11
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: not found
      • Book Chapter: not found
      Repetitorium Intensivmedizin : Vorbereitung auf die Prüfung »Intensivmedizin« 

      Tracheotomie und Bronchoskopie

      other
      ,
      Springer Berlin Heidelberg

      Read this book at

      Buy book Bookmark
          There is no author summary for this book yet. Authors can add summaries to their books on ScienceOpen to make them more accessible to a non-specialist audience.

          Related collections

          Most cited references15

          • Record: found
          • Abstract: found
          • Article: not found

          A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients.

          The timing of tracheotomy in patients requiring mechanical ventilation is unknown. The effects of early percutaneous dilational tracheotomy compared with delayed tracheotomy in critically ill medical patients needing prolonged mechanical ventilation were assessed. Prospective, randomized study. Medical intensive care units. One hundred and twenty patients projected to need ventilation >14 days. None. Patients were prospectively randomized to either early percutaneous tracheotomy within 48 hrs or delayed tracheotomy at days 14-16. Time in the intensive care unit and on mechanical ventilation and the cumulative frequency of pneumonia, mortality, and accidental extubation were documented. The airway was assessed for oral, labial, laryngeal, and tracheal damage. Early group showed significantly less mortality (31.7% vs. 61.7%), pneumonia (5% vs. 25%), and accidental extubations compared with the prolonged translaryngeal group (0 vs. 6). The early tracheotomy group spent less time in the intensive care unit (4.8 +/- 1.4 vs. 16.2 +/- 3.8 days) and on mechanical ventilation (7.6 +/- 2.0 vs. 17.4 +/- 5.3 days). There was also significantly more damage to mouth and larynx in the prolonged translaryngeal intubation group. This study demonstrates that the benefits of early tracheotomy outweigh the risks of prolonged translaryngeal intubation. It gives credence to the practice of subjecting this group of critically ill medical patients to early tracheotomy rather than delayed tracheotomy.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Meta-analysis comparison of open versus percutaneous tracheostomy.

            Multiple studies have been performed to characterize differences in complications and cost-effectiveness of open and percutaneous tracheostomy; however, large enough studies have not been performed to determine a clearly superior method. Our primary objective was to compare complication rates of open versus percutaneous tracheostomy in prospective, randomized-controlled trials using meta-analysis methodology. Secondary objectives included cost-effectiveness and procedure length analyses. Meta-analysis. From 368 abstracts, 15 prospective, randomized-controlled trials involving nearly 1,000 patients were reviewed to extract basic demographic data in addition to complications, case length, and cost-effectiveness. Pooled odds ratios (OR) with confidence intervals (CI) were calculated in addition to subgroup analyses and meta-regression. Pooled OR revealed statistically significant results against percutaneous tracheostomy for the complication of decannulation/obstruction (OR 2.79, 95% CI 1.29-6.03). There were significantly fewer complications in the percutaneous group with respect to wound infection (0.37, 0.22-0.62) and unfavorable scarring (0.44, 0.23-0.83). There was no statistically significant difference for complications of false passage (2.70, 0.89-8.22), minor hemorrhage (1.09, 0.61-1.97, P = .77), major hemorrhage (0.60, 0.28-1.26), subglottic stenosis (0.59, 0.27-1.29), death (0.70, 0.24-2.01), and overall complications (0.75, 0.56-1.00). However, the overall complications trended toward favoring the percutaneous technique. Percutaneous tracheostomy case length was shorter overall by 4.6 minutes, and costs were less by approximately $456 USD. Our meta-analysis illustrates there is no clear difference but a trend toward fewer complications in percutaneous techniques. Percutaneous tracheotomies are more cost-effective and provide greater feasibility in terms of bedside capability and nonsurgical operation.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Tracheostomy in the intensive care unit: a nationwide survey.

              The indication, timing and technique of tracheostomy have changed over the last several years. We performed a survey to assess the current practice of tracheostomy in German intensive care units (ICUs). A postal questionnaire was sent to the head physicians of 513 German ICUs, excluding pediatric ICUs. We obtained responses from 455 of the 513 ICUs (89%). In 90% of the ICUs, tracheostomies were performed during the first 14 d of mechanical ventilation. Eighty-six percent of the ICUs routinely performed percutaneous dilatational tracheostomy; the modified Ciaglia technique was the most popular percutaneous technique (69%). The majority (98%) of the percutaneous procedures were performed under bronchoscopic control. Surgical tracheostomy is usually performed in the operating room (72%) by a surgeon (61%), whereas percutaneous dilatational tracheostomies are usually performed at the patient's bedside in the ICU (98%) by an intensivist (93%). Tracheostomized patients were followed up routinely in 26% of the ICUs, and in 45% of the ICUs there were guidelines regarding the indication, the timing and the technique of tracheostomy. Percutaneous dilatational tracheostomy is the procedure of choice for tracheostomy in critically ill patients in Germany. The modified Ciaglia technique is the preferred percutaneous technique, and nearly all physicians routinely use bronchoscopic guidance. Most tracheostomies are done during the second week of mechanical ventilation.
                Bookmark

                Author and book information

                Book Chapter
                2011
                : 3-16
                10.1007/978-3-642-16879-6_1
                26282082-960f-4c51-bc3c-787239f89de2
                History

                Comments

                Comment on this book

                Book chapters

                Similar content1,071