Practical considerations

Minitracheostomy can be a very quick procedure, but the confused or hypoxic patient will still find it unacceptable, and it is potentially difficult and dangerous if the patient is restless. It is better to intubate such borderline cases and consider minitracheostomy at the time of extubation when the airway is safe. A bleeding diathesis or concomitant dialysis is a contraindication to this method without correction of coagulation; one life-threatening hemorrhage of a patient on anticoagulants has been described. Patients with chronic obstructive pulmonary disease can often only manage sitting up and are prone to coughing bouts; the introduction of blood in the airway can rapidly induce bronchospasm. Each case needs careful appraisal to balance this risk; basically, if the patient can cough, minitracheostomy should be avoided.

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