Prise en charge des patients trachéotomisés dans l'environnement hospitalier

Prevalence rate of tracheostomised patients reaches around 10% in intensive care unit. Although the best timing to perform tracheostomy is difficult to define, it is never considered before the 4th day of mechanical ventilation (except in the case of burned and cervicofacial traumatised patients). In intensive care unit patients, bedside percutaneous dilational tracheostomy is to be preferred. The procedure should exclusively be performed by experienced staffs following a predetermined protocol. Choosing the proper size of tracheostomy cannula is critical and relies on the targeted objectives of the tracheotomy. These objectives may vary over time depending on whether patients need a continuous mechanical support or whether they are in the weaning period. Final removal of the tracheostomy tube (tracheostomy decannulation) is a crucial step that remains at risk of complications. The decision of decannulation results from a tight collaboration between medical and paramedical teams (ENT, physiotherapist, intensivist, etc.). When tracheostomy decannulation remains compromised, patients should be referred to long-term ventiliation weaning centers.