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Research Article | Volume 13 Issue:2 (, 2023) | Pages 1241 - 1247
A Study of Indications of Tracheostomy in Tertiary Care Hospital
Under a Creative Commons license
Open Access
DOI : 10.5083/ejcm
Published
June 2, 2023
Abstract

Background: Tracheostomy derives its name from the Greek word meaning “I cut the trachea” and has probably been known from about 3500 years BC.  Tracheostomy is one of the oldest surgical procedure in which a stoma is created into the anterior wall of trachea and through which a tube is inserted to facilitate breathing.  Chevalier Jackson established the principles of the operation at the beginning of the twentieth century and these still remain in place today. An Elective tracheostomy is the most frequently done procedure especially in Intensive care units (ICU) for those requiring prolonged mechanical ventilation in critically ill patients. About 24% of all patients in ICU need tracheostomy. Tracheostomy allows for patient mobilization, helps in breathing, physical and occupational therapy and decreases the need for sedation when compared to keeping patients intubated for prolonged duration. The most common indication of tracheostomy has changed from amatory causes in the past to prolonged intubation in the present day. Various modifications of the technique of tracheostomy have reduced complications and deaths due to tracheostomy. The purpose of this study is to highlight the indications of tracheostomy in tertiary care hospital in the light of the relevant literature. Methods: The study consists of 150 patients who underwent tracheostomies in a tertiary care hospital including covid positive patients.  Results:  The most common age group undergoing tracheostomy is 61- 70 years (19%) followed 51-60 years of age group (15%). The mean age for present study is 47 years. Male prepordance is seen with a male: female ratio of 2.2:1.  Dyspnea was the main and chief symptom in all cases. In present study the most common indication is prolonged mechanical ventilation (83%) followed by upper airway obstruction (12%). In prolonged mechanical ventilation, most of the tracheostomies were done for tracheobronchial toileting (32%) in head injury (12%) and in patients with lower airway obstruction (COPD, ARDS) (20%) followed by weaning purpose (28%). In present study, in upper airway obstruction (12%) most cases are of subglottic stenosis (4%) followed by benign and malignant lesions of larynx (3%) and corrosive ingestion (2%). In present study, tracheostomies in 5% of patients were done for anesthesia as a prophylaxis in patients with difficult intubation. 30% tracheostomies were done within 7 days of intubation. 27% tracheostomies were done between 7-10 days of intubation. 43% tracheostomies were done after 10 days of intubation.  Conclusion: The most common indication of tracheostomy is prolonged mechanical ventilation. Indication for tracheostomy in acute infective upper airway obstruction is diminished due to early availability of short term airway intubation and high antibiotics.

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