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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4510_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Foreword
- •Contents
- •Contributors
- •Introduction
- •References
- •Macrostructure
- •Anatomical Variations
- •References
- •Tracheostomy Tube Types
- •Introduction
- •Structure
- •Materials
- •Metallic Tubes
- •Plastic Tubes
- •Microstructure
- •Vascularization
- •Innervation
- •Cannula Types
- •Dimensions
- •Fenestration
- •Cuffed Tubes
- •Cuffless Tubes
- •Tracheostomy Tube Sizes
- •References
- •Tracheostomy: Conventional Technique
- •Introduction
- •Legislation
- •Is Informed Consent Necessary?
- •Surgical Technique
- •Surgical Instruments
- •Location
- •General Conditions
- •Positioning
- •Anesthesia
- •Incision
- •Dissection
- •Tracheostomy
- •References
- •Introduction
- •Percutaneous Tracheostomy
- •Procedure
- •Postoperative Care
- •Complications
- •Cost
- •References
- •Introduction
- •Basic Surgical Technique
- •Percutaneous Dilatational Tracheostomy Kits
- •Single Progressive Plastic Dilator (Ciaglia Blue Rhino®, Cook®)
- •Dilation by Metallic Forceps (Griggs® Forceps, Portex®)
- •Balloon Dilator Through Water Pressure (Dolphin BT®, Cook®)
- •Screw Rotating Plastic Dilator (PercuTwist®, Rush®)
- •Hands-On Percutaneous Dilatational Tracheostomy Training Program Course
- •References
- •Conventional or Percutaneous Tracheostomy?
- •Introduction
- •Percutaneous Versus Conventional Tracheostomy: Surgical Approach
- •Coagulation Pitfalls
- •Urgent Tracheostomy
- •Morbid Obesity
- •Bulky Thyroid Goiter
- •Cervical Immobility
- •Previous Tracheostomy or Cervical Scar
- •References
- •Pediatric Tracheostomy
- •Introduction
- •Indications
- •Preoperative Evaluation
- •Oncological Tracheostomy: Technical Peculiarities
- •Percutaneous Tracheostomy
- •Pediatric Tracheostomy Tube Choices
- •Postoperative Care
- •Tracheostomy Tube Changes
- •Tube Hygiene
- •Cuff
- •Humidification
- •References
- •Epidemiology
- •Percutaneous Versus Open Surgical Techniques
- •Complications
- •References
- •Oncological Tracheostomy
- •Introduction
- •Vertical Partial Laryngectomy
- •Horizontal Partial Laryngectomy
- •Supraglottic Laryngectomy
- •Supracricoid Laryngectomy
- •Near-Total Laryngectomy
- •Endoscopic Technique
- •Total Laryngectomy
- •References
- •Mediastinal Tracheostomy
- •Introduction
- •History
- •Indications
- •Case Report
- •References
- •Transtumoral Tracheostomy
- •Introduction
- •Patient Approach
- •Surgical Technique
- •Technical Care
- •Complications
- •References
- •Introduction
- •References
- •General Considerations
- •Submental Intubation
- •Dentofacial Deformity Treatment Planning
- •Final Considerations
- •References
- •Cricothyroidostomy
- •Indications
- •Contraindications
- •Ethical Aspects
- •Anatomical Considerations
- •Procedure
- •Precautions
- •Surgical Cricothyroidostomy
- •Puncture Cricothyroidostomy (Seldinger Technique)
- •Prehospital Care
- •Hospital Care
- •Complications
- •Concluding Remarks
- •References
- •Indications for Performing Tracheostomy in the Intensive Care Unit: When and Why?
- •Introduction
- •Indications, Advantages, and Disadvantages of Tracheostomy
- •Indications
- •Benefits and Disadvantages
- •When to Perform Tracheostomy
- •Important Exceptions
- •Moderate and Severe Traumatic Brain Injury
- •After Cardiac Surgery
- •Amyotrophic Lateral Sclerosis
- •Tracheostomy Techniques, Complications Related to the Procedure, and Contraindications
- •Conventional (Open) Tracheostomy
