Elective Tracheostomy

Question 1

What does ST stand for?

Answer 1

Surgical Tracheotomy

Question 2

What does PDT stand for?

Answer 2

Percutaneous Dilation Tracheotomy

Question 3

Where is ST usually performed?

Answer 3

In the OR

Question 4

Pt positioning during ST

Answer 4

supine w/ neck extended and elevated shoulders

Question 5

Explain the procedure for ST

Answer 5

Vertical incision over 2nd/3rd ring
thyroid isthmus divided and spread
T-shaped cut for tracheal opening. 2cm horizontal (between 2-3 or 3-4 ring)
then vertical cut through 1-2 distal rings

Question 6

Where is PDT usually performed?

Answer 6

in the ICU on intubated and ventilated pts under deep IV sedation/analgesia

Question 7

Where is the needle puncture usually made?

Answer 7

between the first and second ring

or ideally between the second and third tracheal ring

Question 8

Advantages of PDT over ST

Answer 8

Done in ICU, less OR time, no need for general anaesthesia
Smaller incision=less trauma, less infection risk, less scarring, stabilization ~5 days
Less transfer chances
Less time needed

Question 9

Contraindications to PDT

Answer 9

Absolute: need to stat airway 
Relative: 
infection
children < 12yo
coagulopathy
extreme vent demands
tracheal obstruction
abnormal neck anatomy
no ability to extend neck
airborne pathogen

Question 10

Short term complications with ST

Answer 10

bleeding
pneumothorax
air embolism
false passage creating
tracheal wall injury (posterior)
laryngeal nerve damage

Question 11

Long term complications with ST

Answer 11

airway obstruction
infection
tracheal-esophageal fistula
rupture of innominate artery (brachiocephalic)
dysphagia
tracheal dilation
tracheal ischemia, necrosis
granulation tissue bleed

Question 12

Complications with PDT

Answer 12

all similar to ST

especially bleeding,

Question 13

Signs of false passage

Answer 13

subcutaneous emphysema and resp failure