<p>Tracheostomy – advantages and disadvantages</p><p>13/9/10</p><p>Tracheostomy = an airway that is inserted subglottically through neck tissues directly into the trachea</p><p>INDICATIONS</p><p>- bypass glottic or supraglottic stenosis/obstruction - access for tracheal toilet - provision of a more comfortable airway for prolonged ventilation - protection from aspiration</p><p>ADVANTAGES</p><p>- reduced sedation requirement (greater comfort than oro-tracheal intubation) - airway protection while unconscious - allows gradual weaning of ventilatory support (reduced work of breathing) - enhanced communication (written or phonation) - decreased ICU mortality - enhanced nursing care (mouth care and mobility) - ease of replacement of tracheal tube - can facilitate transfer to the ward</p><p>DISADVANTAGES/COMPLICATIONS</p><p>- requirement for a surgical procedure</p><p>Immediate</p><p>- haemorrhage - surgical emphysema - pneumothorax - air embolism - ciricoid cartilage damage - pretracheal dilation and placement - endobronchial placement - cuff herniation - occlusion of tip by carina or tracheal wall - …death</p><p>Delayed</p><p>- infection (tracheostomy site, larynx, tracheobronchial tree, mediastinum) - obstruction with secretions - ulceration/perforation (mucosal, inominate artery, tracho-oesophageal fistula) - dysphagia c/o mechanical compression of oesophagus (requires N/G or PEG for enteral nutrition) - problems with de-cannulation -> emergency airway management</p><p>Late</p><p>Jeremy Fernando (2011) - tracheal granulomata - tracheal or laryngeal stenosis - persistent sinus @ tracheostomy site - tracheomalacia - aphonia/dysphonia (recovery of voice, laryngeal or cord dysfunction) - tracheal dilatation</p><p>EVIDENCE</p><p>- decreased ICU mortality - no difference in nosocomial pneumonia - no difference in outcome if early (< 7 days) or late (>7 days) - no change in hospital mortality (Clec’h et al, Critical Care Med, 2007 Jan; 35(1):132)</p><p>Jeremy Fernando (2011)</p>