[Long-term intubation and tracheotomy]

Abstract

Benefits and disadvantages of long-term nasal and oral endotracheal intubations vs. tracheotomy are discussed. The incidence and severity of complications is higher following prolonged endotracheal intubation than tracheotomy. Laryngeal injury is more serious than tracheal. Tracheotomy therefore is advantageous in all patients requiring long-term ventilatory support. The optimal timing for tracheotomy is ranging from 48 to 120 hours following endotracheal intubation. Tracheal stenosis secondary to trachestomy depends on tracheal wall perfusion. The risk of tracheal stenosis may be minimized by diligent performance of tracheostomy, and by sewing the trachea to the skin, and by using solidly fixed tracheal cannulas with high-volume low-pressure cuffs.