Tracheostomy

Learning objectives

Surgical incision into the trachea that forms a temporary or permanent opening, when intubation is expected to last > 1-2 weeks
Very short and wide tube directly place into trachea → decreased risk of pneumonia
Commonly performed in the OR under general anesthesia
Create access to remove secretions from the lungs
Often needed when health problems require long-term use of a machine (ventilator) to help you breathe
Emergency tracheostomy is performed when the airway is suddenly blocked due to a traumatic injury to the face or neck
Patients with a tracheostomy can be weaned from a ventilator faster than patients with a ETT
Consider: shared airway, difficult airway
- Close communication with surgeon, backup plan discussed

High-flow nasal oxygen therapy to slow the time to desaturation where intubation or face-mask ventilation is difficult/impossible
- Risk on fire as FiO2 is close to 1.0 if diathermy is used
Check the position and size of the tracheostomy tube with a combination of capnography + endoscopy + cuff pressure
- The tube is too short: the cuff may herniate up into the superior larynx (within the vocal cords) thereby causing reduced pulmonary compliance, persistent cuff leaks, or tracheal damage
- Tube too long: risk of endobronchial tube placement

A laryngectomy tube can be used instead of a tracheostomy tube for intraoperative ventilation of the lungs during surgery
Difficult BMV & supraglottic device ventilation (air leak)
Dangerous placement of ETT (direct vision preferred)
Comorbid disease:
- ICU patient with multi-organ failure, sepsis, lung injury, etc
- Neuromuscular disorders, chronic high spinal cord injury
Ensure emergency tracheostomy equipment is available: various sizes of cuffed/uncuffed tracheostomy tubes, suction catheters, graspers, Ambu bags & ties