Tracheotomy in Patients with Increased Intracranial Pressure

Abstract

Severe neurological deficits often necessitate to secure the airway via a tracheostoma. When planning the tracheotomy, it should be noted that in the acute phase of severe brain damage due to impaired cerebral autoregulation, further ischemia-related brain damage is possible. Increases in cerebral pressure, arterial hypotension and hypoxia can worsen the outcome of brain-injured patients both immediately after the initial damage and in the further course. Therefore, absolute priority is given to maintaining optimal cerebral blood flow and avoiding ischemia. After a discussion of the physiology and pathophysiology of cerebral pressure, its monitoring and the identification of therapeutic goals, special aspects of tracheotomy in patients with severe brain damage are presented, including optimal times, risk assessments and appropriate techniques. Perioperative dangers under the aspects of positioning, anesthesiological procedure and special respiratory medical features are described comprehensively, and practical ways of avoiding them are presented.