Perioperative management - Open tracheostomy

  1. Indications

    • 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
  2. Contraindications

    • Infection at the planned incision site
    • Unstable cervical spine
    • Coagulation disorders
    • Massive gas exchange disorders
  3. Preoperative diagnostic work-up

    • Coagulation panel
    • Bronchoscopy
  4. Special preparation


  5. Informed consent

    • 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

General anesthesia of less than 45 minutesStandard monitoring of vital parameters (ECG, NIBP, NMT,

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