Tracheotomie – chirurgisch und perkutan

 

 Buy Article Permissions and Reprints

Zusammenfassung

Tracheotomien werden heute überwiegend aus zwei Gründen durchgeführt: Erleichterung der Langzeitbeatmung und der Entwöhnung vom Respirator, Verhinderung von Komplikationen durch eine prolongierte translaryngeale Intubation. Die offene chirurgische Technik der Tracheotomie („surgical tracheostomy“, ST) hat trotz der breiten Anwendung der perkutanen Dilatationstracheotomie („percutaneous dilational tracheostomy“, PDT) auch heute noch einen gesicherten Stellenwert. Peri- und postoperative Komplikationen sowie die Letalität der beiden konkurrierenden Methoden sind laut Literatur vergleichbar. Bei der PDT sind allerdings deutlich häufiger Kontraindikationen zu beachten. Die Durchführung kann scheitern, und im Rahmen der Anlage oder zu einem späteren Zeitpunkt muss ggf. zur konventionellen Tracheotomie konvertiert werden. Dies erfordert, dass die Technik der chirurgischen Tracheotomie weiterhin weit verbreitet ist und sicher durchgeführt werden kann. Nachfolgend werden daher die Indikationen und das Vorgehen bei beiden Methoden einschließlich der Technik des Stomaverschlusses detailliert beschrieben. Auch spezifische Komplikationen werden erörtert sowie die Ergebnisse von Metaanalysen der konkurrierenden Verfahren diskutiert.

Abstract

Modern indications for tracheostomy are the following: support of mechanical ventilation and weaning from mechanical ventilation, prevention of complications due to prolonged endotracheal tube ventilation. Surgical tracheostomy (ST) still plays an important role in the management of respiratory failure despite the wide use of percutaneous dilatational tracheostomy (PDT). Peri- and postoperative complication rates as well as lethality rates of these competing procedures are similar according to the literature. However, there are more contraindications to PDT to be considered. In case of technical difficulties or failure of the PDT, a conversion to the open procedure may be necessary either after PDT attempt or later on. Therefore, technical expertise should be available in the intensive care setting. Indications, technical aspects, including closure of stoma, of both methods are presented in detail. Moreover, specific complications are presented, as well as results of meta-analyses comparing ST with PDT.

