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What are the advantages of endotracheal tube and tracheostomy tube?

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Update time : 2021-07-08 11:37:58
What are the advantages of endotracheal tube and tracheostomy tube?

Tracheotomy tube and endotracheal tube both have their own advantages (Table 2-9). Many patients can tolerate tracheal intubation for several weeks without complications. However, long-term endotracheal intubation increases the risk of epiglottis injury, and tracheotomy intubation increases the risk of tracheal stricture. Compared with tracheal intubation, the advantages of tracheotomy are: easy airway treatment, can provide more reliable airway than tracheal intubation, reduce accidental extubation rate, and improve patient comfort. Patients can tolerate tracheotomy better than oral endotracheal intubation, so the use of sedatives can be reduced and benefited. Early switch to oral feeding can reduce oropharyngeal trauma and facilitate communication with patients, and reduce the application of sedatives. Although some studies have reported that compared with oral endotracheal intubation, the incidence of ventilator-associated pneumonia (VAP) in patients with tracheotomy is reduced, but this effect is inconsistent in different studies. Most studies have methodological problems. Some patients who cannot be withdrawn from the ventilator may successfully withdraw from the ventilator completely after the tracheotomy. This may be related to the lower resistance of the tracheostomy cannula, the smaller ineffective cavity, the increased ability of airway secretion removal and the improvement of patient comfort. Tracheotomy can improve the patient's respiratory mechanics, thereby reducing the work of breathing, but there is no evidence that this is related to the earlier withdrawal of respiratory support, the reduction of weaning time and the shortening of IC:U time. Adverse reactions include tracheal tube displacement, obstruction, dislocation, bleeding, impaired swallowing reflex, tracheal mucosal erosion, granuloma hyperplasia at the incision, and even stenosis of the tracheal sidewall. Tracheotomy is often used in patients who require long-term mechanical ventilation, require long-term airway protection (such as neurological diseases) or cannot be weaned (multiple attempts at extubation). The doctor should consider that the tracheotomy may only increase the short-term survival rate and increase the proportion of survivors who rely on ventilator, and bear the heavy burden of chronic diseases.

The scope of application of tracheotomy has been greatly expanded. In addition to dyspnea caused by upper respiratory tract obstruction, it can also be used for other diseases for the purpose of prevention and treatment. Depending on the severity of the disease, conventional tracheotomy, cricothyrotomy, emergency tracheotomy, rapid tracheotomy, and bronchoscopy or tracheotomy under anesthesia can be used. Percutaneous dilated tracheostomy, as an alternative to conventional surgical tracheotomy, is more and more used. Recent meta-analysis shows that compared with surgical tracheotomy, percutaneous tracheotomy has fewer complications. However, there was no difference in the overall complication rate related to the operating technique. Prospective randomized controlled studies in recent years have shown that percutaneous dilated tracheostomy has a better cost-effectiveness ratio, but there is no difference between ICU stay and hospital stay.