- •Preparation of the Patient
- •Incision and Access to the Trachea
- •Tracheal Incision and Cannula Insertion
- •Percutaneous Techniques
- •Technique, Preparation, and Access to the Trachea
- •Conventional Versus Percutaneous Techniques
- •Complications Related to the Procedure
- •The following complications can occur, related to the presence of the cannula [1, 3–5, 11, 12, 25, 26, 32, 33]:
- •Contraindications
- •References
- •Considering the best place to do a Tracheostomy: At the Bedside or in the Operating Room?
- •Costs
- •Complications
- •Caveats and Pitfalls of Operating Room Versus Intensive Care Unit Tracheostomy
- •Bedside or Operating Room Tracheostomy?
- •References
- •Tracheostomy Complications
- •Transoperative Complications
- •Bleeding
- •Pneumothorax
- •Esophageal Perforation
- •Recurrent Laryngeal Nerve Injury
- •Cardiopulmonary Resuscitation
- •Pneumomediastinum
- •Combustion
- •Early Complications
- •Cannula Obstruction
- •Displacement of the Tracheostomy Tube
- •Bleeding
- •Surgical Wound Infection
- •Subcutaneous Emphysema
- •Late Complications
- •Tracheal Stenosis
- •Tracheomalacia
- •Tracheoinnominate Fistula
- •Tracheoesophageal Fistula
- •Pneumonia
- •Aspiration
- •References
- •Introduction
- •Discussion
- •Pathophysiology
- •Causes
- •Risk Factors
- •Sites of Larynx and Tracheal Lesions
- •References
- •Introduction
- •History
- •Airway Assessment
- •Medical History
- •Physical Examination
- •Preoxygenation
- •Bag Mask Ventilation
- •Direct Laryngoscopy
- •Laringoscopy Technique
- •Laryngoscope Design
- •The Cormack–Lehane Grade View
- •Laryngeal Mask
- •Insertion Technique
- •Other Supraglottic Devices
- •Videolaryngoscopes
- •Truview
- •GlideScope
- •C-MAC
- •McGrath
- •King Vision
- •VividTrac
- •Airtraq
- •Fiberoptic Bronchoscope
- •Difficult-Airway Algorithms
- •Disclosure
- •References
- •Bronchoscopy Before and After Tracheostomy
- •Introduction
- •General Bronchoscopy Indications
- •Legislation and Competency
- •Instruments
- •Summary of the Bronchoscopy Technique in General (Including in Tracheostomized Patients)
- •Role of Bronchoscopy Before and After Tracheostomy
- •Guidance During Percutaneous Tracheostomy
- •Evaluation of Tracheostomized Patients in Postoperative Surgery of the Airways
- •Aspiration, Collection, and Tracheobronchial Biopsies
- •Evaluation of the Position and Adequacy of the Tracheostomy Cannula
- •Diagnosis and Treatment of Possible Complications After Tracheostomy
- •Diagnosis of Tracheoesophageal Fistula
- •Resection of Tracheal Granulomas
- •Posttracheal Intubation and Posttracheostomy Stenosis
- •An Integral Part of the Scheduled Decannulation Protocol
- •Aspiration of Foreign Bodies
- •Diagnosis and Staging of Synchronic and Metachronous Lesions of the Distal Airways
- •Tracheobronchoscopy
- •Alternatives to Bronchoscopy
- •References
- •Introduction
- •Tracheostomy Care
- •Cannula Fixation
- •Resuscitation Procedure
- •Suction
- •Humidity
- •Emergency Kit
- •Pulmonary Protection
- •Complications
- •Accidental Decannulation or Tube Displacement
- •Pneumothorax
- •Hemorrhage
- •Obstruction
- •Pulmonary Emphysema
- •Infection
- •Humidification
- •Feeding/Swallowing
- •Speech/Voice
- •Comments
- •Websites Consulted
- •References
- •Introduction
- •Decannulation
- •Final Considerations
- •References
- •Rehabilitation After Tracheostomy
- •Introduction
- •Swallowing
- •Oral Communication
- •Tracheoesophageal Prosthesis
- •Vibrating Larynx or Electronic Larynx
- •References
- •Index

