From the Guidelines
Percutaneous tracheostomy is recommended over open surgical tracheostomy to minimize airway derecruitment in patients requiring prolonged mechanical ventilation, as it allows for less airway exposure and potential for alveolar collapse. This approach is particularly important in critically ill patients with respiratory failure, where maintaining recruitment is crucial for optimizing outcomes in terms of morbidity, mortality, and quality of life. The choice between percutaneous dilatational tracheostomy (PDT) and open surgical tracheostomy (OST) should be based on local expertise and resources, with the goal of minimizing aerosol generation and ensuring the safety of both patients and healthcare workers, as suggested by expert panels 1. Key considerations for minimizing airway derecruitment include pre-oxygenation with 100% FiO2 for 3-5 minutes, maintaining PEEP at the patient's baseline level until the last possible moment, and using bronchoscopic guidance for percutaneous procedures to allow for better visualization while maintaining some ventilation 1. By prioritizing percutaneous tracheostomy and adhering to best practices for minimizing aerosol generation and airway derecruitment, healthcare providers can optimize outcomes for patients requiring tracheostomy, particularly in the context of the COVID-19 pandemic. Some of the key strategies for reducing aerosolization during tracheostomy procedures include the use of apnea, discontinuation of positive end-expiratory pressure, and increasing FiO2 to prevent desaturation, as well as incorporating ultrasound guidance and modifying the percutaneous dilatational tracheostomy technique to reduce the need for bronchoscopic guidance 1. Ultimately, the decision between percutaneous and open surgical tracheostomy should be made on a case-by-case basis, taking into account the individual patient's needs and the expertise and resources available to the healthcare team, with the primary goal of minimizing morbidity, mortality, and improving quality of life.
From the Research
Airway Derecruitment in Percutaneous versus Open Tracheostomy
- There are no direct studies comparing airway derecruitment in percutaneous versus open tracheostomy in the provided evidence.
- However, studies have shown that tracheostomy can have various benefits, such as reducing sedation and analgesia requirements 2.
- Percutaneous tracheostomy (PT) is a commonly performed procedure with favorable complication rates, lower infection rates, and shorter procedural durations compared to open tracheostomy 3.
- Airway management is a critical aspect of tracheostomy, and expertise in this area is essential for minimizing complications 4, 5.
- The choice of tracheostomy technique may depend on various factors, including patient anatomy, medical history, and the expertise of the healthcare provider.
- Further research is needed to directly compare airway derecruitment in percutaneous versus open tracheostomy and to determine the optimal approach for individual patients.