96 Percutaneous Tracheostomy	777

2.Procedure

•The deflated-cuff tracheotomy occlusion procedure

–Occlude the opening of the tube with the cuff deflated by a gloved finger observing the patient for objective signs of respiratory distress.

–In case of problems, promptly return the patient to breathing through the tracheotomy tube and perform a fiberendoscopic examination to check for upper airway obstruction.

–If no lesions are present, consider whether the tube is not too large and try again after changing the tube.

The tube can be removed, and the opening is covered with sterile dressings. The wound spontaneously heals in 10 days in most cases.

• Use tracheotomy button or speech valve in patients with prolonged tracheotomy.

Suggested Reading

1.De Leyn P, Bedert L, Delcroix M, Depuydt P, et al. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg. 2007;32:412–21.

Guidelines are developed by the Belgian Society of Pneumology and the Belgian Association for Cardiothoracic Surgery on tracheotomy for mechanical ventilation in adults.

2.Heffner JE. Tracheostomy application and timing. Clin Chest Med. 2003;24:389.

This review discusses the indications of tracheostomy and various types of the procedure along with advantages and disadvantages of one over the other.

3.Al-Ansari MA, Hijazi MH. Clinical review: percutaneous dilatational tracheostomy. Crit Care. 2006;10:202.

This review discusses the general issues related to PCT and the evidence-based recommendations, using the best available evidence, relating to various issues.

4.deBoisblanc BP. Percutaneous dilational tracheostomy techniques. Clin Chest Med. 2003;24:399–407.

This study discusses the various types of techniques developed over the years and their pros and cons and their comparison to the open procedure.

5.Ernst A, Critchlow J. Percutaneous tracheostomy—special considerations. Clin Chest Med. 2003;24:409–12.

A part of the review series in the journal which describes the efficacy of the procedure in special conditions considered to be contraindications to PCT.

6.Angel LF, Simpson CB. Comparison of surgical and percutaneous dilational tracheostomy. Clin Chest Med. 2003;24:423–29.

This review includes previous data relating to comparison of open tracheostomy to open procedure, the safety profile, and other benefits of one over the other.