Difference between revisions of "Tracheotomy"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = General | | anesthesia_type = General or local/MAC | ||
| airway = ETT | | airway = ETT | ||
Tracheostomy tube (TT) | |||
| lines_access = PIV | | lines_access = PIV | ||
| monitors = Standard | ± Arterial line | ||
| considerations_preoperative = | | monitors = Standard | ||
| considerations_intraoperative = | 5-lead ECG | ||
| considerations_postoperative = | ± ABP | ||
| considerations_preoperative = Cause of respiratory failure and ability to perform tracheostomy under general vs awake | |||
Avoidance of premedication if concern for airway obstruction | |||
| considerations_intraoperative = If general anesthesia, communication with surgeon is key for slowly removing ETT. | |||
Do not remove past the vocal cords until surgeon indicates. | |||
If an awake tracheostomy, consider sedation using dexmedetomidine, then converting to general when the tube is secured | |||
| considerations_postoperative = Creation of a false passage | |||
Occlusion of tracheostomy tube | |||
Tube displacement | |||
Tracheoinnominate artery fistula | |||
Airway stenosis | |||
}} | }} | ||
A '''tracheotomy''' refers to any procedure that involves opening the trachea. It can be commonly be interchanged with tracheostomy, which by definition is a procedure that exteriorizes the trachea to the neck skin to produce a more permanent opening.<ref name=":1">{{Cite journal|last=Cheung|first=N. H.|last2=Napolitano|first2=L. M.|date=2014-06-01|title=Tracheostomy: Epidemiology, Indications, Timing, Technique, and Outcomes|url=http://dx.doi.org/10.4187/respcare.02971|journal=Respiratory Care|volume=59|issue=6|pages=895–919|doi=10.4187/respcare.02971|issn=0020-1324}}</ref> | |||
Indications for tracheotomy are numerous but include securing the airway in anticipation of or actual airway obstruction, for example edema, Ludwig angina, or retropharyngeal abscess. Tracheostomy can be part of a scheduled procedure, such as a laryngectomy. If prolonged intubation is anticipated, such as in critically ill patients in an ICU setting, it is also reasonable to consider tracheotomy to protect the larynx from injury and decrease the risk of sinusitis and ventilator-associated pneumonia (VAP),<ref>{{Cite journal|last=Ranes|first=Justin L.|last2=Gordon|first2=Steven M.|last3=Chen|first3=Pam|last4=Fatica|first4=Cynthia|last5=Hammel|first5=Jeffrey|last6=Gonzales|first6=Jeffrey P.|last7=Arroliga|first7=Alejandro C.|date=2006-10-01|title=Predictors of Long-Term Mortality in Patients with Ventilator-Associated Pneumonia|url=https://www.amjmed.com/article/S0002-9343(06)00610-3/abstract|journal=The American Journal of Medicine|language=English|volume=119|issue=10|pages=897.e13–897.e19|doi=10.1016/j.amjmed.2005.12.034|issn=0002-9343}}</ref><ref>{{Cite journal|last=HOLZAPFEL|first=L.|last2=CHEVRET|first2=S.|last3=MADINIER|first3=G.|last4=OHEN|first4=F.|last5=DEMINGEON|first5=G.|last6=COUPRY|first6=A.|last7=CHAUDET|first7=M.|date=1994-06|title=Influence of Long-Term Oro- or Nasotracheal Intubation on Nosocomial Maxillary Sinusitis and Pneumonia|url=http://dx.doi.org/10.1097/00132586-199406000-00057|journal=Survey of Anesthesiology|volume=38|issue=03|pages=177???178|doi=10.1097/00132586-199406000-00057|issn=0039-6206}}</ref><ref>{{Cite journal|last=Cavaliere|first=S.|last2=Bezzi|first2=M.|last3=Toninelli|first3=C.|last4=Foccoli|first4=P.|date=2016-02-03|title=Management of post-intubation tracheal stenoses using the endoscopic approach|url=http://www.monaldi-archives.org/index.php/macd/article/view/492|journal=Monaldi Archives for Chest Disease|volume=67|issue=2|doi=10.4081/monaldi.2007.492|issn=2465-1028}}</ref> as well as reduce the need for sedation and improve overall patient comfort and airway care<ref>{{Cite journal|last=Heffner|first=John E.|last2=Hess|first2=Dean|date=2001-03|title=Tracheostomy Management in the Chronically Ventilated Patient|url=http://dx.doi.org/10.1016/s0272-5231(05)70025-3|journal=Clinics in Chest Medicine|volume=22|issue=1|pages=55–69|doi=10.1016/s0272-5231(05)70025-3|issn=0272-5231}}</ref><ref>{{Cite journal|last=Diehl|first=J|last2=El Atrous|first2=S|last3=Touchard|first3=D|last4=Lemaire|first4=F|last5=Brochard|first5=L.