Advertisement

Tracheotomy in Patients with Increased Intracranial Pressure

  • S.-O. KuhnEmail author
  • K. Hahnenkamp
Chapter
  • 52 Downloads

Abstract

Severe neurological deficits often necessitate to secure the airway via a tracheostoma. When planning the tracheotomy, it should be noted that in the acute phase of severe brain damage due to impaired cerebral autoregulation, further ischemia-related brain damage is possible. Increases in cerebral pressure, arterial hypotension and hypoxia can worsen the outcome of brain-injured patients both immediately after the initial damage and in the further course. Therefore, absolute priority is given to maintaining optimal cerebral blood flow and avoiding ischemia. After a discussion of the physiology and pathophysiology of cerebral pressure, its monitoring and the identification of therapeutic goals, special aspects of tracheotomy in patients with severe brain damage are presented, including optimal times, risk assessments and appropriate techniques. Perioperative dangers under the aspects of positioning, anesthesiological procedure and special respiratory medical features are described comprehensively, and practical ways of avoiding them are presented.

Keywords

Tracheostomy Intracranial pressure ICU Percutaneous tracheostomy Brain damage 

References

  1. 1.
    Ngubane T. Mechanical ventilation and the injured brain. South Afr J Anaest Analg. 2011;17(1):76–80.CrossRefGoogle Scholar
  2. 2.
    Zwienenberg M, Muizelaar JP. Cerebral perfusion and blood flow in neurotrauma. Neurol Res. 2001;23:167–74.CrossRefGoogle Scholar
  3. 3.
    Engelhard K, Menzel M, Baetgen R. Innerklinische Akutversorgung des Patienten mit schwerem Schädel-Hirn-Trauma. Anästh Intensivmed. 2011;52(Suppl. 4):65–72.Google Scholar
  4. 4.
    Terragni PP, Antonelli M, Fumagalli R, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010;303(15):1483–9.CrossRefGoogle Scholar
  5. 5.
    Alali AS, Scales DC, Fowler RA, et al. Tracheostomy timing in traumatic brain injury: a propensity-matched cohort study. J Trauma Acute Care Surg. 2014;76(1):70–6, discussion 76–78.CrossRefGoogle Scholar
  6. 6.
    Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014;59(6):895–919.CrossRefGoogle Scholar
  7. 7.
    McCredie VA, Alali AS, Scales DC, et al. Effect of early versus late tracheostomy or prolonged intubation in critically Ill patients with acute brain injury: a systematic review and meta-analysis. Neurocrit Care. 2017;26(1):14–25.CrossRefGoogle Scholar
  8. 8.
    Dunham CM, Cutrona AF, Gruber BS, et al. Early tracheostomy in severe traumatic brain injury: evidence for decreased mechanical ventilation and increased hospital mortality. Int J Burns Trauma. 2014;4(1):14–24.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Richard I, Hamon MA, Ferrapie AL, et al. Trachéotomie et traumatisme crânien grave: pour qui? Pourquoi? Quand? Comment? Ann Fr Anesth Réanim. 2005;24(6):659–62.CrossRefGoogle Scholar
  10. 10.
    Imperiale C, Magni G, Favaro R, et al. Intracranial pressure monitoring during percutaneous tracheostomy “percutwist” in critically Ill neurosurgery patients. Anesth Analg. 2009;108(2):588–92.CrossRefGoogle Scholar
  11. 11.
    Kleffmann J, Pahl R, Deinsberger W, et al. Effect of percutaneous tracheostomy on intracerebral pressure and perfusion pressure in patients with acute cerebral dysfunction (TIP Trial): an observational study. Neurocrit Care. 2012;17(1):85–9.CrossRefGoogle Scholar
  12. 12.
    Stocchetti N, Parma A, Lamperti M, et al. Neurophysiological consequences of three tracheostomy techniques: a randomized study in neurosurgical patients. J Neurosurg Anesthesiol. 2000;12(4):307–13.CrossRefGoogle Scholar
  13. 13.
    Stocchetti N, Parma A, Songa V, et al. Early translaryngeal tracheostomy in patients with severe brain damage. Intensive Care Med. 2000;26(8):1101–7.CrossRefGoogle Scholar
  14. 14.
    Kieninger M, Windorfer M, Eissnert C, et al. Impact of bedside pecutaneous dilational and open surgical tracheostomy on intracranial pressure, pulmonary gas exchange, and hemodynamics in neurocritical care patients. Medicine. 2019;98(35):e17011.CrossRefGoogle Scholar
  15. 15.
    Reilly PM, Anderson HL, Sing RF, et al. Occult hypercarbia. An unrecognized phenomenon during percutaneous endoscopic tracheostomy. Chest. 1995;107(6):1760–3.CrossRefGoogle Scholar
  16. 16.
    Kuechler JN, Abusamha A, Ziemann S, et al. Impact of percutaneous dilatational tracheostomy in brain injured patients. Clin Neurol Neurosurg. 2015;137:137–41.CrossRefGoogle Scholar
  17. 17.
    Börm W, Gleixner M. Experience with two different techniques of percutaneous dilational tracheostomy in 54 neurosurgical patients. Neurosurg Rev. 2003;26(3):188–91.CrossRefGoogle Scholar
  18. 18.
    Klemm E, Nowak A. Tracheotomy-related death - a systematic review. Dtsch Arztebl Int. 2017;114(16):273–9.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Universitätsmedizin Greifswald, Körperschaft des öffentlichen Rechts, Klinik für Anästhesiologie, Intensiv-, Notfall- und Schmerzmedizin, Ferdinand-Sauerbruch-StraßeGreifswaldGermany

Personalised recommendations