الفهرس 
ABSTRACTOnly 14 pages are availabe for public view
 |  | from | 127 |  |  |
| | | from | 127 | | |
Abstract
Tracheostomy, as C1 means of airway access, with advances In technology and increasing interest in minimally invasive procedures and variations of the standard open tracheostomy, has evolved over the last half century. Since Ciaglia et a1. in 1985 introduced the Percutaneous Dilatational Tracheostomy (PDT), Percutaneous Tracheostomy (PCT) has become increasingly popular and has gained widespread acceptance in many ICU and trauma centers as a viable alternative approach. In the ICU, the most common indications for tracheostomy is a need for prolonged mechanical ventilation. These needs may arise from pneumonia refractory to treatment, severe chronic obstructive pulmonary disease, acute respiratory distress syndrome, severe brain injury, or multiple organ system dysfunction. Tracheostomy is indicated for
prolonged ventilatory support, long-term airway maintenance, and to prevent the complications of long-term translaryngeal intubation. Indications for Percutaneous Tracheostomy (PCT) are the same as those for standard open tracheostomy.
The percutaneous techniques developed not long after Seldinger described needle replacement over a guidewire for arterial catheterization in 1953. In 1955, Sheldon et a1. reported the first attempt to perform percutaneous tracheostomy. They gained airway access with a slotted needle that then was used to guide a cutting trocar into the trachea. Currently, the technique by Ciaglia et a1. in 1985 is the most widely applied. Originally, Ciaglia et a!. described the point of entry to be
subcricoidal; however, this was found to be too high, with a risk of
subglottic stenosis. Therefore, the preferred site of entry is now between the first and the second or the second and third tracheal rings. Initial skin.