|date=1999|title=Changes in the Work of Breathing Induced by Tracheotomy in Ventilator-dependent Patients.|url=http://dx.doi.org/10.1097/01823246-199910020-00013|journal=Cardiopulmonary Physical Therapy Journal|volume=10|issue=2|pages=60|doi=10.1097/01823246-199910020-00013|issn=1541-7891}}</ref>. In addition, tracheotomy should be performed when convenient following emergent cricothyrotomy to reduce the incidence of subglottic stenosis and cricoid chondritis.<ref name=":3" /> Rarer indications for tracheotomy include bilateral vocal cord paralysis or a history of recurrent allergy associated with laryngospasm.<ref name=":3" /> | |||
A tracheostomy may be performed open during a general anesthetic or awake, often with local anesthesia. It can also be performed at the bedside with several percutaneous techniques. | |||
In a surgical tracheotomy, a short transverse incision or midline vertical incision is made 1-2 cm inferior to the cricoid cartilage. The strap muscles are retracted laterally, and the anterior tracheal wall is identified. The thyroid isthmus may need to be retracted or divided if necessary. In adults, several techniques can be used to create a tracheostomy: a vertical slit, a horizontal slit, formation of a tracheal flap consisting of the 2nd or 3rd tracheal rings which is secured to the skin inferiorly, or formation of a window for a more permanent stoma. The ETT is withdrawn in conjunction with placement of the tracheostomy tube (TT), and the TT is subsequently sutured to the skin.<ref>{{Cite journal|last=De Leyn|first=Paul|last2=Bedert|first2=Lieven|last3=Delcroix|first3=Marion|last4=Depuydt|first4=Pieter|last5=Lauwers|first5=Geert|last6=Sokolov|first6=Youri|last7=Van Meerhaeghe|first7=Alain|last8=Van Schil|first8=Paul|date=2007-09|title=Tracheotomy: clinical review and guidelines|url=https://doi-org.stanford.idm.oclc.org/10.1016/j.ejcts.2007.05.018|journal=European Journal of Cardio-Thoracic Surgery|volume=32|issue=3|pages=412–421|doi=10.1016/j.ejcts.2007.05.018|issn=1010-7940}}</ref><ref name=":3">{{Cite book|last=Jaffe|first=Richard A.|title=Anesthesiologist's Manual of Surgical Procedures|publisher=Wolters Kluwer|year=2020|isbn=9781496371256|location=Philadelphia|pages=209-214}}</ref> | |||
In a percutaneous tracheostomy, various procedure methods may be utilized. Most commonly an initial tracheal aperture is made with a needle followed by progressive blunt dilations. A more recent technique allows for dilation in one step. Another method is based on enlarging a small tracheal aperture with blunt forceps, however this method is associated with increased complications such as bleeding.<ref>{{Cite journal|last=Nates|first=Joseph L.|last2=Cooper|first2=D. James|last3=Myles|first3=Paul S.|last4=Scheinkestel|first4=Carlos D.|last5=Tuxen|first5=David V.|date=2000-11|title=Percutaneous tracheostomy in critically ill patients: A prospective, randomized comparison of two techniques:|url=http://journals.lww.com/00003246-200011000-00034|journal=Critical Care Medicine|language=en|volume=28|issue=11|pages=3734–3739|doi=10.1097/00003246-200011000-00034|issn=0090-3493}}</ref> | |||
== Preoperative management == | == Preoperative management == | ||
Line 57: | Line 60: | ||
|Endocrine | |Endocrine | ||
|Consider adrenal suppression, hyperglycemia if ICU patient | |Consider adrenal suppression, hyperglycemia if ICU patient | ||
|} | |} | ||
Line 65: | Line 65: | ||
* Head and Neck CT/MRI | * Head and Neck CT/MRI | ||
* Neck ultrasound to identify anatomy | |||
* CXR, ABG as indicated from H&P | * CXR, ABG as indicated from H&P | ||
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | === Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> === | ||
=== Patient preparation and | * For patients not already intubated, prepare equipment for a possible difficult airway including video laryngoscope, fiberoptic, high flow nasal cannula<span class="reference" id="cite_ref-:2_2-0"></span> | ||
* Most institutions have a "trach set" for the surgical team | |||