Terence Pires de Farias
Editor
Tracheostomy
A Surgical Guide
123

Tracheostomy

Terence Pires de Farias
Editor
Tracheostomy
A Surgical Guide

Editor
Terence Pires de Farias, M.D., Ph.D., M.Sc., Researcher
National Cancer Institute
INCA, Rio de Janeiro, Brazil
ISBN 978-3-319-67866-5 ISBN 978-3-319-67867-2 (eBook)
https://doi.org/10.1007/978-3-319-67867-2
Library of Congress Control Number: 2017964088
© Springer International Publishing AG 2018
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microlms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims
in published maps and institutional afliations.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

I dedicate this book to all patients
suffering from head and neck cancer or
any serious illness that causes an ICU
hospitalization and requires a temporary
or permanent tracheostomy. I especially
dedicate it to my wife Izaura and our
beloved Valentina, the most important
part of our lives; to my parents, who
have always boosted me in my career;
and nally, to my preceptors, who taught
me the art of head and neck surgery,
allowing me to disseminate this information to the younger generations.
Terence Pires de Farias
v

Foreword
Surgical procedures range from safe and simple to extremely complex, technically
demanding, and potentially life-threatening. In this realm, tracheostomy is often
thought of as a mundane topic for discussion because it is a relatively safe, simple,
and often lifesaving procedure. However, if embarked upon without foresight,
proper planning, and an assessment of the clinical scenario (including the patient,
problem, anatomy, and pathology), without adequate support, or in a suboptimal
environment, tracheostomy can be a very hazardous and potentially life-threatening
procedure. Dr. Terence Farias and his coauthors are to be commended for assembling this comprehensive and exhaustive treatise on the topic of tracheostomy. Their
knowledge, wisdom, judgment, and experience are reected in each chapter.
The book begins with an interesting chapter on history, in which the authors
delve into the detailed anatomy of the trachea. Photographs of cadaver dissection
are accompanied by beautiful artwork to illustrate the anatomy. An exhaustive listing of tracheostomy tubes and their specic indications follows. A series of chapters
on surgical technique follows, describing conventional and percutaneous procedures in great detail. The advantages, disadvantages, pearls, and pitfalls of both
approaches are discussed.
The next chapters address the specic scenarios and indications for tracheostomy, with detailed discussions on the specic issues pertaining to each condition.
Throughout these chapters, photographs of case examples and artwork are included
to illustrate the issues. The remaining chapters in the techniques section focus on
tracheostomy and cricothyrotomy in trauma and orthognathic surgery, including the
appropriate place to perform the procedure—either bedside, in the intensive care
unit, or in the operating room. Furthermore, an important chapter on difcult endotracheal intubation addresses management of the difcult airway. The nal chapters
deal with complications, postoperative care, rehabilitation, and decannulation.
This comprehensive text on tracheostomy covers the depth and breadth of the
topic. The book is a “must read” for the surgical trainee, while also being a superb
reference for surgeons and anesthesiologists who are faced with a difcult airway or
vii

viii
Foreword
a challenging tracheostomy. Thus, this book should have a denite place in the
libraries of medical schools, hospitals, departments of surgery and anesthesia, and
even in the operating room, intensive care unit, and emergency rooms. The text is an
invaluable resource on this common but occasionally difcult operation.
Jatin Shah, M.D., Ph.D. (Hon), D.Sc. (Hon)
Head and Neck Oncology
Memorial Sloan Kettering Cancer Center
New York, NY, USA

Contents
The History ofTracheostomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Sissi Monteiro, Terence Pires de Farias, Marcelo de CamargoMillen,
and Rafael Vianna Locio
Anatomy oftheTrachea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Juliana Fernandes de Oliveira, Terence Pires de Farias, Juliana Maria
de AlmeidaVital, Maria Eduarda Gurgel da TrindadeMeiraHenriques,
Maria Alice Gurgel da TrindadeMeiraHenriques, and Maria Eduarda
Lima de Moura
Tracheostomy Tube Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Juliana Maria de AlmeidaVital, Fernando Luiz Dias, Maria Eduarda
Gurgel da TrindadeMeiraHenriques, Maria Alice Gurgel da
TrindadeMeiraHenriques, Maria Eduarda Lima de Moura, and Terence
Pires de Farias
Tracheostomy: Conventional Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Adilis Stepple da Fonte Neto, Terence Pires de Farias, Juliana Maria
de AlmeidaVital, Jose Gabriel Miranda da Paixão, Juliana Fernandes
de Oliveira, and Paulo Jose de CavalcantiSiebra
Percutaneous Tracheostomy Indications andSurgical Technique . . . . . . . 77
Lucio Pereira and Catherine Lumley
Percutaneous Tracheostomy: Pearls andPitfalls, andHow toCreate
a“Hand-On” Training Program Course . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Marianne Yumi Nakai, Marcelo Benedito Menezes, Norberto Kodi
Kavabata, Alexandre Baba Suehara, Antonio Augusto T. Bertelli, William
Kikuchi, and Antonio José Gonçalves
Conventional or Percutaneous Tracheostomy? . . . . . . . . . . . . . . . . . . . . . . 119
Lúcio Noleto, Thiago Pereira Diniz, and Terence Pires de Farias
Pediatric Tracheostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Pedro Collares Maia Filho, Marcelle Morgana Vieira de Assis,
and Terence Pires de Farias
ix

