Current possibilities of performing dilated tracheostomy

Abstract

Objective. Tracheostomy is one of the most frequently performed surgical procedures in seriously ill patients in the intensive care unit and in intensive care units who require long-term mechanical ventilation. Protecting the larynx and upper airway from the complications of prolonged intubation is an important reason for tracheostomy and airway management. Early tracheostomy can reduce the dosage of sedatives used, contributes to a gradual decrease in artificial ventilation support. However, with the development of minimally invasive techniques for performing tracheostomy, the medical community raises the question of the need to choose the optimal surgical method. First, it depends on the timing of its application, the tracheostomy, the duration of the transition to independent breathing, and the behavior of patients after the procedure. The use of dilation tracheostomy can improve the aesthetic outcome of patients.Purpose of a study: Comparative evaluation of the effectiveness of performing tracheostomy using traditional and modified technology at different times of mechanical ventilation in seriously ill surgical and therapeutic patients in the intensive care unit.Material and methods. The study was based on an analysis of the results of treatment of 331 patients (212 men (64 %) and 119 women (36 %)) aged from 18 to 92 years old (average age (55,7 ± 5,2) years), who were in the intensive care unit of the Regional Clinical Hospital No. 1 named after Professor S.V. Ochapovsky (Krasnodar) for 2020–2022, in which a tracheostomy was performed to prevent cicatricial complications. The patients were divided into 2 groups. The first group included 219 patients from the intensive care unit who underwent tracheostomy using traditional technology, and the second group (112 patients) included patients who underwent tracheostomy using a modified technology.Results. A new modified technology for performing tracheostomy in seriously ill surgical and therapeutic patients in the intensive care unit has been improved and developed. Objectively substantiated and noted the advantages and disadvantages of the modified tracheostomy technology from the hemodynamic, gas transport positions, possible complications and long-term results.Conclusion. The use of a new modified technology of tracheostomy imposition allows preventively protecting patients from the development of complications in the form of profuse bleeding in comorbid coagulopathy and against the background of the use of therapeutic dosages of anticoagulation therapy, reducing the risk of decanulation, improving functional and cosmetic results of treatment due to less skin trauma.