20 Percutaneous Tracheostomy

Question 1

Indications for performing a Trache

Answer 1

1. Provide Airway during & after surgical procedures
   (craniofacial / oropharyngeal/ Laryngeal / neck diss)
2. Aid weaning from MV
3. Facilitate suctions of secretions
   Prevent aspiration or LRTI
4. Bypass upper airway obstruction -
   2nd to Tumour
   Inflammation
5. Long term resp support
   NM disorder
   SC injury

Question 2

Perc trach

advantages

Answer 2

Relative quick in experienced hands

Avoid need transfer ETT from ITU

Not require presence surgeons to perform

Question 3

Perc Trach

Disadvantages

Answer 3

Subopt conditions manage bleeding
especially injury to major vessel

Blind Technique incorrectly positioned

Tracheal ring fracture risk post dila

Late tracheal stenosis
as with surg trach

Lack surgical dissection 
increase risk vascular / thyorid injury
** difficult patients
Prev neck surgery
obesity
reduced movements

Question 4

Relative C/I performing perc technique

Answer 4

1. <12
2. Coagulatophy
3. Localised infection
4. Local Malignany
5. Unstable C spine
6. Difficult palpable anatom (BMI)
7. Gross anatomical distortion
   Goitre
8. Prev neck surg
   incl Trach
9. Prev Radtx
10. Burns
11. High vent support
    P>15
    FiO2>60