Tracheostomy: Indications, Procedure, and Temporary vs. Permanent Use

Tracheostomy: Surgical Airway Creation

Tracheostomy = surgical opening (stoma) in anterior trachea (2nd–3rd ring) with tube insertion to secure airway.

Indications

• Upper airway obstruction: Tumor, edema, trauma, infection (epiglottitis), anaphylaxis.
• Prolonged mechanical ventilation: >7–14 days intubation → ↓ VAP, comfort, weaning.
• Secretions management: Neuromuscular disease, impaired cough.
• Head/neck surgery: Anticipated airway compromise.

Procedure (Open Surgical)

1. General anesthesia (or local + sedation if emergent).
2. Transverse/vertical incision over 2nd–3rd tracheal ring.
3. Dissect strap muscles, thyroid isthmus (divide or retract).
4. Incise trachea; insert cuffed tracheostomy tube.
5. Secure with sutures + ties; confirm placement (CO₂, chest rise, CXR).

Percutaneous dilatational tracheostomy (PDT) – bedside, bronchoscopic guidance – common in ICU.

Temporary vs. Permanent

• Temporary: Weaned from vent → decannulate; stoma closes spontaneously.
• Permanent: Irreversible airway loss (laryngectomy, high cervical SCI); stoma matured to skin.

Complications

• Early: Bleeding, pneumothorax, tube misplacement, recurrent laryngeal nerve injury.
• Late: Stenosis, granuloma, tracheoesophageal fistula, infection.

Care Essentials

• Humidification, suctioning, inner cannula cleaning, cuff pressure monitoring, stoma care, speaking valve when appropriate.