耳鼻咽喉科: オープンアクセス

抽象的な

Harmonious Team Approach for Safe Airway Management -The Keio University Experience-

Haruna Yabe ,Koichiro Saito *,Kosuke Uno ,Takeyuki Kono ,Hiroshi Morisaki ,Kaoru Ogawa

Surgical Tracheostomy (ST) has been a standard procedure for surgical airway management for a long time. Recently, Percutaneous Dilatational Tracheostomy (PDT) is getting more and more popular in the US and Europe in this field. In Japan, PDT is becoming well-known following the trend in other countries mainly due to its relatively easy procedure even for non-surgeons to secure the airway. However, part of the multidisciplinary participants in preparing/ performing tracheostomy and postoperative care do not have opportunities to understand the (contra) indications of PDT, or to precisely learn the technical difference between ST and PDT. Furthermore, instruction for use is hard to be strictly followed in diverse situations to potentially induce multiple accidents.

In our institution, PDT was adopted under the collaboration between anesthesiologists and otolaryngologists in January 2008. However, at that time, responsibilities and roles of every participant engaged in the tracheostomy were not clarified, while multiple responsible decisions were necessary for harmonious procedure, e.g. necessity of tracheostomy for the candidate, timing to perform the procedure, selection of proper surgical procedure, and the place where the tracheostomy should be performed. Considering such a muddled situation, we organized a committee consisted of surgeons, anesthesiologists, nurses and administrative organizers to comprehend the recent complicated situations surrounding tracheostomy. The final purpose of organizing the committee was to build a unique intramural rule to prepare and perform elective tracheostomy safely and harmoniously.

In this communication, multiple issues to produce the present confused situation for harmonious elective tracheostomy are summarized. We show our current intramural protocol for elective tracheostomy, delivered in July 2010, which clarifies the sequential role and responsibility of every multidisciplinary participant at each indispensable decision for safe procedure. Furthermore, current practice of tracheostomy in our institution, especially in the intensive care unit, was assessed.