Use of the Self-Inflating Bulb with the Esophageal Tracheal Combitube Registered Trademark (original) (raw)
1995, Anesthesia & Analgesia
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Tracheostomy must be individualized!
2004
Tracheostomy is among the most frequently conducted procedures in critically ill patients . It has advantages compared with translaryngeal endotracheal intubation, including reduced laryngeal anatomical alteration, reduced inspiratory load, and better patient tolerance and ease of nursing. Thus, tracheostomy can enhance patient care in the event of prolonged respiratory support and difficulty in weaning. In the study conducted by Arabi and colleagues [2], those investigators examined the frequency with which tracheostomy was conducted; pathophysiological characteristics of patients undergoing early (first week in the intensive care unit [ICU]) and late tracheostomy (> 7 days in the ICU); and the impact of early tracheostomy on the duration of mechanical ventilation, ICU length of stay and outcomes in a selected population of trauma patients. They reported that the majority of patients underwent tracheostomy after the first week, and that patients who received tracheostomy within the first week had maxillofacial trauma and more severe neurological injuries. Multivariate analysis showed that early tracheostomy was associated with reduced ICU length of stay. That study presents several issues that require consideration when interpreting the findings. First, the data are from a single population of patients with severe neurological and maxillofacial trauma. Second, both surgical and percutaneous tracheostomy techniques were performed. Finally, the percutaneous techniques used in the study were not reported. The optimal timing of tracheostomy remains controversial. The results presented suggest that early tracheostomy may reduce ICU length of stay and resource utilization in severe
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