ABSTRACT
A traqueostomia comumente é realizada eletivamente nas unidades de terapia intensiva em pacientes críticos que necessitam de assistência ventilatória prolongada. É o procedimento realizado com mais freqüência em pacientes graves intubados. Vários estudos comprovam os benefícios da traqueostomia em relação à intubação orotraqueal: facilita a aspiração de secreções, melhor conforto e mobilização dos pacientes, redução do espaço morto, diminui o esforço respiratório e a resistência na via aérea, permite a fala, alimentação por via oral e o desmame da ventilação mecânica com mais facilidade. Apesar de vários estudos indicarem os benefícios da traqueostomia em pacientes críticos, o momento mais adequado para a sua realização ainda é controverso. Pacientes com traumas graves, especialmente o crânioencefálico, provavelmente se beneficiam da realização de traqueostomia precoce. O presente estudo tem como objetivo revisar e discutir as indicações, técnica, complicações e o momento da realização da traqueostomia.
Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. Tracheostomy is themost commonly performed procedure in the critically ill of intubated patients. Several studies have identified the benefits of tracheostomy over endotracheal intubation, such as sparing further injury from translaryngeal intubation, providing a stable airway, facilitating pulmonary toilet, increasing patient comfort and mobility, reduction in dead space, work of breathing, and airway resistance, permitting speech and feedings and facilitating weaning from the ventilator. Despite several studiesadvocating tracheostomy in the surgical critically ill patient, the timing of tracheostomy continues to be a topic of controversy. Patients with severe traumatic injuries, especially those with head injury or altered mental status, are likely to benefit from earlier tracheostomy. The present study aims to review and discuss indications, techniques, complications and timingof tracheostomy.
Subject(s)
Humans , Male , Female , Tracheostomy , Tracheostomy , Tracheostomy/adverse effects , Tracheostomy/history , Tracheostomy/methods , Intraoperative Complications , Intubation, Intratracheal , Respiration, Artificial , Ventilator WeaningABSTRACT
Background: Suprastomal granulation tissue is a complication of tracheostomy which maymake decannulation difficult and presents a therapeutic challenge to the Otorhinolaryngologists. The aims of this study therefore were to evaluate tracheostomy in black African population; determine the prevalence of suprastomal granulation tissue and provide updated information on it that will enable the otorhinolaryngologists to better understand and manage the lesion. Methods: We reviewed case files of patients who had tracheostomy between 1993 and 2007 at University College Hospital; Ibadan; Nigeria for essential clinical data.Results: Of the 256 patients who had tracheostomy; 133(51.95) had prior orotracheal intubation for 10 21days. Suprastomal granulation tissue complicated 16 (6.25) cases; this accounted for 88.89of cases of failed decannulation. Indications for tracheostomy in these patients included severe head injury in 12 (75); tetanus in 3 (18.75)] and intubation granuloma in 1(6.25) of these cases. Sixteen (4.3) cases had stomal infection. Conclusion: This study showed that the prevalence of suprastomal granulation is high among our patients. There is a need for good surgical tracheostomy technique to prevent this complication and stomal infection should be promptly treated while cuffed orotracheal intubation for more than two weeks in unconscious and tetanus patients should be avoided