Freeman Bradley D
Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Box 8109, St Louis, MO 63110, USA.
Crit Care Clin. 2017 Apr;33(2):311-322. doi: 10.1016/j.ccc.2016.12.007.
Tracheostomy remains one of the most commonly performed surgical procedures in the setting of acute respiratory failure. Tracheostomy literature focuses on 2 aspects of this procedure: when (timing) and how (technique). Recent trials have failed to demonstrate an effect of tracheostomy timing on most clinically important endpoints. Nonetheless, relative to continued translaryngeal intubation, studies suggest that tracheostomy use is associated with less need for sedation and enhanced patient comfort. Evidence likewise suggests that percutaneous dilational tracheostomy is advantageous with respect to cost and complication profile and should be considered the preferred approach in appropriately selected patients.
气管切开术仍然是急性呼吸衰竭情况下最常施行的外科手术之一。气管切开术的文献聚焦于该手术的两个方面：时机（何时进行）和技术（如何进行）。近期的试验未能证明气管切开术的时机对大多数临床重要终点有影响。尽管如此，相对于持续经喉插管，研究表明使用气管切开术可减少镇静需求并提高患者舒适度。同样有证据表明，经皮扩张气管切开术在成本和并发症方面具有优势，在适当选择的患者中应被视为首选方法。
