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Tracheostomy

Appropriateness and Indications in Cancer Patients
  • Macarena R. VialEmail author
  • Joseph L. Nates
Reference work entry

Abstract

Increased survival in cancer patients and increased use of immunosuppressive treatments has resulted in a higher number of cancer patients admitted to intensive care units (ICUs). Tracheostomy is the most commonly performed procedure in ICUs, so the question of the appropriateness of tracheostomy is one clinicians will face even more in the coming years. The main benefits of tracheostomy in critically ill cancer patients are often clear in cases with upper airway obstruction, but this is not the case in prolonged mechanical ventilation. The main benefit appears to be an overall reduction in the duration of mechanical ventilation. In order to maximize this benefit, tracheostomy should be performed as early as possible, but unfortunately, clinicians are not good at predicting who will require prolonged mechanical ventilation. Therefore, the benefit has to be weighed against the risk of performing unnecessary procedures, and ideally, it should not be performed before 7 days of endotracheal intubation. Finally and more importantly, appropriateness will depend on the overall plan of care and prognosis of the underlying malignancy.

Keywords

Tracheostomy Acute respiratory failure Mechanical ventilation Percutaneous tracheostomy Airway obstruction 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Interventional Pulmonology UnitClínica Alemana de Santiago-Universidad del DesarrolloSantiagoChile
  2. 2.Servicio de Enfermedades Respiratorias, Unidad de Neumologia IntervencionalClínica Alemana de SantiagoVitacura, SantiagoChile
  3. 3.Department of Critical Care and Respiratory CareThe University of Texas MD Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Yenny Cardenas
    • 1
  1. 1.Critical Care DepartmentUniversidad del Rosario Hospital Universitario Fundacion Santa Fe deBogotaColombia

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