x
Contents
Tracheostomy andObesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
André Leonardo de CastroCosta, Marcus Antônio de MelloBorba,
Daniela Silva Santos, and Terence Pires de Farias
Oncological Tracheostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Carlos Eduardo Santa Ritta Barreira, Marina Azzi Quintanilha, Terence
Pires de Farias, Jose Gabriel Miranda da Paixão, Juliana Fernandes de
Oliveira, Fernando Luiz Dias, and Paulo Jose de CavalcantiSiebra
Mediastinal Tracheostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Paulo José de CavalcantiSiebra, Ruiter Diego de MoraesBotinelly,
Terence Pires de Farias, Alexandre Ferreira Oliveira,
and Fernando Luiz Dias
Transtumoral Tracheostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Dorio Jose Coelho Silva, Ricardo Mai Rocha, Terence Pires de Farias,
and Rafael ViannaLocio
Tracheostomy andRadiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Célia Maria Pais Viégas, Diego Chaves Rezende Morais, and Carlos
Manoel Mendonça de Araujo
Tracheostomy inOrthognathic Surgery andFacial Trauma Surgery:
Is There aPlace? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Ricardo Lopes da Cruz, Fernando Cesar A. Lima, and Antônio
Albuquerque de Brito
Cricothyroidostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Adriana Eliza Brasil Moreira, Rodrigo Gonçalves, João Lisboa de
SousaFilho, José Francisco de SalesChagas, Maria Beatriz Nogueira
Pascoal, and Ricardo Alexander Marinho da Silva
Indications forPerforming Tracheostomy intheIntensive Care Unit:
When andWhy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Carlos Eduardo Ferraz Freitas, Gustavo Trindade Henriques-Filho,
Marcos Antonio Cavalcanti Gallindo, Maria Eduarda Gurgel da
TrindadeMeiraHenriques, Maria Alice Gurgel da
TrindadeMeiraHenriques, and Maria Eduarda Lima de Moura
Considering the best place to do a Tracheostomy: At theBedside
orintheOperating Room? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Jose Gabriel Miranda da Paixão, Jorge Pinho Filho, Fernando Luiz Dias,
Adilis Stepple da Fonte Neto, Juliana Fernandes de Oliveira,
and Terence Pires de Farias
Tracheostomy Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Gabriel Manfro, Fernando Luiz Dias, and Terence Pires de Farias

Contents
Predicting Factors forTracheal Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Paulo Soltoski, Paola Andrea Galbiatti Pedruzzi,
and Monique Pierosan Cardoso
Difficult Intubation: How toAvoid aTracheostomy . . . . . . . . . . . . . . . . . . 335
Ronald Lima, Leonardo Vianna Salomão, and Pedro Rotava
Bronchoscopy Before andAfter Tracheostomy . . . . . . . . . . . . . . . . . . . . . . 363
Marcus Antônio de MelloBorba, André Leonardo de CastroCosta,
Daniela Silva Santos, and Terence Pires de Farias
What Is theBest Way toTake Care ofaPatient
withaTracheostomy Tube? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
Lica Arakawa-Sugueno
When andHow toRemove aTracheostomy . . . . . . . . . . . . . . . . . . . . . . . . . 391
Priscila Rodrigues Prado Prado Zagari and Roberta Melo Calvoso Paulon
Rehabilitation After Tracheostomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
Priscila Rodrigues Prado Prado Zagari, Roberta Melo Calvoso Paulon,
and Luciana Paiva Farias
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
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