Atemwegsmanagement – Tracheotomie Revisited

Zusammenfassung

Die Tracheotomie ist ein bereits seit 5000 Jahren durchgeführtes Verfahren zur Atemwegssicherung. Generell unterscheidet man zwei Verfahren, die perkutane Dilatationstracheotomie und die chirurgische Tracheotomie. Die chirurgische Tracheotomie wird im OP Saal durchgeführt. Die perkutane Dilatationstracheotomie zählt zu den Standardverfahren in der Intensivmedizin. Sie kann unter geeigneter Indikationsstellung und nach Ausschluss von Kontraindikationen auf der Intensivstation durch den Intensivmediziner durchgeführt werden. Es gibt verschiedene Techniken der perkutanen Dilatationstracheotomie. Grundlage jeder Technik ist allerdings das Seldinger Verfahren. Um Komplikationen während der Durchführung zu vermeiden ist eine bronchoskopische Kontrolle obligat. Trotzdem sind die chirurgische Tracheotomie und die dilatative Tracheotomie sichere Verfahren mit wenig Komplikationen.

Abstract

Since 5000 years tracheotomy is a common way for airway management. Generally, Tracheotomy will be divided in a surgical tracheotomy the percutaneous Tracheotomy. The surgical Tracheotomy takes place in the operation theater. The percutaneous Tracheotomy is one of the standard procedures in the Intensive care unit. There are many methods to perform the percutaneous Tracheotomy. The gist of every method is the seldinger procedure. Bronchoscopic supervision during the whole procedure is one of the most important things to prevent complications. However percutaneous and surgical tracheotomy are safe and have a low rate of complications.

Schlüsselwörter:

Perkutane Dilatationstracheotomie - chirurgische Tracheotomie - Weaning - Maschinelle Beatmung - Intensivstation - Seldinger Technik

Keywords:

Percutaneous Tracheotomy - surgical Tracheotomy - Weaning - Mechanical ventilation - Intensive care unit - Seldinger technique

