The tracheotomy punch for urgent tracheotomy

Tracheotomy is a commonly performed surgical technique used for long-term mechanical ventilation, upper airway obstruction, need for pulmonary toilet, and as an adjunct to surgery where ventilation is anticipated. Urgent tracheotomy may be performed when difficulty is encountered during an elective tracheotomy, or when cricothyroidotomy is impossible or contraindicated due to distorted anatomy or laryngeal obstruction. Various methods of creating a tracheal opening have been described and each of these methods has technical advantages and disadvantages. In the urgent setting, a rapid and technically simple approach is needed for optimal results. We have used the Eisele tracheotomy punch (Pilling, Teleflex Medical, Research Triangle Park, NC) for all tracheotomies, both elective and urgent. In this report we describe five illustrative cases in which the tracheotomy punch was used successfully in the urgent setting to ensure rapid airway access.     

Pediatric tracheotomy

Tracheotomies are increasingly performed in the pediatric population in the context of long-term treatment. There are specific pediatric aspects that require attention: differences in the pediatric compared to adult anatomy, the necessity for later reconstruction and the negative impact on oral feeding and speech development. Caring for pediatric tracheostomy patients is more challenging compared to adult patients. This needs to be addressed by a dedicated team during both in- and outpatient treatment.     

Pediatric tracheotomy

The indications and complications of tracheotomy in 93 children between 1970-82 were studied and recorded. There has clearly been a shift in indications for pediatric tracheotomy while the early postoperative complication rate has improved. Longterm tracheotomy is on the increase due to a larger number of children with neurological problems and of infants requiring tracheotomy for chronic obstructive airway disease.     

不同气管切开术的应用对比研究

我院重症监护治疗室（ICU）在纤支镜直视下行经皮气管切开术（percutaneous dilational tracheotomy，PDT），与同期进行的经皮气管切开术及传统开放性气管切开术（surgical tracheotomy，ST）进行对比，取得较好效果，现介绍于下。[第一段]     

舌瓣形气管切开术

目的探讨舌瓣形气管切开术的应用价值。方法对350例行舌瓣形气管切开术患者资料进行总结分析。结果350例患者行舌瓣形气管切开术均顺利。318例气管切开麻醉均成功。16例术后需更换气管套管患者无并发呼吸困难。56例全喉切除、35例近或次全喉切除术后由于喉狭窄原因不能拔除气管套管外,余下259例拔除气管套管,均未发生气管狭窄。全组有15例并发皮下气肿、4例伤口出血,并发症发生率为(19/350)5.4%。结论舌瓣形气管切开术操作简单,方便气管插管麻醉,对气管及甲状腺损伤轻,可避免气管狭窄。气管套管更换方便。目的探讨舌瓣形气管切开术的应用价值。方法对350例行舌瓣形气管切开术患者资料进行总结分析。结果350例患者行舌瓣形气管切开术均顺利。318例气管切开麻醉均成功。16例术后需更换气管套管患者无并发呼吸困难。56例全喉切除、35例近或次全喉切除术后由于喉狭窄原因不能拔除气管套管外,余下259例拔除气管套管,均未发生气管狭窄。全组有15例并发皮下气肿、4例伤口出血,并发症发生率为5.4%(19/350)。结论舌瓣形气管切开术操作简单,方便气管插管麻醉,对气管及甲状腺损伤轻,可避免气管狭窄。气管套管更换方便。