125 - Tracheotomy

Summary

Tracheotomy is performed to establish an airway in patients with existing or impending airway obstruction, such as those with neoplasia of the upper aerodigestive tract and those with trauma to the face, oral cavity, or neck in whom edema, bleeding, and loss of function produces airway compromise. The procedure also provides access to the trachea for suctioning and clearance of secretions. In an emergency situation, mask ventilation or endotracheal intubation is done to gain control of the airway, followed by tracheotomy under more controlled circumstances.

For patients who cannot be ventilated or intubated, cricothyroidotomy is preferable since tracheotomy is a poor emergency procedure. Performed between the larynx and the cricoid cartilage, cricothyroidotomy involves a higher anatomic level than that of tracheotomy. The highly vascular thyroid gland is avoided and airway access can be established in seconds. Immediately following emergency cricothyroidotomy, tracheotomy is done to reposition the tube in a more suitable location in the trachea so that injury to the cricoid cartilage can be avoided and subglottic stenosis will not develop.

Tracheotomy is also performed to prevent complications from prolonged endotracheal intubation. Although low-pressure cuffs on endotracheal tubes have decreased the frequency of such complications, long-term intubation requires careful management. Improper position and excessive pressure in the cuff as well as relative movement between the tube and the patient can produce severe injury to the trachea.