Perioperative management - Open tracheostomy

• Prolonged mechanical ventilation for more than 21 days.
• Airway obstruction, e.g., due to injury or tumor
• Compared with translaryngeal intubation, open tracheostomy offers these benefits:  – avoids injury to the arytenoid cartilages
  – avoids mucosal lesions at the vocal cords and trachea as well as in mouth and nose
  – reduces airway resistance (decreases the work of breathing)
  – decreases dead space
  – better securing option
  – easier oral hygiene
  – less analgesics and sedatives needed
  – more convenient for patient (can speak and ingest oral diet, no foreign-body feeling)
  – enables or facilitates weaning

• Infection at the planned incision site
• Unstable cervical spine
• Coagulation disorders
• Massive gas exchange disorders

• Coagulation panel
• Bronchoscopy

None

• Bleeding
• Infection
• Tracheal injury
• Possible necessity of revision surgery
• Pneumothorax
• Injury to the recurrent nerve
• Cutaneous/mediastinal emphysema
• Scar formation at the tracheostomy
• Cardiac arrest by vagal stimulation