Tracheostomy decannulation: implication on respiratory mechanics

BACKGROUND: Tracheostomy decreases airway resistance and work of breathing. No comprehensive data are available on respiratory mechanics after tracheostomy decannulation. We evaluated respiratory mechanics after decannulation. METHODS: Twenty-five patients with tracheostomy were included. Measurement of arterial blood gases, air-flow, and esophageal pressure during spontaneous breathing were evaluated. RESULTS: Overall arterial blood gas parameters as well as flow and pressure measurements including work of breathing and airway resistance were not affected by the intervention. Inspiratory time fraction increased from 40.0 + or - 0.04 to 43% + or - 0.05% (p = .007). We observed marked individual differences. Postdecannulation change in work of breathing is best predicted by change in airway resistance (R = 0.869, R(2) = 0.755, p < .0001) CONCLUSION: Inspiratory time increased after decannulation, and arterial blood gas levels and respiratory mechanics did not change for the whole cohort. Individual changes in work of breathing are considerable and correlate closely to changes in airway resistance.     

Tracheostomy

The technique of percutaneous tracheostomy is described in detail. The benefits, contraindications and complications of the technique are listed.     

Tracheostomy

In this paper a comparison has been made between excision-type window tracheostomies and classical Björk flap and modified flap tracheostomies, based upon a review of all tracheostomies performed at Harare Hospital, Salisbury, over a 20-month period, together with bronchoscopic follow-up whenever possible.The modified flap type of tracheostomy is constructed by means of a broad-based flap dividing two tracheal rings and having rounded corners. It produces a good stoma through which tube changing can be performed with ease and safety. Any form of permanent defect in the trachea left by merely extubating a tracheostomy will almost always produce a narrowing at the level of the stoma, which is probably most severe if a flap-type of stoma has been made. Routine replacement of a modified flap will nearly always avoid this.A serious stricture was produced in three (3%) patients in the series. In two, this was at the level of the tube tip in patients who had been on prolonged artificial ventilation; one required resection. These strictures are probably due to movement of the tube tip during ventilator therapy, and it is suggested that some method of coupling the ventilator to the tube might be devised to avoid this.     

Complications to Tracheostomy and Long-Term Intubation: A Follow-Up Study

Hospital records of 79 patients treated with tracheostomy or long-term intubation from 1969 to 1971 were reviewed, and the 43 surviving patients were examined by laryngoscopy, x-ray and spirometry for complications subsequent to these treatments. Early complications included one tube occlusion and one case of postextubation stridor in each group, one dislocated tube, one bilateral pneumothorax, and one case of fatal innominate arterial hemorrhage in the tracheostomy group, and two cases of atelectasis in the long-term intubation group. Necropsy findings included necrotic ulcers in the larynx of intubated patients and eroded tracheal mucosa in both groups. Late complications in surviving patients were prolonged hoarseness in six patients treated with prolonged intubation, two of whom had also had tracheostomy. Radiologically verified tracheal stenosis (40-60%), four at the stoma level and one at the cuff level, all occurred in the tracheostomy group.