What’s new in intensive care: tracheostomy—what is known and what remains to be determined
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Tracheostomy is done in 10–15% of patients undergoing mechanical ventilation (MV), and the prevalence has increased over the past 20 years . The main indications are prolonged MV and difficult or prolonged weaning, and most patients requiring tracheostomy are admitted to the intensive care unit (ICU) for acute respiratory failure, coma, neuromuscular disease, or trauma. Percutaneous dilatational tracheostomy (PDT) can be performed in the ICU by non-surgeons, and clinical guidelines recommend this approach unless contraindicated .
Does tracheostomy affect lung mechanics?
Theoretically, tracheostomy could reduce inspiratory and expiratory resistive loads, because compared to endotracheal tubes (ETT), cannulae have larger inner diameters and are less susceptible to thermolabile deformation and obstruction due to secretions. Tracheostomy could also improve expiratory flow, thus minimizing intrinsic positive-end expiratory pressure (PEEPi). Both these factors should reduce the work of...
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Conflicts of interest
The authors declare that they have no conflict of interest.
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