* Surgeon should be immediately available to perform cricothyrotomy/tracheotomy if ventil<span class="reference" id="cite_ref-:2_2-0"></span>ation is impossible | |||
=== Patient preparation and premedicatio<span class="reference" id="cite_ref-:2_2-0"></span>n<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | |||
* Standard premedication if elective | * Standard premedication if elective | ||
** Avoid if critically ill or symptoms upper airway obstruction | ** Avoid if critically ill or symptoms of upper airway obstruction | ||
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | === Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> === | ||
Line 89: | Line 94: | ||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
|- | |- | ||
| | |Critically ill patients, already intubated | ||
| | | | ||
* Convert ICU sedation to GA with | * Convert ICU sedation to GA with carefully titrated inhalational agent | ||
* May consider TIVA if patient at decreased risk for hemodynamic instability | |||
|- | |- | ||
| | |As part of scheduled procedure | ||
| | | | ||
* Standard IV induction | * Standard IV induction | ||
* Consider awake FOI if airway problems anticipated | * Consider awake FOI if airway problems anticipated | ||
|- | |- | ||
|Awake | |Awake | ||
| | | | ||
* | * Consider sedation using precedex; avoid bolusing as it may cause airway obstruction | ||
* Consider calming music such as classical | |||
|} | |} | ||
Line 109: | Line 114: | ||
* Supine, head extended with shoulder roll | * Supine, head extended with shoulder roll | ||
** Note ETT cuff can migrate cephaled - risk of inadvertent perforation by surgeon | ** Note ETT cuff can migrate cephaled - risk of inadvertent perforation by surgeon | ||
** Important to tape ETT securely | |||
* Table may be turned 180 degrees in awake cases | |||
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | === Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> === | ||
{| class="wikitable" | {| class="wikitable" | ||
|+ | |+ | ||
|- | |- | ||
|General | |General | ||
| | | | ||
* Consider TIVA with propofol/remifentanil | * Consider TIVA with propofol/remifentanil; remifentanil may not be necessary however consider small boluses of fentanyl | ||
* Muscle relaxation required, may use rocuronium | * Muscle relaxation required, may use rocuronium | ||
* Usually no antibiotics indicated | |||
* PONV prophylaxis with dexamethasone, ondansetron | |||
* Normovolemia, normothermia | * Normovolemia, normothermia | ||
* To avoid ETT cuff puncture, can advance ETT closer to carina before trachea opened | |||
* To avoid ETT cuff puncture, | * Slowly remove ETT under visualization of surgeon however do not remove completely to avoid airway loss | ||
* Slowly remove ETT under visualization of surgeon however do not remove completely | * Once TT secured, connect to circuit and gently suction | ||
* Once | |||
* Remove ETT once EtCO2 tracing confirmed and inflation pressures within normal limits | * Remove ETT once EtCO2 tracing confirmed and inflation pressures within normal limits | ||
|- | |- | ||
|Awake | |Awake | ||
| | | | ||
* Once TT secured, convert to GA while surgeons finish the procedure | |||
* Can use propofol/remifentanil | |||
|} | |} | ||
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | === Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> === | ||
{| class="wikitable" | |||
|- | |||
|Critically ill patients, already intubated | |||
| | |||
* Transport to ICU on similar ventilator settings and level of sedation | |||
|- | |||
|Awake or as part of scheduled procedure | |||
| | |||
* Consider precedex bolus or infusion at end of procedure for its sedative, anxiolysis, and analgesic-sparing properties | |||
|} | |||
== Postoperative management == | == Postoperative management == | ||
Line 153: | Line 173: | ||
|Awake or as part of scheduled procedure | |Awake or as part of scheduled procedure | ||
| | | | ||
* Inpatient unit | |||
|} | |} | ||
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | === Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> === | ||
