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Anästhesiol Intensivmed Notfallmed Schmerzther 2012; 47(10): 598-604
DOI: 10.1055/s-0032-1325292
Fachwissen
Intensivmedizin
© Georg Thieme Verlag Stuttgart · New York

Punktionstracheotomie in der Intensivmedizin – Update 2012

Percutaneous tracheostomy in intensive care medicine – Update 2012
Tina Kunz
,
Reinhard Strametz
,
Matthias Gründling
,
Christian Byhahn
Further Information

Publication History

Publication Date:
24 October 2012 (online)

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Zusammenfassung

Die Punktionstracheotomie ist ein fester Bestandteil der intensivmedizinischen Beatmungstherapie und bietet viele Vorteile gegenüber der prolongierten orotrachealen Intubation. Für den optimalen Zeitpunkt zur Tracheotomie gibt es gegenwärtig jedoch noch keine Evidenz. Der Eingriff wird in Allgemeinanästhesie unter fiberoptischer Kontrolle durchgeführt, wobei die Ciaglia Blue-Rhino-Technik am weitesten verbreitet ist. Ein neuartiges Verfahren stellt die CiagliaBlue-Dolphin-Technik dar, bei der eine radiäre Dilatation mithilfe eines flüssigkeitsgefüllten Hochdruckballons erfolgt. Unter Beachtung der Kontraindikationen (z.B. schwierige Intubation, keine sichere Identifikation laryngotrachealer Landmarken, hochgradige Gerinnungsstörungen) ist die Komplikationsrate aller Verfahren gering, wobei der Einsatz der Sonografie zu einer weiteren Erhöhung der Sicherheit beitragen kann. Schlussendlich muss beachtet werden, dass es sich bei der Punktionstracheotomie um einen Elektiveingriff handelt, für den eine rechtsgültige Einwilligung des Patienten oder seines Betreuers erforderlich ist.

Abstract

Percutaneous tracheostomy has become an established procedure in airway management of critically ill patients. It offers advantages over prolonged tracheal intubation. To date, there is no evidence of the optimal timing of the procedure. The Ciaglia Blue Rhino technique is the most common technique and, as any other techniques of percutaneous tracheostomy, is performed under general anaesthesia and with continuous bronchoscopic control. The recently introduced Ciaglia Blue Dolphin technique is based on radial dilatation with a fluid-filled high pressure balloon. Provided that specific contraindications are observed (e.g. difficult tracheal intubation, inability to identify anatomic landmarks, severe coagulopathy etc.), all techniques have low complication rates. The use of ultrasound may further enhance perioperative safety. Finally it must be noted that percutaneous tracheostomy is an elective procedure that requires informed consent from the patient or an attorney of law.

Kernaussagen

  • Die Tracheotomie als eine der ältesten chirurgischen Prozeduren hat sich durch die modernen Punktionstechniken zu einem Standardeingriff in der Intensivmedizin entwickelt.

  • Schäden infolge der endotrachealen Langzeitintubation (Verletzung der Aryknorpel, Mund- und Nasenschleimhaut, bis hin zur Trachealstenose), können durch Tracheotomie vermieden werden.

  • Kontraindikationen sind vor dem Eingriff unbedingt zu beachten [Tab. 2].

  • Für den idealen Zeitpunkt der Tracheotomie gibt es keine Evidenz.

  • Der liegende Endotrachealtubus kann vor Beginn der Punktion durch eine Larynxmaske ersetzt werden.

  • Bronchoskopie während der praktischen Durchführung ist obligat.

  • Der einliegende Führungsdraht muss immer frei beweglich sein, um Trachealverletzungen zu vermeiden.

  • Die Punktionstracheotomie ist eine elektive, aber hochinvasive Maßnahme.

Schlüsselwörter:

Tracheotomie - Dilatationstracheotomie - Beatmung - Intensivmedizin

Key words:

tracheostomy - dilatational tracheostomy - ventilation - intensive care

Ergänzendes Material

 

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