Tracheostomy - Definition, Indications, Contraindications & Types

🫁 Tracheostomy - Definition, Types, Indications, Contraindications & Functions

Tracheostomy is a very important ENT surgical procedure and a frequently asked viva topic.

In this article we will cover:

• Difference between Tracheotomy vs Tracheostomy
• Functions of tracheostomy
• Physiological changes
• Indications
• Contraindications
• Types of tracheostomy
• Advantages and disadvantages

🔪 Tracheotomy vs Tracheostomy

✅ Tracheotomy

• Making a surgical opening in the trachea
• It is one step of the tracheostomy procedure

✅ Tracheostomy

• A surgical procedure in which a stoma is created on the skin
• This stoma communicates with the tracheal lumen

👉 Therefore:
Tracheotomy = Opening in trachea
Tracheostomy = Formation of permanent/temporary airway stoma

⚙️ Functions of Tracheostomy

1- Relief of Upper Airway Obstruction

• Bypasses obstruction at larynx / pharynx / upper trachea

2- Reduction of Respiratory Dead Space

What is normal dead space?

What is the % reduction seen in dead space in Tracheostomy?

3- Reduction in Airway Resistance

4- Protection Against Aspiration

• Prevents aspiration of blood / secretions

What are some cases in which Tracheostomy is done to prevent aspiration?

5- Tracheobronchial Toileting

• Easy suction of secretions
• Improves gas exchange

6- Route for Ventilation & Drug Delivery

What are the Physiological Effects of Tracheostomy?

🚨 Indications of Tracheostomy

📌 A. Based on Cause

1️⃣ Respiratory Obstruction

• Infective causes
• Traumatic causes
• Neoplastic causes
• Congenital causes
• Others (Laryngeal edema, Foreign body larynx)

Name some infective indications of Tracheostomy.

Name some traumatic indications of Tracheostomy.

Name some congenital indications of Tracheostomy.

Name some neoplastic indications of Tracheostomy.

2️⃣ Retained Secretions

• Due to inability to cough
• Painful cough
• Aspiration of secretions

Name some causes where retained secretions is the indication for performing Tracheostomy.

3️⃣ Respiratory Insufficiency

• Chronic bronchitis
• Emphysema
• Bronchiectasis

4️⃣ Need for Prolonged Ventilation

• Intubation > 3 weeks

What are the advantages of performing Tracheostomy over intubation in a patient who needs prolonged ventilation?

5️⃣ As Part of Surgical Procedure

• Permanent: Total laryngectomy
• Temporary: Major oral / oropharyngeal resections

📌 B. Based on Site of Obstruction

• Nose / Nasopharynx → Choanal atresia
• Tongue base → Macroglossia
• Supraglottis → Epiglottitis
• Glottis → Vocal cord palsy
• Subglottis → Stenosis / hemangioma
• Trachea → Tracheomalacia / stenosis

📌 C. Indications in Infants & Children

Infants → Mostly congenital

Children → Mostly inflammatory / traumatic

What are some indications of Tracheostomy in infants and in children?

⛔ Contraindications of Tracheostomy

👉 No absolute contraindication in emergency

Relative Contraindications

• Bleeding disorders
• Unstable cervical spine injury
• Local infection at incision site

📚 To know the complete list of Relative Contraindications of Tracheostomy, please purchase my notes.

📚 Types of Tracheostomy

🔹 Based on Timing

• Elective
• Emergency

What are the 2 types of Elective Tracheostomy?

What is Emergency Tracheostomy?

🔹 Based on Duration

• Temporary
• Permanent

What is Permanent Tracheostomy? Name some indications of Permanent Tracheostomy.

🔹 Based on Site

• High Tracheostomy
• Mid Tracheostomy ⭐ (Most common)
• Low Tracheostomy

What is High Tracheostomy? What is the tracheal level at which it is done?

Name an indication of High Tracheostomy.

What is the complication of doing High Tracheostomy?

What is Mid Tracheostomy? What is the tracheal level at which it is done?

What is Low Tracheostomy? What is the tracheal level at which it is done?

What is the complication of doing Low Tracheostomy?

⭐ Advantages of Tracheostomy over Endotracheal Intubation

• Can be maintained long term
• Reduced dead space

📚 To know the complete list of Advantages of Tracheostomy, please purchase my notes.

⚠️ Disadvantages of Tracheostomy

• Surgical procedure → Time consuming
• Risk of infection
• Difficult decannulation
• Loss of phonation

📚 To know the complete list of Disadvantages of Tracheostomy, please purchase my notes.

What is difficult decannulation? What are some causes of difficult decannulation?

🧠 Exam Pearls

• Dead space reduction → 30–50%
• Most common site → Mid tracheostomy
• No absolute contraindication in emergency
• High tracheostomy → Only for carcinoma larynx

Next topic:
➡️ Steps of Tracheostomy & Post-operative Care