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Explain the term Tracheostomy ?
If the duration of mechanical ventilation is likely to be prolonged, it is wise to do an early tracheostomy. Otherwise, a tracheostomy is usually done if at the end of two weeks of ventilation it looks unlikey that the patient may be extubatable within a day or two. A tracheostomy may offer the following advantages compared an endotracheal tube:
• Reduces anatomical dead space, • Reduces resistance to breathing, • Weaning may be quicker, • Easier to do tracheal toilet, • Sedation can be lightened or stopped, • Better communication possible compared to an endotracheal tube, • Easier to mobilize, and • Possible to eat and drink.
In the ICU, it is generally preferable to do the tracheostomy by the bedside because transferring a sick patient to the theatre and back can be hazardous. Apart from the conventional open method, the percutaneous guidewire - dilatation method is increasingly being used in ICUs. Complications with this technique have been shown to be no more compared to the conventional method.
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