From the classroom to the emergency room, OR and beyond.

You're joining trauma ICU rounds with your host, Dr. Dennis Kim.

Welcome back to trauma ICU rounds.

Today on rounds, I wanted to spend some time discussing tracheostomies, which are very common, if not the most common procedure, performed

in critically ill patients requiring long-term mechanical ventilatory support, and in fact was

one of the very first surgical procedures that I participated in as a medical student at the

bedside in the ICU. Trakes may provide our patients with a host of benefits above and beyond being much

more comfortable and better tolerated than, say, a polyvonacloride tube shoved down your throat.

These benefits may include but are not limited to the potential for decreased work of breathing,

decrease vent days, and shorter ICU as well as overall hospital length of stay.

Now, there have been multiple prospective randomized controlled trials looking at the timing

of tracheostomy.

And early versus late trache as well as the primary outcome measures have varied across

these studies.

But for the purposes of our discussion

today, I do want to talk about two trauma populations specifically when we get into the

indications and timing for tracheosomies. As is the case with any surgical procedure,

performance of a tracheosomy is accompanied by the potential for several early and delayed complications,

some of which may be potentially fatal, if not managed properly, or if there's a delay in

recognition. Further, identification of high-risk factors preoperatively may influence our

decision to proceed via an open versus procutaneous approach.

So we have three key objectives for today's discussion, and by the end of rounds, you

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