* Multimodal approach combining non-opioid (acetaminophen, NSAIDs), bolus/PCA opioids, peripheral local anesthetics | * Multimodal approach combining non-opioid (acetaminophen, NSAIDs), low dose bolus opioids/PCA opioids, peripheral local anesthetics | ||
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | === Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> === | ||
Line 186: | Line 207: | ||
* Late complications (seen beyond 1 week): | * Late complications (seen beyond 1 week): | ||
** Note early postoperative complications may also occur after 1 week | ** Note early postoperative complications may also occur after 1 week | ||
** Tracheocutaneous, tracheoesophageal | ** Tracheocutaneous, tracheoesophageal fistula | ||
** Tracheoinnominate artery fistula | |||
*** Potential for catastrophic bleeding | |||
** Airway stenosis | ** Airway stenosis | ||
*** Posterior glottic, subglottic, tracheal | *** Posterior glottic, subglottic, tracheal | ||
*** Risk factors: inappropriately large | *** Risk factors: inappropriately large TT (>7.5), obese patients (often sized with inappropriately large TT)<ref name=":0" /> | ||
*** Tracheal airway diameters do not correlate with body weight<ref name=":0" /> | *** Tracheal airway diameters do not correlate with body weight<ref name=":0" /> | ||
Line 197: | Line 220: | ||
|+ | |+ | ||
! | ! | ||
!Bedside - Percutaneous | !Bedside - Percutaneous | ||
|- | |- | ||
|Unique considerations | |Unique considerations | ||
|Advantages over tracheostomies in the OR | |Advantages over tracheostomies in the OR | ||
Line 221: | Line 240: | ||
* prior neck surgery | * prior neck surgery | ||
* some believe anticoagulation | * some believe anticoagulation | ||
|- | |- | ||
|Potential complications | |Potential complications | ||
|2.2x more likely to have early postoperative complications vs open<ref name=":0" /> | |2.2x more likely to have early postoperative complications vs open<ref name=":0" /> | ||
|} | |} |
Latest revision as of 11:40, 5 April 2022
Anesthesia type |
General or local/MAC |
---|---|
Airway |
ETT Tracheostomy tube (TT) |
Lines and access |
PIV ± Arterial line |
Monitors |
Standard 5-lead ECG ± ABP |
Primary anesthetic considerations | |
Preoperative |
Cause of respiratory failure and ability to perform tracheostomy under general vs awake Avoidance of premedication if concern for airway obstruction |
Intraoperative |
If general anesthesia, communication with surgeon is key for slowly removing ETT. Do not remove past the vocal cords until surgeon indicates. If an awake tracheostomy, consider sedation using dexmedetomidine, then converting to general when the tube is secured |
Postoperative |
Creation of a false passage Occlusion of tracheostomy tube Tube displacement Tracheoinnominate artery fistula Airway stenosis |
Article quality | |
Editor rating | |
User likes | 0 |
A tracheotomy refers to any procedure that involves opening the trachea. It can be commonly be interchanged with tracheostomy, which by definition is a procedure that exteriorizes the trachea to the neck skin to produce a more permanent opening.[1]
Indications for tracheotomy are numerous but include securing the airway in anticipation of or actual airway obstruction, for example edema, Ludwig angina, or retropharyngeal abscess. Tracheostomy can be part of a scheduled procedure, such as a laryngectomy. If prolonged intubation is anticipated, such as in critically ill patients in an ICU setting, it is also reasonable to consider tracheotomy to protect the larynx from injury and decrease the risk of sinusitis and ventilator-associated pneumonia (VAP),[2][3][4] as well as reduce the need for sedation and improve overall patient comfort and airway care[5][6]. In addition, tracheotomy should be performed when convenient following emergent cricothyrotomy to reduce the incidence of subglottic stenosis and cricoid chondritis.[7] Rarer indications for tracheotomy include bilateral vocal cord paralysis or a history of recurrent allergy associated with laryngospasm.[7]
A tracheostomy may be performed open during a general anesthetic or awake, often with local anesthesia. It can also be performed at the bedside with several percutaneous techniques.