• Literatur

• 1 Genzwürker H, Hinkelbein J. Fallbuch Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie. Stuttgart: Thieme; 2007
  Google Scholar
• 2 Flaatten H, Gjerde S, Heimdal JH et al. The effect of tracheostomy on outcome in intensive care unit patients. Acta Anaesthesiol Scand 2006; 50: 92-98
  CrossrefPubMedGoogle Scholar
• 3 Cantais E, Kaiser E, Le-Goff Y et al. Percutaneous tracheostomy: prospective comparison of the translaryngeal technique versus the forceps-dilational technique in 100 critically ill adults. Crit Care Med 2002; 30: 815-819
  CrossrefPubMedGoogle Scholar
• 4 Kearney PA, Griffen MM, Ochoa JB et al. A single-center 8-year experience with percutaneous dilational tracheostomy. Ann Surg 2000; 231: 701-709
  CrossrefPubMedGoogle Scholar
• 5 Melloni G, Muttini S, Gallioli G et al. Surgical tracheostomy versus percutaneous dilatational tracheostomy: A prospective-randomized study with long-term follow-up. J Cardiovasc Surg 2002; 43: 113-121
  PubMedGoogle Scholar
• 6 Goldenberg D, Golz A, Netzer A et al. Tracheotomy: changing indications and a review of 1,130 cases. J Otolaryngol 2002; 31: 211-215
  CrossrefPubMedGoogle Scholar
• 7 Bartels H, Bogdanski R. Tracheotomie, Tracheostomie. Laryngorhinologie 2011; 90: 766-783
  PubMedGoogle Scholar
• 8 Alon BN, Altman E, Best LE. Emergency percutaneous tracheostomy in trauma patients: an early experience. Ann Thorac Surg 2004; 77: 1045-1047
  CrossrefPubMedGoogle Scholar
• 9 Burkert S, Schmidt A, Knipping S. Follow-up nach Dilatationstracheotomie. Abstract 80. Jahresversammlung der Deutschen Gesellschaft für HNO-Heilkunde, Rostock 2009. DOI: 10.3205/09hnod205
  PubMedGoogle Scholar
• 10 Mansharamani NG, Koziel H, Garland R et al. Safety of bedside percutaneous dilatational tracheostomy in obese patients in the ICU. Chest 2000; 117: 1426-1429
  CrossrefPubMedGoogle Scholar
• 11 Alon BN, Orlovsky M, Best LA. Percutaneous tracheostomy in patients with cervical spine fractures – feasible and safe. Interact Cardio Vasc Thorac Surg 2006; 5: 427-429
  CrossrefPubMedGoogle Scholar
• 12 Beiderlinden M, Groeben H, Peters J. Safety of percutaneous dilational tracheostomy in patients ventilated with high positive end-expiratory pressure (PEEP). Intensive Care Med 2003; 29: 944-948
  CrossrefPubMedGoogle Scholar
• 13 Meyer M, Critchlow J, Mansharamani N et al. Repeat bedside percutaneous dilational tracheostomy is a safe procedure. Crit Care Med 2002; 30: 986-988
  CrossrefPubMedGoogle Scholar
• 14 Toursarkissian B, Fowler CL, Zweng TN et al. Percutaneous dilational tracheostomy in children and teenagers. J Pediatr Surg 1994; 11: 1421-1424
  PubMedGoogle Scholar
• 15 Wang F, Wu Y, Bo L et al. The timing of tracheotomy in critically ill patients undergoing mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials. Chest 2011; 140: 1456-1465
  CrossrefPubMedGoogle Scholar
• 16 Chacko J, Nikahat J, Gagan B et al. Real-time ultrasound-guided percutaneous dilatational tracheostomy. Intensive Care Med 2012; 38: 920-921
  CrossrefPubMedGoogle Scholar
• 17 Shan L, Hao P, Xu F et al. Benefits of early tracheotomy: a meta-analysis based on 6 observational studies. Respiratory Care 2013; 58: 1856-1862
  CrossrefPubMedGoogle Scholar
• 18 Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest 1989; 96: 178-180
  CrossrefPubMedGoogle Scholar
• 19 Jackson C. Tracheotomy. Laryngoscope 1909; 19: 285-290
  PubMedGoogle Scholar
• 20 Jackson C. High Tracheotomy and other errors the chief causes of chronic laryngeal stenosis. Surg Gynecol Obstet 1921; 33: 392-398
  PubMedGoogle Scholar
• 21 Björk VO. Partial resection of the only remaining lung with the aid of respirator treatment. J Thorac Cardiovasc Surg 1960; 39: 179-188
  PubMedGoogle Scholar
• 22 Brantigan CO, Grow JB. Cricothyroidotomy. J Thorac Cardiovasc Surg 1976; 71: 72-81
  PubMedGoogle Scholar
• 23 Matthews HR, Hopkinson RB. Treatment of sputum retention by minitracheostomy. Br J Surg 1984; 71: 147-150
  CrossrefPubMedGoogle Scholar
• 24 Ciaglia P, Firsching P, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest 1985; 87: 715-719
  CrossrefPubMedGoogle Scholar
• 25 Männle C, Herth FJF. Dilatative Tracheotomie. In: Haverkamp W, Herth F, Messmann H, Hrsg. Internistische Intensivmedizin. Stuttgart: Thieme; 2009
  Article in Thieme ConnectGoogle Scholar
• 26 Byhan C, Wilke HJ, Lischke V et al. Translaryngeal tracheostomy: two modified techniques versus the basic technique – early experiences in 75 critically ill adults. Intensive Care Med 2000; 26: 457-461
  CrossrefPubMedGoogle Scholar
• 27 Bartls H, Bogdanski R. Tracheotomie, Tracheostomie. Allg Viszeralchir up2date 2010; 4: 297-312
  PubMedGoogle Scholar
