3. Indications
⢠Usually elective
⢠Major Indications â
ďPrevent laryngeal and upper airway damage due to prolonged intubation
ďAllow easy access to the lower airway for managing secretions
ďStable airway for prolonged mechanical ventilation
15. Cuffed vs Uncuffed
⢠Children â usually uncuffed tube used unless
ďNeed for high pressure ventilation
ďHigh risk of aspiration
16. OS vs PDT
⢠Open Surgical technique usually used in children
⢠PDT usually in adults and children >13-15 years
17. Timing of Tracheotomy
⢠Early tracheostomy (<7 days) post cardiac surgery has improved
outcomes as compared to late tracheostomy(>7 days)
Puentes et al. Anaesthesiology Intensive Therapy 2016,vol.48,89-94
ďAtrial Fibrillation (AF)
ďKidney Dysfunction
ďKidney failure
ďReduced ICU stay and Hospital stay
⢠No difference in mortality and infection rate
18. Care
⢠Tube Care â Suction, Position, Inner Tube,
⢠Skin Care and Hygiene
⢠Infection and C/S
22. Decannulation
⢠Protocol
ďDetermine the correction of the precipitating cause
ďIf necessary a formal airway assessment â vocal cord insufficiency, stomal
granulation, supra-stomal collapse, distal tracheal granulation or
tracheomalacia
ďClosure of the stoma to be done by secondary intention
ďCuffed to uncuffed
ďGradual down sizing upto 3-0 tube
ďCapping intermittently during daytime and then continuously
ďO2 saturation monitoring
ďDe-cannulation and stoma occlusion
23. Discharge on Tracheostomy
⢠The first tracheostomy changed after 1 week â tract maturation
⢠Preparations while changing the tube
⢠Before discharge we should ensure
ďSensitized to routine tracheostomy care
ďLearn to identify important problems â need of suctioning, mucus plugging
and respiratory difficulty
ďShould be able to change tracheostomy tube if urgent need arises
ďShould have at home â spare tubes, suction catheter with machine, sterile
saline bottles with syringes
ďLocal hygiene and skin care
Tracheostomy tube size especially diameter of the tube corresponds with the age of the patient. In addition to the diameter the length and curvature of the tube is also taken into account. Ideally the length of the tube should extend atleast 2cm beyond the stoma and tip should be not closure than 1-2cm from the carina. Distal end of tube should be parallel with the trachea to avoid abutting the anterior or posterior wall of the trachea.