Tracheostomy procedure for post graduate level trainees

1. Tracheostomy: A Postgraduate
Perspective
• Indications, Techniques, Complications, and Advances
• Presenter: [Your Name]
• Institution: [Your Institution]
• Date: [Date]

2. Objectives
• • Understand indications for tracheostomy
• • Describe surgical and percutaneous techniques
• • Discuss postoperative care and complications
• • Review recent advances and controversies

3. Introduction
• • Definition: Surgical or percutaneous opening in the trachea to secure an
airway
• • History: From ancient Egypt to modern ICU care
• • Importance: Critical care, ENT, trauma, oncology, emergencies

4. Indications
• • Prolonged mechanical ventilation (>7-10 days)
• • Upper airway obstruction
• • Failure to wean from ventilation
• • Neurological disorders
• • Pulmonary toilet in chronic aspiration

5. Types of Tracheostomy
• • Timing: Emergency, Elective
• • Technique: Surgical, Percutaneous (PDT)
• • Duration: Temporary, Permanent

6. Surgical Anatomy
• • Tracheal rings (2nd-4th)
• • Thyroid isthmus
• • Pretracheal fascia, strap muscles
• • Inferior thyroid veins, thyroid ima artery
• [Insert surgical anatomy image here]

7. Surgical Technique
• • Positioning: neck extension
• • Skin incision, dissection
• • Tracheal incision: window, slit, Bjork flap
• • Insert tube, secure, confirm placement
• [Insert surgical technique diagram here]

8. Percutaneous Dilatational
Tracheostomy (PDT)
• • Bedside ICU procedure
• • Seldinger: needle → guidewire → dilators → tube
• • Variants: Ciaglia, Griggs, Fantoni
• • Advantages: less bleeding, faster
• [Insert PDT technique diagram here]

9. Comparison: Surgical vs
Percutaneous
• Feature | Surgical | Percutaneous
• ---|---|---
• Setting | OR, ICU | ICU bedside
• Time | ~30-45 min | ~15-20 min
• Bleeding | Higher | Less
• Complications | Infection, bleeding | Paratracheal insertion

10. Postoperative Care
• • Tube care, humidification
• • Suctioning, cuff monitoring
• • Stoma care
• • Communication aids
• • Early mobilization

11. Complications
• Immediate: Bleeding, pneumothorax, misplacement
• Early: Infection, emphysema, obstruction
• Late: Stenosis, tracheomalacia, fistula
• [Insert complication examples image here]

12. Decannulation
• • Criteria: adequate airway, minimal secretions
• • Process: downsizing, capping, monitoring
• • Outcome: stoma closure or surgical revision

13. Recent Advances
• • Ultrasound-guided PDT
• • Bronchoscopic guidance
• • Bioengineered grafts
• • 3D-printed stents
• • Speech, swallowing aids
• [Insert recent advances image here]

14. Ethical and Practical Considerations
• • Timing in critically ill
• • End-of-life decisions
• • Multidisciplinary approach

15. Summary
• • Lifesaving procedure with evolving techniques
• • Proper selection, technique, care reduce complications
• • Innovations improve outcomes

16. References
• • UpToDate
• • Bailey’s Head and Neck Surgery
• • Guidelines (AAO-HNS, SCCM)
• • Landmark studies

17. Acknowledgments
• Thank team members, mentors, department

18. Questions
• Thank you!
• Questions and discussion.