• 28 Byhan C, Zogda M, Birkelbach O et al. Blue Dolphin: a new technique for percutaneous tracheostomy using balloon dilation. Crit Care 2008; 12 (Suppl. 02) P333
  CrossrefPubMedGoogle Scholar
• 29 Griggs WM, Worthley LI, Gilligan JE et al. A simple percutaneous tracheostomy technique. Surg Gynecol Obstet 1990; 170: 543-545
  PubMedGoogle Scholar
• 30 Frova G, Quintel M. A new simple method for percutaneous tracheostomy: controlled rotating dilation. Intensive Care Med 2002; 28: 299-303
  CrossrefPubMedGoogle Scholar
• 31 Fantoni A, Ripamonti D. A non-derivative, non-surgical tracheostomy: the translaryngeal method. Intensive Care Med 1997; 23: 386-392
  CrossrefPubMedGoogle Scholar
• 32 Al-Ansari MA, Hijazi MH. Clinical review: Percutaneous dilatational tracheostomy. Crit Care 2006; 10: 202
  CrossrefPubMedGoogle Scholar
• 33 Verghese C, Rangasami A, Kapila A et al. Airway control during percutaneous dilatational tracheostomy: pilot study with the intubating laryngeal mask airway. Br J Anaesth 1998; 81: 608-609
  CrossrefPubMedGoogle Scholar
• 34 Gallagher TQ, Hartnick CJ. Tracheocutaneous fistula closure. Adv Otorhinolaryngol 2012; 73: 76-79
  PubMedGoogle Scholar
• 35 Shen KR, Mathisen DJ. Management of persistent tracheal stoma. Chest Surg Clin N Am 2003; 13: 369-373
  CrossrefPubMedGoogle Scholar
• 36 Kremer K, Lierse W, Platzer W, Schreiber HW, Weller S Hrsg. Chirurgische Operationslehre. Band 2: Thorax. Stuttgart: Thieme; 1991
  Google Scholar
• 37 Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care 2008; 10: R55
  PubMedGoogle Scholar
• 38 Bradley PJ. Management of the obstructed Airway and Tracheostomy. In: Kerr AG, Hrsg. Scott-Brownʼs Otolaryngology. London: Butterworth & Heinemann; 1997
  Google Scholar
• 39 Myers EN, Carrau RL. Early complications of tracheotomy: incidence and management. Clin Chest Med 1991; 12: 589-595
  PubMedGoogle Scholar
• 40 Feller-Kopman D. Acute complications of artificial airways. Clin Chest Med 2003; 24: 445-455
  CrossrefPubMedGoogle Scholar
• 41 Epstein SK. Late complications of tracheostomy. Respir Care 2005; 50: 542-549
  PubMedGoogle Scholar
• 42 Gründling M, Quintel M. Perkutane Dilatationstracheotomie. Indikationen, Techniken, Komplikationen. Anaesthesist 2005; 54: 929-944
  CrossrefPubMedGoogle Scholar
• 43 Simon M, Metschke M, Braune SA et al. Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors. Crit Care 2013; 17: R258
  CrossrefPubMedGoogle Scholar
• 44 Das P, Zhu H, Shah RK et al. Tracheotomy-related catastrophic events: results of a national survey. Laryngoscope 2012; 122: 30-37
  CrossrefPubMedGoogle Scholar
• 45 Hurter H, Post-Stanke A, Tolksdorf W. Lethal vascular erosion after percutaneous dilatation tracheostomy. Anasthesiol Intensivmed Notfallmed Schmerzther 2000; 35: 658-660
  Article in Thieme ConnectPubMedGoogle Scholar
• 46 Yang FY, Criado E, Schwartz JA et al. Trachea-innominate artery fistula: retrospective comparison of treatment methods. South Med J 1988; 81: 701-706
  CrossrefPubMedGoogle Scholar
• 47 Hamaguchi S, Nakajima Y. Two cases of tracheoinnominate artery fistula following tracheostomy treated successfully by endovascular embolization of the innominate artery. J Vasc Surg 2012; 55: 545-547
  CrossrefPubMedGoogle Scholar
• 48 Cardillo G, Carbone L, Carleo F et al. Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment. Eur J Cardiothorac Surg 2010; 37: 581-587
  CrossrefPubMedGoogle Scholar
• 49 Welter S, Krbek T, Halder R et al. A new technique for complete intraluminal repair of iatrogenic posterior tracheal lacerations. Interact Cardiovasc Thorac Surg 2011; 12: 6-9
  CrossrefPubMedGoogle Scholar
• 50 Sviri S, Samie R, Roberts BL et al. Long-term outcomes following percutaneous tracheostomy using the Griggs technique. Anaesth Intensive Care 2003; 31: 401-407
  PubMedGoogle Scholar
• 51 Antonelli M, Michetti V, Di Palma A et al. Percutaneous translaryngeal versus surgical tracheostomy: a randomized trial with 1-yr double-blind follow-up. Crit Care Med 2005; 33: 1015-1020
  CrossrefPubMedGoogle Scholar
• 52 Oliver ER, Gist A, Gillespie MB. Percutaneous vs. surgical tracheotomy. Laryngoscope 2007; 117: 1570-1575
  CrossrefPubMedGoogle Scholar
• 53 Dulguerov P, Gysin C, Perneger T et al. Percutaneous or surgical tracheostomy: a meta-analysis. Crit Care Med 1999; 27: 1617-1625
  CrossrefPubMedGoogle Scholar
• 54 Freeman B, Isabella K, Lin N et al. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest 2000; 118: 1412-1418
  CrossrefPubMedGoogle Scholar
• 55 Higgins KM, Punthakee X. Meta-analysis comparison of open versus percutaneous tracheostomy. Laryngoscope 2007; 117: 447-454
  CrossrefPubMedGoogle Scholar