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Tracheostomy

Appropriateness and Indications in Cancer Patients

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Oncologic Critical Care

Abstract

Increased survival in cancer patients and increased use of immunosuppressive treatments has resulted in a higher number of cancer patients admitted to intensive care units (ICUs). Tracheostomy is the most commonly performed procedure in ICUs, so the question of the appropriateness of tracheostomy is one clinicians will face even more in the coming years. The main benefits of tracheostomy in critically ill cancer patients are often clear in cases with upper airway obstruction, but this is not the case in prolonged mechanical ventilation. The main benefit appears to be an overall reduction in the duration of mechanical ventilation. In order to maximize this benefit, tracheostomy should be performed as early as possible, but unfortunately, clinicians are not good at predicting who will require prolonged mechanical ventilation. Therefore, the benefit has to be weighed against the risk of performing unnecessary procedures, and ideally, it should not be performed before 7 days of endotracheal intubation. Finally and more importantly, appropriateness will depend on the overall plan of care and prognosis of the underlying malignancy.

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Author information

Authors and Affiliations

  1. Interventional Pulmonology Unit, Clínica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile

    Macarena R. Vial

  2. Servicio de Enfermedades Respiratorias, Unidad de Neumologia Intervencional, Clínica Alemana de Santiago, Vitacura, Santiago, Chile

    Macarena R. Vial

  3. Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joseph L. Nates

Authors
  1. Macarena R. Vial
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  2. Joseph L. Nates
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Corresponding author

Correspondence to Macarena R. Vial .

Editor information

Editors and Affiliations

  1. Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joseph L. Nates

  2. Division of Anesthesiology, Critical Care and Pain Medicine, Department of Critical Care and Respiratory Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kristen J. Price

Section Editor information

  1. Critical Care Department, Universidad del Rosario Hospital Universitario Fundacion Santa Fe de, Bogota, Colombia, Colombia

    Yenny Cardenas

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Vial, M.R., Nates, J.L. (2020). Tracheostomy. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74588-6_61

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  • DOI: https://doi.org/10.1007/978-3-319-74588-6_61

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74587-9

  • Online ISBN: 978-3-319-74588-6

  • eBook Packages: MedicineReference Module Medicine

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