Indications and Procedural Steps of Tracheostomy

Types of Tracheostomy: Surgical vs. Percutaneous Techniques

Tracheostomy is a critical surgical procedure performed to secure an airway in patients with compromised breathing. Depending on the clinical scenario, the procedure can be conducted using a surgical or percutaneous approach.

Indications for Tracheostomy

• Prolonged mechanical ventilation
• Upper airway obstruction (e.g., tumors, trauma, severe infections)
• Neurological impairments leading to airway compromise
• Congenital abnormalities affecting airway patency

Surgical Tracheostomy

Surgical tracheostomy is the traditional method performed under general anesthesia in a sterile operating room setting. The procedure involves:

1. Incision made over the anterior neck
2. Identification and separation of thyroid isthmus (if necessary)
3. Creation of tracheal incision, often between the 2nd and 4th tracheal rings
4. Placement of a tracheostomy tube to maintain airway patency
5. Securing and monitoring for complications like bleeding or infection

Percutaneous Tracheostomy

Percutaneous techniques are increasingly favored in intensive care units due to their minimally invasive nature. This method employs:

1. Needle puncture with a guidewire placement
2. Dilation of the tract using sequential dilators
3. Insertion of the tracheostomy tube with minimal disruption to surrounding tissues
4. Reduced procedural time and risk of infection

Postoperative Care and Complications

After tracheostomy placement, regular suctioning, humidification, and tube maintenance are essential to prevent complications such as:

• Tracheal stenosis
• Infection and airway obstruction
• Accidental decannulation
• Subglottic tracheal injury

Conclusion

Both surgical and percutaneous tracheostomy serve vital roles in airway management. The choice of technique depends on patient-specific factors and institutional preferences.