Tracheotomie – chirurgisch und perkutan

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.

Key words

Langzeitbeatmung - Entwöhnung - perkutane Dilatationstracheotomie (PDT) - chirurgische Tracheotomie (ST) - Stoma - Trachealkanüle

Key words

mechanical ventilation - weaning - percutaneous dilatational tracheostomy (PDT) - surgical tracheostomy (ST) - stoma - tracheal cannula

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