In a surgical tracheotomy, a short transverse incision or midline vertical incision is made 1-2 cm inferior to the cricoid cartilage. The strap muscles are retracted laterally, and the anterior tracheal wall is identified. The thyroid isthmus may need to be retracted or divided if necessary. In adults, several techniques can be used to create a tracheostomy: a vertical slit, a horizontal slit, formation of a tracheal flap consisting of the 2nd or 3rd tracheal rings which is secured to the skin inferiorly, or formation of a window for a more permanent stoma. The ETT is withdrawn in conjunction with placement of the tracheostomy tube (TT), and the TT is subsequently sutured to the skin.[8][7]
In a percutaneous tracheostomy, various procedure methods may be utilized. Most commonly an initial tracheal aperture is made with a needle followed by progressive blunt dilations. A more recent technique allows for dilation in one step. Another method is based on enlarging a small tracheal aperture with blunt forceps, however this method is associated with increased complications such as bleeding.[9]
Preoperative management
Patient evaluation
System | Considerations |
---|---|
Airway | Thorough evaluation of airway anatomy. Understand relative contraindications to bedside tracheostomy including short/large neck, enlarged thyroid, inability to extend the neck, suspected/confirmed C-spine fracture, prior neck surgery. |
Neurologic | Assess neurological deficits, neurological or neuromuscular disease as cause of respiratory failure |
Cardiovascular | All patients possibly with significant cardiac risk factors, related to smoking, EtOH abuse, male gender, HLD, HTN |
Pulmonary | Understand restrictive versus obstructive deficit and cause. Manipulation of airway is a stimulus for bronchospasm, particularly in reactive airway disease |
Gastrointestinal | Assess for GERD/possible recurrent aspiration |
Hematologic | If malignancy or chronic disease, coagulopathies or anemia may be present |
Renal | Assess for renal disease if chronic disease |
Endocrine | Consider adrenal suppression, hyperglycemia if ICU patient |
Labs and studies
- Head and Neck CT/MRI
- Neck ultrasound to identify anatomy
- CXR, ABG as indicated from H&P
Operating room setup
- For patients not already intubated, prepare equipment for a possible difficult airway including video laryngoscope, fiberoptic, high flow nasal cannula
- Most institutions have a "trach set" for the surgical team
- Surgeon should be immediately available to perform cricothyrotomy/tracheotomy if ventilation is impossible
Patient preparation and premedication
- Standard premedication if elective
- Avoid if critically ill or symptoms of upper airway obstruction
Regional and neuraxial techniques
- Local infiltration of neck and transtracheal instillation of local anesthetic
Intraoperative management
Monitoring and access
- Standard monitors
- Invasive monitors depending on condition
- Avoid ECG pads in the prepped area
Induction and airway management
Critically ill patients, already intubated |
|
As part of scheduled procedure |
|
Awake |
|
Positioning
- Supine, head extended with shoulder roll
- Note ETT cuff can migrate cephaled - risk of inadvertent perforation by surgeon
- Important to tape ETT securely
- Table may be turned 180 degrees in awake cases
Maintenance and surgical considerations
General |
|
Awake |
|
Emergence
Critically ill patients, already intubated |
|
Awake or as part of scheduled procedure |
|
Postoperative management
Disposition
- Obtain CXR to assess tracheostomy tube position and check for evidence of pneumothorax / pneumomediastinum
- Regular cleaning of tube with careful suctioning, stomal care, and monitoring of cuff pressure if inflated
- Humidification of inspired air
- Opioids (and opioid sedation) can minimize reaction to suctioning in early postoperative period
- Do not remove for 5-7 days until track formed
Critically ill patients, already intubated |
|
Awake or as part of scheduled procedure |
|
Pain management
- Multimodal approach combining non-opioid (acetaminophen, NSAIDs), low dose bolus opioids/PCA opioids, peripheral local anesthetics
Potential complications
- Intraoperative
- Bleeding although EBL generally minimal
- Most commonly from cut edge of the thyroid
- Pneumothorax
- Seen if low neck dissection of false passage formation
- Pneumomediastinum
- Subcutaneous emphysema
- Pulmonary edema from breathing against obstruction prior to procedure
- Creation of false passage during procedure
- Particularly true if increased mucosal swelling (edema, prolonged intubation) or increased tissue fragility (chronic steroid therapy)
- Signs include absent end tidal, increased PIP
- If suspect, should attempt to reintroduce existing ETT
- Notably, nonotolaryngologists 9.1x more likely to have intraoperative complications[10]
- Bleeding although EBL generally minimal
- Early postoperative complications (within 1 week):
- Granulation tissue, cellulitis / tracheitis
- Infection such as pneumonia
- Vocal cord dysfunction
- Occlusion of tracheostomy tube
- Secretions, mucus plug, blood, mainstem
- Tracheostomy tube displacement
- Re-intubate orally or through trach site
- Late complications (seen beyond 1 week):
- Note early postoperative complications may also occur after 1 week
- Tracheocutaneous, tracheoesophageal fistula
- Tracheoinnominate artery fistula
- Potential for catastrophic bleeding
- Airway stenosis
Procedure variants
Bedside - Percutaneous | |
---|---|
Unique considerations | Advantages over tracheostomies in the OR
Absolute contraindications[11]
Relative contraindications[11]
|
Potential complications | 2.2x more likely to have early postoperative complications vs open[10] |
References
- ↑ 1.0 1.1 Cheung, N. H.; Napolitano, L. M. (2014-06-01). "Tracheostomy: Epidemiology, Indications, Timing, Technique, and Outcomes". Respiratory Care. 59 (6): 895–919. doi:10.4187/respcare.02971. ISSN 0020-1324.
