INDICATIONS OF TRACHEOSTOMY

Dr.H.R.YUSA HERWANTO,M.Ked,(ORL-HNS),SpTHT-KL
Departemen Telinga Hidung Tenggorok Bedah Kepala Leher
Univerisitas Sumatera Utara Medan

BACKGROUND
Tracheostomy is an operative procedure that
creates a surgical airway in the cervical trachea
The term tracheostomy is considered to be
synonymous with tracheotomy
This technique of slashing the throat to save the
life was known as semislaughter
However, once the technique was perfected as a
last resort in largely hopeless cases of diphtheria
in the past, the opportunities it offered for medical
heroism ensured its place in the surgical
armamentarium

"This operation redounds to

the honor of the physician
and places him on a footing
with the gods"
Fabricius (17th century)

DOCUMENTED REFERENCES
100 BC: Asclepiades of Persia described a
tracheostomy incision for improving the airway
Approximately 400 BC: Hippocrates condemned
tracheostomy, citing threat to carotid arteries
Approximately 100 AD: Antyllus described the first
familiar tracheostomy as a horizontal incision
between 2 tracheal rings to bypass upper airway
obstruction. He also pointed out that tracheostomy
would not ameliorate distal airway disease (eg.
Bronchitis)
600 AD: The Susruta Samhita contained routine
acknowledgment of tracheostomy as accepted
therapy in India

1546: Brasavola from Italy published an

account of tracheostomy for tonsillar obstruction.
He was the first person known to actually
perform the operation
1561-1636: Sanctorius was the first to use a
trocar and cannula. He left the cannula in place
for 3 days
1702-1743: George Martine developed the
inner cannula
1833: Trousseau reported 200 patients with
diphtheria treated with tracheostomy
1921: Chevalier Jackson codified indications
and techniques for modern tracheostomy and
warned of complications of high tracheostomy
(cricothyrotomy)
1)Evolution of an Airway - tracheostomy history article by Steven E. Sittig,

INDICATIONS
1. Airway obstruction
2. Protection of the tracheo-bronchial
tree
3. Ventilatory insufficiency

CONDITIONS CAUSING
AIRWAY OBSTRUCTION
CONGENITAL
Subglottic stenosis
laryngeal web and cyst
stenosis of the trachea
tracheo-oesohageal anomalies
TRAUMA
gunshot and cut throat laryngeal injuries
inhalation of steam or poisonous gases
swallowing of corrosive

 FOREIGN BODIES
LODGED IN THE
LARYNX
TUMOURS
INFECTION
acute epiglottitis
croup
Ludwigs angina
VOCAL CORD
PARALYSIS

PROTECTION OF THE
TRACHEO-BRONCHIAL
TREE
From bronchial secretions
From overspill and aspiration
(copious secretions)
Comatose states - head injury,
poisoning or post neurosurgical
procedure

Certain neurological condition which

weaken the ability to clear the
secretion - myasthenia gravis,
Guillain-Barre syndrome
Multiple facial fractures
Burns of the face
Head and neck surgery

VENTILATORY
INSUFFICIENCY
Pulmonary disease
exacerbation of chronic bronchitis with
emphysema
post-operative pneumonia with
suppression of cough
severe pneumonia
Abnormalities of the thoracic cage
severe chest injury (flail chest)

Neuromuscular dysfunction
Guillain-Barre syndrome
Tetanus
Poliomyelitis
Prolonged ventilation

TRACHEOSTOMY

ENDOTRACHEAL INTUBATION

Reduced need for sedation.

Need to be sedated almost all the time.

More invasive and complicated compared

with endotracheal tube placement.

Easier and quicker to perform compared with

tracheostomy.

Reduced damage to glottis.

Tolerated well for short periods.

Tracheostomy site can bleed or become

infected.
Requires skill to perform the procedure.

Weaning more difficult after a long period of

placement.
Prevents aspiration of secretions.

Reduced patient discomfort.

Reduced work of breathing (by reducing dead
space).
Scar formation.
May be associated with long-term
complications, eg swallowing difficulties.

Can be used to give certain medications, eg

adrenalin (epinephrine).
Need to warm and filter gases, as the nose,
which would normally provide this function,
is bypassed.
Improper placement can occur, eg
oesophageal placement.

TYPES OF TRACHEOSTOMY
High tracheostomy
Low tracheostomy
Emergency tracheostomy
Elective tracheostomy
Temporary tracheostomy
Permanent tracheostomy
Surgical tracheostomy
Percutaneous tracheostomy
Paediatric tracheostomy
1) Standards for the care of adult patients with a temporary tracheostomy, Intensive Care Society (2008)
2) Best practice statement: caring for the patient with a tracheostomy, NHS Quality Improvement Scotland
(2007)
3) Best practice statement: caring for the child/young person with a tracheostomy, NHS Quality
Improvement Scotland (September 2008)

THANK YOU.