Tracheostomy is an artificial opening created in the trachea in the neck to allow access to the lower airway. It has major indications for preventing laryngeal damage from prolonged intubation, managing secretions, and providing stable airway access for prolonged mechanical ventilation. The techniques include open surgical and percutaneous dilatational tracheostomy. Early tracheostomy within 7 days of cardiac surgery has been shown to improve outcomes compared to late tracheostomy by reducing atrial fibrillation, kidney dysfunction, ICU stay, and hospital stay with no increase in mortality or infections. Complications can occur during surgery or post-operatively including hemorrhage, pneumothorax, nerve injury, and infections. Care involves tube

1. Tracheostomy
Pratik Manek

2. Introduction
• Artificial airway
• Tracheostomy tube – opening created on anterior aspect of trachea –
neck incision

3. Indications
• Usually elective
• Major Indications –
Prevent laryngeal and upper airway damage due to prolonged intubation
Allow easy access to the lower airway for managing secretions
Stable airway for prolonged mechanical ventilation

4. Techniques
• Open surgical (OS)
• Percutaneous Dilatational Tracheostomy (PDT)
• OSPDT

6. Open surgical

13. Concerns

14. Tracheostomy tube selection

15. Cuffed vs Uncuffed
• Children – usually uncuffed tube used unless
Need for high pressure ventilation
High 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
Atrial Fibrillation (AF)
Kidney Dysfunction
Kidney failure
Reduced ICU stay and Hospital stay
• No difference in mortality and infection rate

18. Care
• Tube Care – Suction, Position, Inner Tube,
• Skin Care and Hygiene
• Infection and C/S

19. Complications
• Intra-Operative
Hemorrhage
Pneumo-thorax/Pneumo-mediastinum
Esophageal Injury
Recurrent Laryngeal Nerve injury
Loss of Airway
Creation of false passage
Cardiac arrest and death

20. Complications
• Early post-operative (<7 days, i.e tract maturation)
Hemorrhage
Dysphagia and aspiration
Wound infection
Tube obstruction (blood clot/mucus plug)
Accidental decannulation
Tube displacement into false passage
Subcutaneous Emphysema

21. Complications
• Late post-oprative (>7 days)
Stomal and tracheal granulation
Supra-stomal collapse
Tracheal stenosis
Tracheomalacia
Tracheo-Esophageal Fistula
Tracheo-Innominate Fistula
Tracheo-Cutaneous Fistula

22. Decannulation
• Protocol
Determine the correction of the precipitating cause
If necessary a formal airway assessment – vocal cord insufficiency, stomal
granulation, supra-stomal collapse, distal tracheal granulation or
tracheomalacia
Closure of the stoma to be done by secondary intention
Cuffed to uncuffed
Gradual down sizing upto 3-0 tube
Capping intermittently during daytime and then continuously
O2 saturation monitoring
De-cannulation and stoma occlusion

23. Discharge on Tracheostomy
• The first tracheostomy changed after 1 week – tract maturation
• Preparations while changing the tube
• Before discharge we should ensure
Sensitized to routine tracheostomy care
Learn to identify important problems – need of suctioning, mucus plugging
and respiratory difficulty
Should be able to change tracheostomy tube if urgent need arises
Should have at home – spare tubes, suction catheter with machine, sterile
saline bottles with syringes
Local hygiene and skin care

24. Thank You