In den letzten Jahren ist es im Bereich der Intensivmedizin zu einem erheblichen Wandel hinsichtlich Indikation, Zeitpunkt und Technik der Tracheotomie gekommen. Die perkutane Dilatationstracheotomie hat sich hierbei zu einem Standardverfahren entwickelt. Sie wird im Regelfall durch den Intensivmediziner selbst durchgeführt und weist bei entsprechender Sorgfalt eine niedrige Komplikationsrate auf. Vorteile dieser Technik gegenüber der chirurgischen Technik sind die geringe Inzidenz von Stomainfektionen, das bessere kosmetische Ergebnis nach Dekanülierung, fehlende Notwendigkeit eines operativen Stomaverschlusses sowie eine Kostenersparnis. Essentiell bei der dilatativen Technik sind die Kenntnis der Anatomie, die Beachtung der Kontraindikationen und eine durchgehende bronchoskopische Kontrolle während der Tracheotomie. Zudem erfordert der Kanülenwechsel bei dilatativ angelegtem Tracheostoma spezielle Kenntnisse und Vorbereitungen. Bestehen Kontraindikationen für eine perkutane Dilatationstracheotomie, so ist eine chirurgische Tracheotomie indiziert. Der optimale Tracheotomiezeitpunkt wird weiterhin kontrovers diskutiert.
Abstract
Indication, timing and technique of tracheostomy have undergone considerable changes during the past years. Percutaneous tracheostomy has become a standard procedure in modern intensive care. It can be performed by the intensive medicine specialists themselves with low complication rates. Advantages are less stomal infections, better cosmetic results and cost savings in comparison to the surgical technique. Exact knowledge of the anatomic details, careful attention to contraindications and bronchoscopic supervision throughout the procedure are essential for optimal results. Exchange of the tracheostomy tube requires adequate preparation and training. If contraindications exist or permanent mechanical ventilation can be anticipated, surgical tracheostomy is indicated. The optimal timing of tracheostomy remains controversial.
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