Perioperative management - Percutaneous dilatational tracheotomy

• Prolonged mechanical ventilation (> 10 days)

Benefits compared with intubation:

• No injury of the arytenoid cartilages
• Prevention of mucosal lesions (nose/mouth, vocal cords, trachea)
• Less airway resistance (decreased ventilatory effort)
• Less dead space
• Better fixation
• Easier oral care
• Less analgesics/sedatives required
• Better patient comfort
• Easier weaning

• Emergencies
• Difficult airways suspected
• Rather difficult or even impossible standard intubation
• Infection at the planned puncture site
• Difficult anatomical conditions (e.g., large goiter, head reclination not possible)
• Unstable cervical spine
• Coagulation disorders
• Need for permanent tracheostomy or patient discharged home > epithelialized permanent tracheostomy required

• Coagulation panel
• Bronchoscopy

Fiberoptic monitoring while puncturing the trachea is strongly recommended.

• Bleeding
• Infection
• Tracheal injury
• Surgical revision
• Pneumothorax
• Injury to the recurrent nerve
• Cutaneous emphysema (incl. mediastinal emphysema)
• Scarring of the tracheostomy