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Indications for a tracheostomy
  1. Obstruction of the upper airway, e.g. foreign body, trauma, infection, laryngeal tumour, facial fractures
  2. Impaired respiratory function, e.g. head trauma leading to unconsciousness, bulbar poliomyelitis
  3. To assist weaning from ventilatory support in patients on intensive care
  4. To help clear secretions in the upper airway
  5. When it is anticipated that tracheostomy tube will remain for longer period than 3 weeks (subglottic stenosis if tube left longer)

Comparison of tracheostomy and endotracheal intubation

Features of Tracheostomy

Endotracheal intubation

1. Reduced need for sedation

1. Easier and quicker to perform compared with tracheostomy

2. Reduced damage to glottis

2. Tolerated well for short periods

3. Reduced work of breathing (by reducing dead space)

3. Weaning more difficult after long period of placement

4. Reduced patient discomfort

4. Need to be sedated

5. More invasive and complicated compared with endotracheal tube placement

5. Prevents aspiration of secretions

6. Scar formation

6. Can be used to give certain medications e.g. adrenalin

7. Tracheostomy site can bleed or become infected

7. Need to warm and filter gases as bypass the nose which would normally provide this function

8. Requires skill to perform the procedure

8. Improper placement can occur e.g. oesophageal placement

May be associated with long-term complications e.g. swallowing difficulties


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