Tracheostomy from Insertion to de cannulation

Abstract

Tracheostomy is a common surgical procedure, and is increasingly performed in the intensive care unit (ICU) as opposed to the operating room. Procedural knowledge is essential and is therefore outlined in this review. We also review several high-quality studies comparing percutaneous dilational tracheostomy and open surgical tracheostomy. The percutaneous method has a comparable, if not superior, safety profile and lower cost compared with the open surgical approach; therefore the percutaneous method is increasingly chosen. Standard and specialized varieties of tracheostomy tubes are available and the appropriate type is determined by patient anatomy and the indication for the tracheostomy. Fibre optic endoscopic evaluation of swallowing should be considered in assessment of bulbar function and tracheostomy weaning. A patient with a tracheostomy who develops respiratoryDistress during the ward weaning process should be investigated for upper airway pathology. Studies comparing early versus late tracheostomy suggest morbidity benefits that include less nosocomial pneumonia, shorter mechanical ventilation and shorter stay in the ICU. However, we discuss the questions that remain regarding the optimal timing of tracheostomy. We outline the potential acute and chronic complications of tracheostomy and their management, and we review the different tracheostomy tubes, their indications and when to remove them.