Tracheostomy

 The most common indications for modern tracheostomy are prolonged ventilation for respiratory failure and airway protection following traumatic brain injury with neurologic dysfunction. For background purposes, history and facts related to early tracheostomy are provided. Thereafter, anatomy and physiology are discussed, as are other anatomical considerations, including the site of the procedures, anesthesia, and patient positioning. Counseling and informed consent are also discussed. The operative techniques are provided for emergent surgical airway (cricothyroidotomy and transtracheal needle ventilation and oxygenation) and open and percutaneous tracheostomy. Tracheostomy management is described. Complications are listed and described. Early complications include displacement, pneumomediastinum/pneumothorax, bleeding, infection, acute obstruction, and negative pressure pulmonary edema. Late complications include subglottic tracheal stenosis, tracheal granulation, vocal cord dysfunction, tracheoesophageal fistula, tracheoinnominate fistula, and tracheocutaneous fistula. This review contains 13 figures, 1 video, 2 tables, and 38 references.