Principles and Practice of Percutaneous Tracheostomy PDF

Principles and Practice of Percutaneous Tracheostomy PDF



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Preface

Tracheostomy is one of the most commonly performed surgical procedures in intensive care unit patients and is indicated when airway protection, airway access or mechanical ventilation are needed for a prolonged period. Tracheostomy also facilitates weaning from the ventilator. Since its inception tracheostomy has remained in the domain of surgeons. Many a times the anesthesiologists or intensive care physicians looking after these patients get frustrated due to non-availability of the surgeon, operation room or encountered difficulties in shifting critically ill patients to operation room. This may have delayed timely formation of tracheostomy in needy patients. Anesthesiologists are supposed to be master in the art of airway management; however, dependency on surgeons to establish airway by surgical means gives a sense of incompleteness. With the advent of percutaneous dilatational tracheostomy (PDT), a bedside procedure, another much needed tool in airway management has been added in the armamentarium of anesthesiologists and intensive care physicians. Not only this, the PDT is gradually proving its superiority over surgical tracheostomy in many ways.
Over the last two decades surgical tracheostomy has largely been replaced by the PDT and more and more such procedures are being carried out worldwide. In early 1990s, when I was working as Anesthetic Registrar at Ulster Hospital, Dundonald, UK, my esteemed consultant Dr JM Murray, MD, FFARCSI taught me this procedure and I owe everything to him about this wonderful art of minimally invasive airway access. At that time, there were only two types of percutaneous tracheostomy kits: the Ciaglia’s multiple dilators and Griggs guidewire dilating forceps. Presently, a number of PDT kits and techniques are available for clinical use and it is likely that further developments will take place in this field of airway
access.
Advancement in readily available techniques of bedside percutaneous tracheostomy has carried respiratory therapy to a heightened level. Regrettably, many physicians remain ignorant of these clinically relevant advances and management of percutaneous tracheostomy and tracheostomized patients. Therefore, it is prudent to provide thorough knowledge of this important procedure to our trainees and colleagues who have been working in the field of anesthesia, intensive care unit, high dependency unit and pulmonary medicine. In this book I have tried to include all important and different PDT techniques available at present. There are various chapters written by guest authors’ who have immensely contributed to the development and refinement of this novel technique. I sincerely hope that this comprehensive text on percutaneous tracheostomy alongwith relevant illustrations and pictures will be useful to the consultant anesthesiologist, intensivist, internist, chest physician, ENT surgeons and trainee residents.


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