approach is that it attempts to match use of tracheostomy to patients with a need for continued ventilatory support.
Variation in clinical practice is costly. To the extent that variation in tracheostomy practice reflects suboptimal use of this procedure, greater understanding of tracheostomy utility has the potential to enhance the quality of care and more effectively target resources.
创伤是导致急性呼吸衰竭患者发生的常见诱发因素。创伤患者行气管切开术的选择标准仍未明确界定。本文的目的是讨论气管切开术的益处和风险的最新知识，并强调标准化实践的潜在策略。
许多研究都探讨了气管切开术时机对临床重要终点的影响。总的来说，这些研究的结果存在矛盾，难以在临床上应用。因此，气管切开术的实践差异很大。提出了一种标准化气管切开术实践的方法，即部分根据患者的临床轨迹决定气管切开术的时机。这种方法的吸引力在于，它试图根据需要持续通气支持的患者来使用气管切开术。
临床实践的差异是有代价的。在某种程度上，气管切开术实践的差异反映了该手术的使用不够理想，如果能更深入地了解气管切开术的实用性，有可能会提高护理质量，并更有效地利用资源。
