Use of the Blue Rhino tracheostomy set for emergency airway management

Management of the chronically ventilated patient with a tracheostomy

Tracheostomy is the most common surgical procedure performed on critically ill patients. For those who survive their critical illnesses but remain ventilator-dependent, tracheostomy provides patients with a secure airway that frees the mouth for oral nutrition, enhances verbalized speech, and promotes generalized comfort. Avoiding complications from tracheostomy requires a skilled multi-disciplinary approach to ensure that the benefits outweigh the risks of the procedure.

A survey of tracheostomy practice in a cardiothoracic intensive care unit

OBJECTIVE

The purpose of this study was to assess current practice of performing tracheostomies in critically ill cardiac surgical patients, to establish complication rates, and to identify areas of this clinical practice that could be improved.

DESIGN

Retrospective observational study.

SETTING

A cardiothoracic intensive care unit in a teaching hospital.

PARTICIPANTS

The most recent series of 100 tracheostomies performed in patients admitted to the intensive care unit.

INTERVENTIONS

Percutaneous or surgical tracheostomy for respiratory management.

MEASUREMENTS AND MAIN RESULTS

A total of 95 patients had 1 tracheostomy performed. One patient had a tracheostomy performed twice, and 1 patient had a tracheostomy performed 3 times; these repetitions were caused by recurrent respiratory failure. The median time from tracheal intubation to tracheostomy was 5 days (range, 1-23 days; interquartile range, 4-8 days), and median period between insertion and decannulation was 20 days (range, 2-77 days; interquartile range, 12-25 days). The most common reason for insertion was an anticipated long weaning time (55%) followed by insertion after failed extubation (32%). The Ciaglia percutaneous dilational technique was used for 89% of tracheostomies, whereas surgical techniques were used for 8%. The most common complication was either complete or partial obstruction of the tracheostomy tube (24%) followed by infection of the tracheostomy site in 18% (17/94) and bleeding at the time of insertion (11%).

CONCLUSION

The percutaneous dilational technique of tracheostomy was used predominantly in this unit. The median time from tracheal intubation to tracheostomy was 5 days. The most common complications were bleeding at the time of insertion, obstruction of the tracheostomy tube, and stomal infection.