Tracheostomy Complication Clinical Trial
Official title:
"Outcomes of Tracheostomy Done for Patients Admitted in Anesthesia Intensive Care Units of Assiut University Hospital"
This study was undertaken to Identify the factors affecting the outcomes of tracheostomy done
in ICU for patients subjected to prolonged intubation and ventilation and to suggest
guidelines to control:
1. proper timing of tracheostomy
2. process of decannulation.
Tracheostomy is described as the creation of a stoma at the skin surface which leads into the
trachea. From the first tracheostomy until about 1930, the operation was performed
exclusively for laryngeal obstruction. Nowadays, due to the development of the care of
critically ill patients in intensive care units (ICUs), there are other indications for the
procedure including prolonged intubation and pulmonary toilet.
The initial management of patients in an intensive care unit involves a series of
interventions that aim to stabilize and then optimize their physiological state. Mechanical
ventilation (MV) is a commonly utilized intervention to support a patient's respiratory
function. The second phase in ICU management focuses on weaning the patient from the
artificial supportive mechanisms.
The principle role of tracheostomy in the ICU is to expedite the weaning process in patients
requiring prolonged mechanical ventilation and those predicted to be at risk of pulmonary
aspiration. Tracheostomy facilitates weaning primarily by allowing increased level of patient
activity and mobility.
Tracheostomy protects the larynx and the upper airway from prolonged intubation which may
lead to laryngotracheal stenosis. Patients with tracheostomies tend to have fewer days of
mechanical ventilation because of the improvements in the respiratory physiology. This is
especially in trauma patients. They have improved secretion clearance as suction is easy and
less strength is required for expectoration. This may be linked to the lower incidence of
pneumonia and respiratory infections seen, especially in trauma victims.
Patients with tracheostomy are less sedated and therefore able to move in bed. The patients
may also be able to swallow, so may be started on oral feeding sooner and mouth care is
easier compared with an endotracheal tube (ETT) tube.
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