The extra-anatomical percutaneous access to the trachea is known in two ways: As a life-saving emergency measure in acute airway obstruction above the larynx, ideally penetrating the cricothyroid ligament between the thyroid and cricoid cartilage (cricothyrotomy), and as a generally elective procedure in intensive care medicine to enable long-term ventilation using an indwelling tube, thus bypassing the nasal or oral, pharyngeal space, and larynx.
Access to the trachea is achieved either through a puncture tracheotomy, as detailed in the Webop contribution Punktionstracheotomie or as a plastic tracheotomy.
Tracheotomy is one of the oldest surgical procedures ever.
Medical historical literature already mentions it in the Rig-Veda of Hinduism from the 2nd millennium BC or by Galen.
Andreas Vesalius praised it, "since suddenly life is saved by it, which seemed already lost" (8).
In the first half of the 19th century, the procedure gained the status of a standardized procedure through the publications of Armand Trousseau on his treatments of numerous children with diphtheria (6,7).
Today, tracheotomy is a routine procedure in surgery and intensive care medicine for long-term ventilated patients. Descriptions of the procedure, its modifications, possible complications, and postoperative care have been published many times. A selection of the literature can be found in the following list.
An impressive publication on a few cases of fatal complications in this procedure was presented in 1966 by A. Potondi from Budapest and O. Pribilla from Kiel in the "Deutsche Zeitschrift für gerichtliche Medizin." At that time, the complication rate of this operation across all publications was still about 30%, although without separating elective from emergency measures; thus, this writing also includes three cases of postoperative fatal bleeding reported by Billroth still in the patients' homes (9).
Current figures are expectedly significantly better: for example, A. Valentin from Vienna in his 2007 review "Tracheotomy in Intensive Care Patients" cites a rate between 2.9 and 5.4% for later tracheal stenosis and again emphasizes the importance of the correct timing for the procedure: "For example, the positive results of an extremely early tracheotomy in patients with an estimated ventilation duration of > 14 days in a randomized study by Rumbak (Crit Care Med 2004; 32: 1689) are countered by the argument that many of these patients might not have needed the tracheotomy at all. In fact, in the control group (planned tracheotomy on day 14-16), 13% of the patients were already extubated before the tracheotomy" (11).
And in a meta-analysis by Higgins KM from 2007 on about 1000 patients, considering events such as minor bleeding, major bleeding, subglottic stenosis, and mortality rate – especially in comparison between plastic and puncture tracheotomy – the OR (pooled odd ratio) for all complications is given as 0.75 with a fluctuation between 0.56 and 1.0 CI.