Perioperative management - Percutaneous dilatational tracheotomy

  1. Indications

    • Prolonged mechanical ventilation (> 10 days)

    Benefits compared with intubation:

    • No injury of the arytenoid cartilages
    • Prevention of mucosal lesions (nose/mouth, vocal cords, trachea)
    • Less airway resistance (decreased ventilatory effort)
    • Less dead space
    • Better fixation
    • Easier oral care
    • Less analgesics/sedatives required
    • Better patient comfort
    • Easier weaning
  2. Contraindications

    • Emergencies
    • Difficult airways suspected
    • Rather difficult or even impossible standard intubation
    • Infection at the planned puncture site
    • Difficult anatomical conditions (e.g., large goiter, head reclination not possible)
    • Unstable cervical spine
    • Coagulation disorders
    • Need for permanent tracheostomy or patient discharged home > epithelialized permanent tracheostomy required
  3. Preoperative diagnostic work-up

    • Coagulation panel
    • Bronchoscopy
  4. Special preparation

    Fiberoptic monitoring while puncturing the trachea is strongly recommended.

  5. Informed consent

    • Bleeding
    • Infection
    • Tracheal injury
    • Surgical revision
    • Pneumothorax
    • Injury to the recurrent nerve
    • Cutaneous emphysema (incl. mediastinal emphysema)
    • Scarring of the tracheostomy
Anesthesia

The procedure is performed with the patient ventilated and under analgesia/sedation. ... - Operatio

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