Indications
Emergency tracheostomy
It is performed due to an anatomic obstacle preventing the establishment of a secure airway.
Planned tracheostomy
Prolonged endotracheal intubation can result in tracheal stenosis presumably due to ischemic injury of the trachea. Converting a patient from endotracheal intubation to tracheostomy should be considered if the patient has failed weaning on several attempts, if extubation trials have not been successful, or if the patient will require prolonged ventilator support. Benefits include easier access for tracheobronchial suctioning, patient comfort, lower or no sedation is needed, better patient communication, lower work of breathing, and management outside the ICU. The generally accepted standard is that patients should not have endotracheal tubes for longer than 14–21 days.
Procedure
Tracheostomy is performed by an ENT surgeon or general surgeon. The procedure may be performed in the operating room or at the bedside. One modern technique utilizes a fiberoptic scope to localize from inside the desired location. The surgeon then makes the external incision using the light source as the guide. Immediately after the tracheostomy is performed, the tube is vulnerable to being dislodged. Usually it is secured with ties to the skin. After about one week a tract will mature and the tube can be removed and re-inserted with minimal expertise. This permits training of the patient or family to care for the tracheostomy and clean the tube.
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