A variety of complications resulting from tracheostomy placement have been described. The most frequent causes of death in tracheostomy patients are obstruction and haemorrhage. Other additional benefits are represented by facilitation of nursing care, more efficient suction of respiratory secretions and better patient’s comfort, swallowing and early phonation 21, 22, although it is an invasive procedure with intrinsic technical risks 23– 27. It has also been reported to lower the mortality rate 17– 19 and to prevent complications of a prolonged orotracheal intubation 20. Tracheostomy have several advantages respect translaryngeal endotracheal intubation: its might improve the weaning period through decreases respiration work and facilitate weaning by reducing airway resistance and need for less sedation 14– 16. The frequency of tracheostomy varied widely according the hospitals (0–60 %) and was associated with the policy of hospitals to accept or refuse tracheostomized patients on their normal wards 11, and is predicted to become more common as demand for intensive care services increases 12, 13. Most tracheostomies were performed during the 2nd week of ventilation. A retrospective nation-wide survey study reveal that the prevalence of tracheostomy was 10% in the ventilated patients under mechanical ventilation for more 24 hours. Tracheostomy is a technique frequently performed on critically ill patients with respiratory failure who requiring prolonged mechanical ventilation. A tracheostomy is the formation of an artificial opening into the trachea between two adjacent rings of cartilage, with the aim of facilitate weaning from mechanical ventilation by decreasing anatomical dead space, prevention / treatment of retained tracheo-bronchial secretions or bypass upper airway obstruction. Tracheostomy is one of the oldest surgical procedures and was first successfully performed in the late 19 th century. It is directly correlated with the level of the injury and the degree of motor completeness in cervical spinal cord injured patients, and related with direct chest trauma in thoracic spinal cord injured patients 3, 4. Tracheostomy is performed more frequently when the spinal cord injury is at cervical level. For these reasons, tracheostomy is frequently performed in these patients 5, 10. Patients with cervical SCI frequently need prolonged mechanical ventilation as a result of worsening pulmonary vital capacity due to paralysis of respiratory muscles, severe impairment of tracheobronchial secretions clearance and high incidence of respiratory complications like pneumonia or atelectasis, 3, 6– 9. An injury in cervical spinal cord causes tetraplegia and prolonged respiratory failure due to paralysis of the respiratory muscles, through to loss of function of the corticospinal ways and the second motor neuron injury 5. Respiratory insufficiency is the most common early complication and the primary cause of death both in the acute and chronic phases of recovery from SCI 2– 4. Approximately half of these patients suffer cervical spinal cord injury (SCI) 1. It is estimated that approximately 40 new traumatic spinal cord injuries are produced annually per million population in the U. Tracheostomy can be removed when no longer needed without major complications. Tracheostomy can be performed just after anterolateral cervical spine fixation surgery. Tracheostomy should be implemented as soon as possible in SCI patients they require prolonged mechanical ventilation. Percutaneous technique, performed in the ICU, should be considered the preferred procedure for performing elective tracheostomies in spinal cord injured patients. For these reasons, tracheostomy is frequently performed in these patients, more frequently when the spinal cord injury is at cervical level. Patients with thoracic spinal cord injury may need mechanical ventilation due to associate injuries. Patients with cervical spinal cord injury frequently need prolonged mechanical ventilation as a result of worsening pulmonary vital capacity due to paralysis of respiratory muscles, severe impairment of tracheobronchial secretions clearance and high incidence of respiratory complications like pneumonia or atelectasis.
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