Zusammenfassung
Die Tracheotomie hat durch die Entwicklung der Intensivmedizin in den letzten Jahren erheblich an Bedeutung gewonnen und ist der häufigste operative Eingriff in diesem Bereich. Die Auswahl des Tracheotomieverfahrens (chirurgisch vs. dilatativ) sollte sich an der voraussichtlichen Dauer der Notwendigkeit einer Trachealkanülenversorgung orientieren. Durch die Entscheidung für einen operativen oder dilatativen Tracheotomiemodus können das weitere Atemwegsmanagement und die Schluckrehabilitation maßgeblich beeinflusst werden, da diese vom Zustand des Tracheostomas und dessen Pflegbarkeit unmittelbar abhängen. Die Auswahl der geeigneten Trachealkanüle hilft, Komplikationen zu vermeiden und den Patientenkomfort zu verbessern. Zur Risikominimierung sind Kenntnisse über die Vorgehensweise bei lebensbedrohlichen Komplikationen durch eine Tracheotomie erforderlich. Eine regelmäßige Befundkontrolle kann Inzidenz und Schwere von Früh- und Spätkomplikationen bereits im Anfangsstadium reduzieren sowie das langfristige Therapieergebnis verbessern.
Abstract
Tracheostomy has gained importance due to recent developments in critical care medicine. This procedure is the most frequent surgical intervention on intensive care wards. Indications for tracheostomy (conventional versus dilatational) should consider the duration of the need for a tracheal cannula. The decision for one of the types of tracheostomy may have a relevant impact on the airway management and the rehabilitation of swallowing, because these are dependent on state of the tracheostoma and its subsequent maintenance. Selection of the appropriate cannula helps to avoid complications and improve patient comfort. To minimize the risks during tracheostomy, skills and expertise on the management of life- threatening complications are necessary. Early and late complications can be detected by regular examination of the tracheostoma which may help to repress complications in an early stage and can improve the long term outcome.
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Richter, T., Sutarski, S. Tracheostoma. Anaesthesist 58, 1261–1274 (2009). https://doi.org/10.1007/s00101-009-1648-3
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DOI: https://doi.org/10.1007/s00101-009-1648-3