Résumé
La trachéotomie est un geste fréquemment pratiqué en réanimation dans des indications diverses en relais de l’intubation. Malgré les nombreux avantages qu’on lui reconnait, la trachéotomie est source de complications. Réévaluer son intérêt et procéder à la décanulation dès que possible est donc un enjeu majeur. L’intervention d’équipes spécialisées multidisciplinaires, l’utilisation de protocoles standardisés, améliorent le suivi et favorisent la décanulation plus précoce. Celle-ci est possible si plusieurs conditions sont réunies : la pathologie ayant motivé la trachéotomie doit être résolue, le statut neurologique compatible, le patient stable cliniquement, les voies aériennes libres, le patient capable d’expectorer et le risque d’inhalation écarté. L’évaluation de ces différentes étapes passe par la compréhension et l’évaluation de fonctions telles que la toux, la déglutition et la parole. Par ailleurs, en cas d’impossibilité de sevrage de la trachéotomie, il est possible d’améliorer notablement le confort des patients trachéotomisés en leur donnant accès pendant cette période à la parole et l’alimentation orale notamment. Ceci doit être un enjeu pour tout praticien prenant en charge des patients trachéotomisés.
Abstract
Tracheostomy is a common intensive care procedure performed for a variety of reasons in intubated patients who require prolonged airway access. Despite its many recognized advantages, tracheostomy is associated with complications. A reappraisal of the usefulness of this procedure and performance of decannulation as early as possible are therefore key goals. Involvement of specialized multidisciplinary teams and use of standardized protocols improve patient’s follow-up and chances of earlier decannulation. Candidates for decannulation should meet several criteria including resolution of the condition that required tracheostomy, neurological status consistent with independent breathing, stable clinical status, patent airways, ability to expectorate, and no risk of inhalation. These criteria should be evaluated by assessing coughing, swallowing, and speech functions. If weaning off the tracheostomy is not feasible, patient comfort can be improved by allowing speech and oral feeding, particularly when cannula is in place. This concern should be the main goal of all physicians providing care to tracheostomized patients.
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Brunet, J., Dufour-Trivini, M., Sauneuf, B. et al. Gestion de la décanulation : quelle prise en charge pour le patient trachéotomisé ?. Réanimation 24, 20–28 (2015). https://doi.org/10.1007/s13546-014-1007-5
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DOI: https://doi.org/10.1007/s13546-014-1007-5