Tracheostomy

Question 1

Define tracheostomy.

Answer 1

Tracheostomy is a surgical procedure that creates an opening in the anterior wall of the trachea to facilitate airway access and ventilation.

NB “tracheotomy” defines procedures that directly connect the trachea with the skin of the neck.

Question 2

What are the indications for tracheostomy?

Answer 2

Emergency:

• Acute upper airway obstruction with failed intubation with ET tube or where it cannot be placed due to oedema or mass
• Emergency cricothyrotomy
• Fractures of the face and neck
• Penetrating laryngeal trauma

Elective:

• Difficulty weaning off mechanical ventilation
• Unable to protect own airway
• Need for ventilation/secretion control
• Severe subglottic stenosis or vocal cord paralysis

Question 3

What are the contraindications to tracheostomy?

Answer 3

• Cellulitis of the neck
• Uncontrolled bleeding
• Absence of cervical trachea/ short neck with inability to palpate trachea
• Children < 15yrs
• Previous complex tracheal surgery

Question 4

What are the complications of tracheostomy?

Answer 4

• Bleeding
• Pneumothorax/pneumomediastinum from false tract
• Oesophageal perforation
• Tracheal ring fractures
• Loss of airway - should be replace under brochoscopic guidance