Trakeotomi
Özet
Trakeotomi, tarihi antik Mısır ve Roma dönemlerine kadar uzanan, üst solunum yolu obstrüksiyonları, uzamış mekanik ventilasyon ihtiyacı ve pulmoner bakım gibi temel endikasyonlarla uygulanan cerrahi bir prosedürdür. Ciddi kanama bozuklukları ve trakeaya ulaşımı engelleyen kitleler gibi sınırlı kontrendikasyonları bulunur. Cerrahi teknik olarak elektif şartlarda kozmetik açıdan yatay kesi, acil durumlarda ise dikey kesi tercih edilerek ikinci ve üçüncü veya üçüncü ve dördüncü halkalar arasından havayoluna girilir. Alternatif bir yöntem olan perkütanöz trakeotomi, Seldinger tekniğine dayanmakta olup çocuklarda, orta hat kitlelerinde ve ciddi pıhtılaşma sorunlarında kontrendikedir. Operasyon sonrası süreçte kanülün aspirasyonu, nemlendirilmesi ve kaf basıncının takibi gibi trakeotomi bakımı hayati önem taşır; çünkü hatalı uygulamalar bası hasarına yol açabilir. Kanama, pnömotoraks ve havayolu yangınları erken dönem komplikasyonlar arasındayken; trakeomalazi ve fistüller geç dönemde görülebilir. Altta yatan tıbbi durum düzeltildiğinde, fiberoptik endoskopi ile açıklık doğrulanarak, hastanın solunum ve sekresyon kontrolü test edilerek dekanülasyon aşamasına geçilir.
Tracheotomy is a surgical procedure with a history dating back to ancient Egypt and Rome, primarily indicated for upper airway obstruction, prolonged mechanical ventilation, and pulmonary care. It has few absolute contraindications, such as major vascular masses obstructing the trachea and severe bleeding disorders. The surgical technique involves a vertical incision in emergencies or a cosmetic horizontal incision in elective cases, entering the airway between the second and third or third and fourth tracheal rings. Percutaneous dilatation tracheotomy, based on the Seldinger technique, offers faster application but is strictly contraindicated in pediatric patients, midline neck masses, and severe coagulopathy. Postoperative tracheotomy care, including frequent aspiration, humidification, and cuff pressure monitoring, is vital to prevent complications. Complications are classified into early stages, such as bleeding, pneumothorax, and airway fires, and late stages, including tracheomalacia and fistulas caused by ischemic necrosis. Once the underlying medical condition is resolved, decannulation is evaluated through fiberoptic endoscopy, ensuring the patient can maintain airway patency and tolerate tube capping.
Referanslar
Pahor AL. Ear, Nose and Throat in Ancient Egypt. J Laryngol Otol. 2007;106(8):677–87.
Jones WHS. Hippocrates in English. The Classical Review2009; 2(2):88–9.
Gordon BL: The Romance of Medicine. Philadelphia, FA Davis, 1947, p 461.
Frost EA. Tracing the tracheotomy. Ann Otol Rhinol Laryngol 1976;85:618–24.
Watkinson JJ, Gaz MN, Wilson JA. Tracheostomy. In Watkinson JC, Gaze MN, Wilson JS, editor: Stell and Maran’s head and neck surgery, ed 4, Oxford, UK, 2000, Butterworth Heinemann, pp 153–68.
Colice GL. Historical background. In Tobin MJ, editor: Principles and practice of mechanical ventilation, New York, 1994, McGraw-Hill, pp 1–37.
Trousseau A. Lectures on Clinical Medicine, vol 2, Cormack JR (trans) London, 1869, The New Sydenham Society, p 598.
Rowbotham ES, Magill I. Anaesthesia in the plastic surgery of the face and jaws. Proc R Soc Med 1921;14:17–27.
Pratt LW, Moore VJ, Marshall PJ, et al. Should T and A’s be intu¬bated? Laryngoscope 1968;78:1398–409..
Jackson C, Jackson CL: The Larynx and Its Diseases. Philadelphia, WB Saunders, 1937.
Carter P, Benjamin B. "Ten-year review of pediatric tracheotomy." Annals of Otology, Rhinology & Laryngology. 1983;92: 398-400.
Dayal VS, Masri We. "Tracheostomy in intensive care setting." The Laryngoscope. 1986;96: 58-60.
Fearon, Blair, and David Ellis. "The management of long term airway problems in infants and children." Annals of Otology, Rhinology & Laryngology 80.5 (1971): 669-677.
Şanlı M, Işık AF, Tunççözgür B, ve ark. Cerrahi Uyguladığımız Postentübasyon Trakea stenozlu İki Olgu. Solunum Hastalıkları. 2006;17: 141-144
McWhorter AJ. Tracheostomy: timing and techniques. Curr Opin Otolaryngol Head Neck Surg. 2003; 11:473–9.
Blot F, Similowski T, Trouillett JL, et al. Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patients. Intensive Care Med. 2008; 24:1779–87.
Durbin CG, Jr:.Tracheostomy: why, when and how? Respir Care. 2010; 55:1056–68.
Plummer AL, Gracey DR. Consensus conference on artificial airways in patients receiving mechanical ventilation. Chest. 1989; 96:178–80.
Björk VO: Partial resection of the only remaining lung with the aid of respirator treatment. J Thorac Cardiovasc Surg.1960; 29:179–88.
Toye FJ, Weinstein JD. A percutanenous tracheostomy device. Surgery. 1969; 65:384–9.
Arabi Y, Haddad S, Shirawi N, et al. Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Crit Care. 2004; 8:R347–R352.
Liao L, Myers J, Johnston J, et al. Percutaneous tracheostomy: one center’s experience with a new modality. Am J Surg. 2005; 190:923–6.
Papson JP, Russell KL, Taylor DM. Unexpected events during the intrahospital transport of critically ill patients. Acad Emerg Med. 2007; 14:574–7.
Freeman BD, Isabella K, Lin N, et al: A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in criti¬cally ill patients. Chest. 2000; 118:1412–8.
Friedman Y, Fildes J, Mizock B, et al: Comparison of Percutaneous and Surgical Tracheostomies. Chest 1996;110:480–5.
Moe KS, Stoeckli SF, Schmid S, et al. Percutaneous tracheostomy: a comprehensive evaluation. Ann Otol Rhinol Laryngol 1999;108:384–91.
Durbin CG. Techniques for performing tracheostomy. Respir Care 2005;50:488–96.
Gaudet PT, et al. "Pediatric tracheostomy and associated complications." The Laryngoscope. 1978;88: 33-1641.
Klemm E, Nowak A. Tracheotomy and Airway: A practical Guide. Springer İnternaitonal Publishing, 2020.
