Tracheostomy must be individualized! 英文参考文献.docVIP

Critical Care October 2004 Vol 8 No 5 Pelosi and Severgnini Commentary Tracheostomy must be individualized! Paolo Pelosi and Paolo Severgnini Universita’ degli Studi dell’Insubria, Servizio di Anestesia B, Ospedale di Circolo e Fondazione Macchi, Varese, Italy Corresponding author: Paolo Pelosi, ppelosi@ Published online: 8 September 2004 Critical Care 2004, 8:322-324 (DOI 10.1186/cc2966) This article is online at /content/8/5/322 ? 2004 BioMed Central Ltd Related to Research by Arabi et al., see page 395 Abstract Tracheostomy is one of the most frequent procedures carried out in critically ill patients with major advantages compared to translaryngeal endotracheal intubation such as reduced laryngeal anatomical alterations, reduced inspiratory load, better patients tolerance and nursing. Thus, tracheostomy can enhance patients care in patients who need prolonged mechanical ventilation and/or control of airways. The right timing of tracheostomy remains controversial, however it appears that early tracheostomy in selected severe trauma, burn and neurological patients could be effective to reduce the duration of mechanical ventilation intensive care stay and costs. Percutaneous tracheostomy techniques are becoming the procedure of choice in the majority of the cases, since they are safe, easy and quick, and complications are minor. However, percutaneous tracheostomies should be always performed by experienced physicians to avoid unnecessary additional complications. It is not clear the superiority of one percutaneous technique compared to another, but experience of the operator and clinical individual anatomical, physiopathological characteristics of the patient should be always considered. We believe that the operator should have experience of at least one intrusive and one extrusive percutaneous technique. The general optimal tracheostomy technique and timing do not exist,