- ↑ Ranes, Justin L.; Gordon, Steven M.; Chen, Pam; Fatica, Cynthia; Hammel, Jeffrey; Gonzales, Jeffrey P.; Arroliga, Alejandro C. (2006-10-01). "Predictors of Long-Term Mortality in Patients with Ventilator-Associated Pneumonia". The American Journal of Medicine. 119 (10): 897.e13–897.e19. doi:10.1016/j.amjmed.2005.12.034. ISSN 0002-9343.
- ↑ HOLZAPFEL, L.; CHEVRET, S.; MADINIER, G.; OHEN, F.; DEMINGEON, G.; COUPRY, A.; CHAUDET, M. (1994-06). "Influence of Long-Term Oro- or Nasotracheal Intubation on Nosocomial Maxillary Sinusitis and Pneumonia". Survey of Anesthesiology. 38 (03): 177???178. doi:10.1097/00132586-199406000-00057. ISSN 0039-6206. Check date values in:
|date=
(help) - ↑ Cavaliere, S.; Bezzi, M.; Toninelli, C.; Foccoli, P. (2016-02-03). "Management of post-intubation tracheal stenoses using the endoscopic approach". Monaldi Archives for Chest Disease. 67 (2). doi:10.4081/monaldi.2007.492. ISSN 2465-1028.
- ↑ Heffner, John E.; Hess, Dean (2001-03). "Tracheostomy Management in the Chronically Ventilated Patient". Clinics in Chest Medicine. 22 (1): 55–69. doi:10.1016/s0272-5231(05)70025-3. ISSN 0272-5231. Check date values in:
|date=
(help) - ↑ Diehl, J; El Atrous, S; Touchard, D; Lemaire, F; Brochard, L. (1999). "Changes in the Work of Breathing Induced by Tracheotomy in Ventilator-dependent Patients". Cardiopulmonary Physical Therapy Journal. 10 (2): 60. doi:10.1097/01823246-199910020-00013. ISSN 1541-7891.
- ↑ 7.0 7.1 7.2 Jaffe, Richard A. (2020). Anesthesiologist's Manual of Surgical Procedures. Philadelphia: Wolters Kluwer. pp. 209–214. ISBN 9781496371256.
- ↑ De Leyn, Paul; Bedert, Lieven; Delcroix, Marion; Depuydt, Pieter; Lauwers, Geert; Sokolov, Youri; Van Meerhaeghe, Alain; Van Schil, Paul (2007-09). "Tracheotomy: clinical review and guidelines". European Journal of Cardio-Thoracic Surgery. 32 (3): 412–421. doi:10.1016/j.ejcts.2007.05.018. ISSN 1010-7940. Check date values in:
|date=
(help) - ↑ Nates, Joseph L.; Cooper, D. James; Myles, Paul S.; Scheinkestel, Carlos D.; Tuxen, David V. (2000-11). "Percutaneous tracheostomy in critically ill patients: A prospective, randomized comparison of two techniques:". Critical Care Medicine. 28 (11): 3734–3739. doi:10.1097/00003246-200011000-00034. ISSN 0090-3493. Check date values in:
|date=
(help) - ↑ 10.0 10.1 10.2 10.3 Halum, Stacey L.; Ting, Jonathan Y.; Plowman, Emily K.; Belafsky, Peter C.; Harbarger, Claude F.; Postma, Gregory N.; Pitman, Michael J.; LaMonica, Donna; Moscatello, Augustine; Khosla, Sid; Cauley, Christy E. (2011-12-19). "A multi-institutional analysis of tracheotomy complications". The Laryngoscope. 122 (1): 38–45. doi:10.1002/lary.22364. ISSN 0023-852X.
- ↑ 11.0 11.1 Nun, Alon Ben; Altman, Eduard; Best, Lael Anson (2005-10-01). "Extended Indications for Percutaneous Tracheostomy". The Annals of Thoracic Surgery. 80 (4): 1276–1279. doi:10.1016/j.athoracsur.2005.02.007. ISSN 0003-4975.
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