Extraanatomical percutaneous access to the trachea is performed in one of two settings: As life-saving stat procedure in acute airway obstruction cephalad of the larynx, ideally penetrating the cricothyroid ligament between the thyroid and cricoid cartilages (coniotomy).
Or, in most cases, as an elective procedure in intensive care for prolonged mechanical ventilation through a tracheal tube bypassing the oropharynx, hypopharynx and larynx.
The tracheostomy (PDT) gained by puncture, probing with a guidewire and careful dilation serves to place a tracheotomy tube, equipped with a cuff and made of different materials, which facilitates airway hygiene. In one modification of this procedure, access is gained not by percutaneous puncture but surgical dissection.
Tracheotomy is one of the oldest surgical procedures known to man.
Historical medical reports include those of the Rig-Veda in Hinduism (1) two thousand years BC and by Galen (2 and 3).
With the publications by Armand Trousseau (4) on his treatment of numerous diphtheria cases in childhood (5) the procedure became standardized in the first half of the 19th century.
Statistical analysis of the periprocedural complications in tracheotomy yields rates widely differing between 5% and 48%, with no significant benefit favoring surgical dissection over PDT (6).
When compared with the PDT usually performed outside of the OR, the study by M. Pauliny et al. in 2012, which updated this comparison in 109 patients and looked at secondary bleeding, infection and air leaks (pneumothorax, pneumomediastinum), demonstrated no statistical benefit for the more complex surgical procedure (7).
Their results corresponded with those published in 1997 by Th. M. Treu and M. Koch (8), who paraphrased the percutaneous dilatational tracheotomy as “a new procedure” and reported 9 (unsuccessful) malpunctures in 112 cases investigated.
In PDT, the most common acute problems resulting from malpunctures are vascular in nature. The paper by Peter Gilbey published in August of 2012 has compiled such errors and includes a severe nonvascular complication.
Without a doubt, the procedure as painted by Henri de Toulouse-Lautrec (9) in 1891 (“Opération de trachéotomie”) should also be noted; it depicts none less than Docteur Jules Emile Péan. As can be seen, this must have been early on during the “opération” because in the painting he is deeply examining the mouth of the patient.
There is discussion in the literature regarding the initial publication of the standardized procedure as we know it today; most experts favor the study by P. Ciaglia from 1985 (10) and its long-term follow-up of 1992 (11).