TY - CHAP M1 - Book, Section TI - Tracheostomy A1 - D. Doyle, Jeffrey A1 - Scales, Damon C. A2 - Hall, Jesse B. A2 - Schmidt, Gregory A. A2 - Kress, John P. PY - 2015 T2 - Principles of Critical Care, 4e AB - In critically ill patients, tracheostomy is most commonly performed to facilitate delivery of prolonged mechanical ventilation. Less frequently, it may be performed for relief of upper airway obstruction or for management of chronic pulmonary secretions.The most compelling reason to perform tracheostomy for patients requiring prolonged mechanical ventilation is to improve patient comfort and decrease sedation requirements.The available evidence base suggests that performing tracheostomy early in patients expected to require prolonged mechanical ventilation does not reduce mortality, rates of ventilator-associated pneumonia, or duration of intensive care unit admission.Surgical tracheostomy and percutaneous dilational tracheostomy (PDT) have comparable complication rates, but PDT is often more convenient and requires less resources to perform.Cricothyroidotomy, rather than tracheostomy, should be the surgical airway of choice in emergency situations, except in the unusual case of subglottic obstruction.In cases of accidental tracheostomy tube dislodgement occurring before a mature tract has formed, blind attempts at reinserting the tracheostomy tube risk creating a false passage anterior to the trachea. Endotracheal intubation from above is the safest method of airway control in the early posttracheostomy period (eg, <7 days). SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesssurgery.mhmedical.com/content.aspx?aid=1107718209 ER -