Indications for and management of tracheostomies

There has been documented evidence of tracheostomies for over two millennia, the majority being descriptions of relieving acute upper airway obstructions in an emergency. Refinement of anaesthetic and surgical techniques resulted in the increased frequency and success of the procedure and in the latter half of the 20th century they were being used increasingly as adjuncts to long-term respiratory support for patients who had either lost their upper airway or who had limited bulbar function and reduced ability to clear secretions via coughing and expectorating. Further technical developments have resulted in the adoption of the percutaneous dilatational tracheostomy (PDT) as a means of facilitating ventilatory weaning in intensive care. In the UK approximately 16% of adult intensive care patients undergo PDT and if care of these patients is to be maintained at a high level clinicians must have a working knowledge of upper airway anatomy, indications for the procedure, complications and the ongoing care and management of such patients.