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Estenose traqueal pós-traqueostomia : uma complicação evitável?
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A traqueostomia é um procedimento comum nas Unidades de Cuidados Intensivos (UCI), que representa uma forma adequada de manutenção da via aérea. Esta pode ser realizada cirúrgica ou percutaneamente e, apesar de ainda estar em debate qual a técnica mais segura, bem como o timing ideal para a realização do procedimento, apresenta um considerável conjunto de vantagens em pacientes que necessitam de suporte ventilatório prolongado, com melhoria do respetivo conforto. Porém, à semelhança de todos os procedimentos invasivos, a traqueostomia não é isenta de complicações, sendo a estenose traqueal uma delas. As estenoses traqueais podem apresentar-se com diferentes graus de gravidade e são classificadas como agudas ou crónicas, podendo distinguir-se consoante o local da traqueia onde têm origem. O perfil típico do doente com estenose traqueal é o de uma mulher, obesa, com diabetes mellitus e hipertensa. A estenose traqueal pós-traqueostomia é uma complicação que, sendo pouco comum, se apresenta com uma gravidade significativa. Esta tem origem na irritação mecânica causada pelo tubo de traqueostomia na parede da traqueia. Apesar da decrescente incidência da estenose traqueal enquanto complicação de traqueostomia, o estudo da patologia continua a revelar-se um ponto essencial para prevenir a sua ocorrência através de medidas simples e ligadas ao procedimento da traqueostomia que podem salvar vidas.
Tracheostomy is a common procedure in the Intensive Care Units (ICU) and an adequate form of airway support. It can be performed surgically or percutaneously, and although the discussion on which technique to be the safest or its ideal timing has yet to come to a conclusion, it shows a considerable set of advantages in patients in need of prolonged ventilator support, including improving their comfort. It is not, however, free of complications, as it is an invasive procedure. Tracheal stenosis is one of these complications and may have different presentations, more or less severe. It is classified as acute or chronic and distinguished according to the place in the trachea where the stenosis had its origin. Its patient typical profile is the one of woman, obese, with diabetes mellitus and hypertension. Tracheal stenosis post-tracheostomy is a significantly severe complication, despite being uncommon, and results of the mechanical pressure caused by the tracheostomy tube on the tracheal wall. Regardless of the decreasing incidence of tracheal stenosis as a tracheostomy complication, the study of its pathology remains a crucial point in preventing its occurrence through simple measures related to the tracheostomy procedure that can save lives.
Tracheostomy is a common procedure in the Intensive Care Units (ICU) and an adequate form of airway support. It can be performed surgically or percutaneously, and although the discussion on which technique to be the safest or its ideal timing has yet to come to a conclusion, it shows a considerable set of advantages in patients in need of prolonged ventilator support, including improving their comfort. It is not, however, free of complications, as it is an invasive procedure. Tracheal stenosis is one of these complications and may have different presentations, more or less severe. It is classified as acute or chronic and distinguished according to the place in the trachea where the stenosis had its origin. Its patient typical profile is the one of woman, obese, with diabetes mellitus and hypertension. Tracheal stenosis post-tracheostomy is a significantly severe complication, despite being uncommon, and results of the mechanical pressure caused by the tracheostomy tube on the tracheal wall. Regardless of the decreasing incidence of tracheal stenosis as a tracheostomy complication, the study of its pathology remains a crucial point in preventing its occurrence through simple measures related to the tracheostomy procedure that can save lives.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Traqueostomia Estenose Prevenção Otorrinolaringologia