The role of tracheostomy in the adult intensive care unit

Acute neuromuscular respiratory paralysis.

“…Whilst mechanical ventilation via an orotracheal tube can be performed for a limited period of time (usually for 5-7 days in our unit), a tracheostomy simplifies management considerably and allows the withdrawal of all sedation. 46 The tracheostomy tube is well tolerated, gives excellent access for tracheal toilet and chest physiotherapy and since the patient can be placed on and off different forms of respiratory support at will, permits easier "weaning". Tracheostomy can now be performed at the bedside, using a percutaneous Seldinger technique, and this appears to be the preferred technique.47 Nevertheless, tracheostomy by whatever method is not without risk (infection of the stoma; primary and secondary haemorrhage).…”

Complications of Tracheostomy Performed in the ICU

“…Cricothy-roidotomy has traditionally been used as an emergency procedure, due to the initially reported high incidence of subsequent subglottic stenosis with this technique, which requires challenging surgical repair. 6,7 However, in a large retrospective study including 655 patients with a 1-year follow-up, Brantigan and Grow 8 demonstrated that complications related to surgical cricothyroidotomy were not more severe or more frequent than those associated with conventional subthyroid tracheostomy.…”

Tracheostomy in Intubated Patients

“…Cricothyroidotomy (between thyroid and cricoids cartilages) has traditionally been used as an emergency procedure, due to the initially reported high incidence of subsequent subglottic stenosis with this technique, which requires challenging surgical repair. 26 Cricothyroidotomy was justifiable in the ICU in the case of emergency, due to the ease of anatomic localization and the unlikely presence of vessels. Once stabilized, the patient should be decannulated, or a standard or elective tracheostomy performed.…”