Preferred site of tracheostomy is between the 2nd and 3rd tracheal rings in the midline Tracheostomy above this site: Can lead to damage to the cricoid cartilage and first tracheal ring Results in increased risk of subglottic stenosis which is difficult to treat...
Advantages Relatively quick in experienced handsAvoids need for transfer of unstable patientsDoes not require involvement of surgeonsCheaperSmaller scarTighter stoma that decreases stomal bleeding and provides better fit Disadvantages Suboptimal conditions for...
Advantages Can be performed when percutaneous contraindicated:Short or thick neck, obeseCoagulopathyUnstable spinePrevious neck / thyroid surgeryAbnormal vesselsResources available to control bleedingPotentially easier management in event of early tube dislodgment or...
Immediate (During Insertion) Arrest and Death (1/600)Haemorrhage (minor or severe) - 4.8%Misplacement (pre-tracheal tissues or to main bronchus)HypoxiaInjury to local structures:Pneumothorax and surgical emphysemaOesophageal perforationVascular injuryThyroid...
Absolute Contraindications Patient RefusalUnstable fractures of the cervical spineSevere local infection of the anterior neck Uncontrollable coagulopathy Relative Contraindications Lack of need:Unlikely to survive >48 hoursUnlikely to require >2 weeks...
