summary

The trachea is easily accessible at the bedside. As such it provides ready access for emergency airway cannulation (eg, in the setting of acute upper-airway obstruction) and for long -term airway access after laryngeal surgery. More commonly,

tracheostomy tubes are placed to allow removal of a translaryngeal endotracheal tube (ETT). The procedure can be done surgically or percutaneously, and with either technique the procedure can be performed in the operating room or at the bedside in the inte nsive care unit (ICU). Tracheostomy is an operative procedure that creates a surgical airway in the cervical trachea . The history of surgical access to the airway is largely one of condemnation. This technique of slashing the throat to save the life was known as semislaughter. However, one the technique was perfected as a last resort in largely hopeless cases of diphtheria, the opportunities for medicine ensured its place in the surgical armamentarium . A tracheostomy is most commonly performed in patients who have had difficulty in weaning from mechanical ventilation, followed by those who have suffered trauma or some catastrophic

insult. Infections and neoplastic processes are less common in diseases that require a surgical airway . Indications of tracheostomy to bypass obstruction, neck trauma that results in severe injury to the thyroid or cricoid cartilage, subcutaneous emphysema, facial fractures, to provide a long term route for mechanical ventilation in cases of respiratory failure, to provide pulmonary toilt, prophylaxis (as in preparation for extensive head and neck procedures and the convalescent period) and severe sleep apnea not amendable to continuous positive airway pressure (CPAP) devices . No absolute contraindication exist to tracheostomy, a strong relative contraindication to discrete surgical access to the airway is the anticipation that the blockage is laryngeal carcinoma. The definite procedures (usually a laryngectomy) is planned, and prior manipulation of the tumour is avoided because i t may lead to increased incidence of stomal recurrence. Temporary tracheostomy may be performed just under the first tracheal ring in anticipation of a laryngectomy at a later time . End of life issues may also come to hear on the decision to perform a tracheostomy. In fact, the performance of tracheostomy does not affect the decision to extend or to withdraw care. Hygiene is improved, quality of life (speaking and eating if relevant) is improved and placement in long term care is facilitated in some cases, however,

dependence on mechanical ventilation may not be changed. The patient is still being kept alive by machines . In the last 5 years, surgical tracheostomy is replaced by percutaneous dilatation tracheostomy, because the second one requires less equipments and it consumes less time and less complications .