Indications for and management of tracheostomies

There has been documented evidence of tracheostomies for over two millennia with the majority being descriptions of relieving acute upper airway obstructions in an emergency situation. The refinement of anaesthetic and surgical techniques resulted in an increase of the frequency and success of the procedure and the latter half of the 20th century saw tracheostomies being used increasingly as an adjunct to long-term respiratory support, not only in patients who had lost their upper airway but also in patients 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 the predominant technique with it being put to frequent use to facilitate 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.