• Literaturverzeichnis

• 1 Weir N. Otolaryngology. An illustrated History. London: Butterworths; 1990
• 2 Pahor AL. Ear, nose and throat in Ancient Egypt. J LaryngolOtol 1992; 106: 773-779
• 3 Frost EA. Tracing the tracheostomy. Ann OtolRhinolLaryngol 1976; 85: 618-624
• 4 Zeitels SM, Broadhurst MS, Akst LM, Lopez-Guerra G. The history of tracheotomy and intubation. In: Myers EN, Johnson JT, eds. Tracheotomy. Airway Management, communication and swallowing. 2nd ed. San Diego, CA: Plural Publishing; 2008: 1-21
• 5 Beatrous WP. Tracheostomy (tracheotomy). Its expanded indications and its present status. Based on an analysis of 1,000 consecutive operations and A review of the recent literature. Laryngoscope 1968; 78: 3-55
• 6 Vesalius A, v. Calcar JS. De humanicorporisfabricalibriseptem. 1543, Basilae,: ex officinaIoannisOporini. 6 leaves, 636 pp. (wrongly numbered 659), 18 leaves.
• 7 Alberti PW. Tracheotomy versus intubation. A 19th century controversy. Ann OtolRhinolLaryngol 1984; 93: 333-337
• 8 Witt Jr. CB. The health and controversial death of George Washington. Ear Nose Throat J 2001; 80: 102-105
• 9 Pahor AL. Tracheostomy. J R Soc Med 1993; 86: 308-308
• 10 Gifford RR. The O'Dwyer tube; development and use in laryngeal diphtheria. ClinPediatr 1970; 9: 179-185
• 11 Jackson CL. Tracheotomy. Laryngoscope 1909; 19: 285-290
• 12 Jackson CL. High tracheotomy and other errors: the chief causes of chronic laryngeal stenosis. SurgGynecolObstet 1923; 32: 292-292
• 13 Pratt LW, Ferlito A, Rinaldo A. Tracheotomy: historical review. Laryngoscope 2008; 118: 1597-1606
• 14 Ferlito A, Rinaldo A, Shaha AR, Bradley PJ. Percutaneous tracheotomy. ActaOtolaryngol 2003; 123: 1008-1012
• 15 Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest 1985; 87: 715-719
• 16 Fantoni A, Ripamonti D, Lesmo A, Zanoni CI. [Translaryngeal tracheostomy. A new era?]. Minerva Anestesiol 1996; 62: 313-325
• 17 Schünke M, Schulte E, Schumacher U. Allgemeine Anatomie und Bewegungssystem (Prometheus: LernAtlas der Anatomie). 2. Aufl. Stuttgart: Thieme; 2007
• 18 Bishop MJ, Hibbard AJ, Fink BR et al. Laryngeal injury in a dog model of prolonged endotracheal intubation. Anesthesiology 1985; 62: 770-773
• 19 Weymuller Jr EA, Bishop MJ, Fink BR et al. Quantification of intralaryngeal pressure exerted by endotracheal tubes. Ann OtolRhinolLaryngol 1983; 92: 444-447
• 20 Marshak G, Doyle WJ, Bluestone CD. Canine model of subglottic stenosis secondary to prolonged endotracheal intubation. Laryngoscope 1982; 92: 805-809
• 21 Rumbak MJ et al. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 2004; 32: 1689-1694
• 22 Holzapfel L, Chevret S, Madinier G et al. Influence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial. Crit Care Med 1993; 21: 1132-1138
• 23 Deutschman CS, Wilton P, Sinow J et al. Paranasal sinusitis associated with nasotracheal intubation: a frequently unrecognized and treatable source of sepsis. Crit Care Med 1986; 14: 111-114
• 24 Kristensen MS. Ultrasonography in the management of the airway. ActaAnaesthesiolScand 2011; 55: 1155-1173
• 25 Fernández-Trujillo A, Santos-Sánchez L, Farré-Lladó O et al. Usefulness of ultrasound in percutaneous tracheotomy. Br J Anaesth 2015; 114: 703-704
• 26 Meininger D, Walcher F, Byhahn C. [Tracheostomy in intensive care long-term ventilation : indications, techniques and complications]. Chirurg 2011; 82: 112-115
• 27 Grant CA, Dempsey G, Harrison J, Jones T. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review. Br J Anaesth 2006; 96: 127-131
• 28 Higgins D, Bunker N, Kinnear J. Follow-up of patients with tracheal ring fractures secondary to antegrade percutaneous dilational tracheostomy. Eur J Anaesthesiol 2009; 26: 147-149
• 29 Badaoui R, Thiel V, Perret C et al. [Bilateral pneumothorax, cervicofacial and mediastinal emphysema after surgical tracheostomy]. Ann Fr AnesthReanim 2013; 32: 718-720
• 30 Kim WH, Kim BH. Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after percutaneous tracheostomy - A case report. Korean J Anesthesiol 2012; 62: 488-492
• 31 Byhahn C, Lischke V, Meininger D, Halbig S, Westphal K. Peri-operative complications during percutaneous tracheostomy in obese patients. Anaesthesia 2005; 60: 12-15
• 32 Halum SL, Ting JY, Plowman EK et al. A multi-institutional analysis of tracheotomy complications. Laryngoscope 2012; 122: 38-45
• 33 McCague A, Aljanabi H, Wong DT. Safety analysis of percutaneous dilational tracheostomies with bronchoscopy in the obese patient. Laryngoscope 2012; 122: 1031-1034
• 34 Romero CM, Cornejo RA, Ruiz MH et al. Fiberoptic bronchoscopy-assisted percutaneous tracheostomy is safe in obese critically ill patients: a prospective and comparative study. J Crit Care 2009; 24: 494-500
• 35 Pirat A, Zeyneloglu P, Candan S et al. Percutaneous dilational tracheotomy in solid-organ transplant recipients. Transplant Proc 2004; 36: 221-223
• 36 Waller EA, Aduen JF, Kramer DJ et al. Safety of percutaneous dilatational tracheostomy with direct bronchoscopic guidance for solid organ allograft recipients. Mayo Clin Proc 2007; 82: 1502-1508
• 37 Meyer M, Critchlow J, Mansharamani N et al. Repeat bedside percutaneous dilational tracheostomy is a safe procedure. Crit Care Med 2002; 30: 986-988
• 38 Van Aken HK et al. Intensivmedizin. Stuttgart: Thieme Verlag; 2006
• 39 Murphy C, Rooney SJ, Maharaj CH et al. Comparison of three cuffed emergency percutaneous cricothyroidotomy devices to conventional surgical cricothyroidotomy in a porcine model. Br J Anaesth 2011; 106: 57-64
• 40 Eisenburger P, Laczika K, List M et al. Comparison of conventional surgical versus Seldinger technique emergency cricothyrotomy performed by inexperienced clinicians. Anesthesiology 2000; 92: 687-690
• 41 Dillon JK, Christensen B, Fairbanks T et al. The emergent surgical airway: cricothyrotomy vs. tracheotomy. Int J Oral MaxillofacSurg 2013; 42: 204-208
• 42 Aneeshkumar MK, Jones TM, Birchall MA. A new indicator-guided percutaneous emergency cricothyrotomy device: in vivo study in man. EurArchOtorhinolaryngol 2009; 266: 105-109
• 43 Kunz T, Strametz R, Gründling M, Byhahn C. Punktionstracheotomie in der Intensivmedizin – Update 2012. AnasthesiolIntensivmedNotfallmedSchmerzther 2012; 47: 598-604
• 44 Siempos II, Ntaidou TK, Filippidis FT, Choi AM. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med 2015; 3: 150-158
• 45 Schönhofer B, Geiseler J, Dellweg D et al. [Prolonged weaning: S2k-guideline published by the German Respiratory Society]. Pneumologie 2014; 68: 19-75