Tracheotomy or tracheostomy, is a surgical procedure which consists of making an incision (cut) on the anterior aspect (front) of the neck and opening a direct airway through an incision in the trachea (windpipe). The resulting stoma (hole) can serve independently as an airway or as a site for a tracheal tube or tracheostomy tube to be inserted, this tube allows a person to breathe without the use of the nose or mouth.The word tracheostomy, including the root stom meaning "mouth," refers to the making of a semi-permanent or permanent opening, and to the opening itself. Some sources offer different definitions of the above terms. Part of the ambiguity is due to the uncertainty of the intended permanence of the stoma (hole) at the time it is created.

There are four main reasons why someone would receive a tracheotomy are

1. Emergency airway access
2. Airway access for prolonged mechanical ventilation
3. Functional or mechanical upper airway obstruction
4. Decreased/incompetent clearance of tracheobronchial secretions

In the acute (short term) setting, indications for tracheotomy include such conditions as severe facial trauma, tumors of the head and neck (e.g., cancers, branchial cleft cysts), and acute angioedema and inflammation of the head and neck. In the context of failed tracheal intubation, either tracheotomy or cricothyrotomy may be performed.

In the chronic (long term) setting, indications for tracheotomy include the need for long-term mechanical ventilation and tracheal toilet (e.g. comatose patients, or extensive surgery involving the head and neck). Tracheotomy may result in a significant reduction in the administration of sedatives and vasopressors, as well as the duration of stay in the Intensive Care Unit (ICU).

In extreme cases, the procedure may be indicated as a treatment for severe Obstructive Sleep Apnea (OSA) seen in patients intolerant of Continuous Positive Airway Pressure (CPAP) therapy. The reason tracheostomy works well for OSA is because it is the only surgical procedure that completely bypasses the upper airway. This procedure was commonly performed for obstructive sleep apnea until the 1980s, when other procedures such as the uvulopalatopharyngoplasty, genioglossus advancement, and maxillomandibular advancement surgeries were described as alternative surgical modalities for OSA.

If prolonged ventilation is required, tracheostomy is usually considered. The timing of this procedure is dependent on the clinical situation and an individual's preference. An international multicenter study in 2000 determined that the median time between starting mechanical ventilation and receiving a tracheostomy was 11 days. Although the definition varies depending on hospital and provider, early tracheostomy can be considered to be less than 10 days (2 to 14 days) and late tracheostomy to be 10 days or more.

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zoe kemp
Journal Manager
Journal of Intensive and Critical Care Nursing
Email: nursing@emedicalsci.org