Korean Journal of Head & Neck Oncology (대한두경부종양학회지)

The Korean Society for Head and Neck Oncology (대한두경부종양학회)
권호 표지

A Tracheotomy in the Intensive Care Unit

중환자실에서의 기관절개술

  • Cho Kang-Han (Department of Otolaryngology-Head and Neck Surgery, Chung-Ang University School of Medicine) ;
  • Lim Do-Hyung (Department of Otolaryngology-Head and Neck Surgery, Chung-Ang University School of Medicine) ;
  • Lee Kyu-Suk (Department of Otolaryngology-Head and Neck Surgery, Chung-Ang University School of Medicine) ;
  • Paik Sang-Heum (Department of Otolaryngology-Head and Neck Surgery, Chung-Ang University School of Medicine) ;
  • Yang Hoon-Shik (Department of Otolaryngology-Head and Neck Surgery, Chung-Ang University School of Medicine) ;
  • Kim Chun-Gil (Department of Otolaryngology-Head and Neck Surgery, Chung-Ang University School of Medicine)
  • 조강한 (중앙대학교 의과대학 이비인후과학교실) ;
  • 임도형 (중앙대학교 의과대학 이비인후과학교실) ;
  • 이규석 (중앙대학교 의과대학 이비인후과학교실) ;
  • 백상흠 (중앙대학교 의과대학 이비인후과학교실) ;
  • 양훈식 (중앙대학교 의과대학 이비인후과학교실) ;
  • 김춘길 (중앙대학교 의과대학 이비인후과학교실)
  • Published : 2002.05.01
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Abstract

Background and Objectives: The tracheotomy is one of the most essential surgical procedures performed in the intensive care unit (ICU). The tracheal stenosis, as a complication following endotracheal intubation or tracheotomy, has been the subject of considerable recent investigation. Many different methods have been developed to avoid the tracheal stenosis but there is still controversy about the tracheal incisions. We had performed tracheotomy using a vertical elliptical tracheal incision in the ICU to evaluate its efficiency and safety. Materials and Methods: 191 patients who underwent the tracheotomy in the ICU between 1995 and 2000 were reviewed retrospectively by chart records and interviews. Results: The complications were reported such as bleeding, infection, subcutaneous emphysema, pneumothorax, tracheoesophageal fistula and tracheal stenosis. The total numbers of complications were 35 cases (18.3%) and the tracheal stenosis was developed in 4 patients. The characteristics of tracheal stenosis are as follows. Conclusion: The vertical elliptical tracheal incision is the safe and reliable methods in ICU patients compared with other methods, but other factors are also important in preventing the complications.

Keywords

References

  1. Futran ND, Dutcher PO, Roberts JK : The safety and efficacy of bedside tracheotomy. Otolaryngol Head and Neck Surg. 1993 ; 109 : 707-711 https://doi.org/10.1177/019459989310900412
  2. Henrich DE, Blythe WR, Weissler MC, Pillsbury HC : Tracheotomy and the intensive care unit patient. Laryngoscope. 1997 ; 107 : 844-847 https://doi.org/10.1097/00005537-199707000-00002
  3. Wang SJ, Sercarz JA, Blackwell KE, Aghamohanunadi M, Wang MB : Open bedside tracheotomy in the intensive care unit. Laryngoscope. 1999 ; 109 : 891-893 https://doi.org/10.1097/00005537-199906000-00009
  4. Heffner JE, Miller KS, Sahn SA : Tracheostomy in the intensive care unit. Part 1: Indications, technique, management. Chest. 1986 ; 90 (2) : 269-274 https://doi.org/10.1378/chest.90.2.269
  5. Heffner JE, Miller KS, Sahn SA : Tracheostomy in the intensive care unit. Part 2 : Complications. Chest. 1986 ; 90 (3) : 430-436 https://doi.org/10.1378/chest.90.3.430
  6. Lulenski GC, Batsakis JG : Tracheal incision as a contributing factor to tracheal stenosis. Ann Otol. 1975 ; 84 : 781-786
  7. Natvig K, Olving JH : Tracheal changes in relation to different tracheostomy techniques. Laryngol and Otol. 1981 ; 95 : 61-68 https://doi.org/10.1017/S0022215100090411
  8. Shin JH, Hwangbo C, Park CM, Choi SH, Lee HJ, Kang YC : Clinical analysis ofiatrogenic tracheal stenosis. Clin Otol. 1998 ; 9 : 263-270
  9. Fry TL, Jones RO, Fischer ND, Pillsbury HC : Comparisons of tracheostomy incisions in a pediatric model. Ann Otol Rhinol Laryngol. 1985 ; 94 : 450-453 https://doi.org/10.1177/000348948509400506
  10. Hughes M, Kirchner JA, Branson RJ : A skinlined tube as a complication of tracheostomy. Arch Otolaryngol. 1971 ; 94 : 568-570 https://doi.org/10.1001/archotol.1971.00770070868013
  11. Eliacher I, Goldsher M, Joachims HZ : Superiorly based tracheostomal flap to counteract tracheal stenosis : Experimental study. Laryngoscope. 1981 ; 91 : 976-981
  12. Bjork VO : Partial resection ofthe only remaining lung with the aid of respirator treatment. J Thorac Cardiovasc Surg. 1960 ; 39 : 179-188
  13. Chung PS, Rhee CK, Jeong PS, Kim YH : Superior based flap tracheostomy. Korean J Bronchoesophagol. 1995 ; 1 : 129-134
  14. Kato I, Uesugi K, Kikuchihara M, et al : Tracheostomy : the horizontal tracheal incision. Laryngol and Otol. 1990 ; 104 : 322-325 https://doi.org/10.1017/S0022215100112599
  15. Duckes HM : Tracheostomy. Thorax. 1970 ; 25 : 573-576 https://doi.org/10.1136/thx.25.5.573
  16. Arola MK : Tracheostomy and its complications: A retrospective study of 794 tracheostomized patients. Ann Chir Gynaecol. 1981 ; 70 : 96-106
  17. Viau F, Lededente A, Le Tinier JY : Complications oftracheostomy. Rev Pneumol Chin. 1988 ; 44 : 24-32
  18. Wood DE, Mathisen DJ : Late complications oftracheotomy. Clin Chest Med. 1991 ; 12 : 597-609