3. Indications
• Usually elective
• Major Indications –
Prevent laryngeal and upper airway damage due to prolonged intubation
Allow easy access to the lower airway for managing secretions
Stable airway for prolonged mechanical ventilation
15. Cuffed vs Uncuffed
• Children – usually uncuffed tube used unless
Need for high pressure ventilation
High risk of aspiration
16. OS vs PDT
• Open Surgical technique usually used in children
• PDT usually in adults and children >13-15 years
17. Timing of Tracheotomy
• Early tracheostomy (<7 days) post cardiac surgery has improved
outcomes as compared to late tracheostomy(>7 days)
Puentes et al. Anaesthesiology Intensive Therapy 2016,vol.48,89-94
Atrial Fibrillation (AF)
Kidney Dysfunction
Kidney failure
Reduced ICU stay and Hospital stay
• No difference in mortality and infection rate
18. Care
• Tube Care – Suction, Position, Inner Tube,
• Skin Care and Hygiene
• Infection and C/S
22. Decannulation
• Protocol
Determine the correction of the precipitating cause
If necessary a formal airway assessment – vocal cord insufficiency, stomal
granulation, supra-stomal collapse, distal tracheal granulation or
tracheomalacia
Closure of the stoma to be done by secondary intention
Cuffed to uncuffed
Gradual down sizing upto 3-0 tube
Capping intermittently during daytime and then continuously
O2 saturation monitoring
De-cannulation and stoma occlusion
23. Discharge on Tracheostomy
• The first tracheostomy changed after 1 week – tract maturation
• Preparations while changing the tube
• Before discharge we should ensure
Sensitized to routine tracheostomy care
Learn to identify important problems – need of suctioning, mucus plugging
and respiratory difficulty
Should be able to change tracheostomy tube if urgent need arises
Should have at home – spare tubes, suction catheter with machine, sterile
saline bottles with syringes
Local hygiene and skin care
Tracheostomy tube size especially diameter of the tube corresponds with the age of the patient. In addition to the diameter the length and curvature of the tube is also taken into account. Ideally the length of the tube should extend atleast 2cm beyond the stoma and tip should be not closure than 1-2cm from the carina. Distal end of tube should be parallel with the trachea to avoid abutting the anterior or posterior wall of the trachea.