Tracheostomy — Procedure Guide, Recovery & Risks | MyMedicPlus

Tracheostomy creates a surgical opening in the anterior trachea below the cricoid cartilage to establish a direct airway. It may be performed as an open surgical procedure in the operating room or as a percutaneous dilational tracheostomy (PDT) at the bedside.

Indicated for prolonged mechanical ventilation (typically >7–10 days), upper airway obstruction from tumour or trauma, inability to clear secretions, failed weaning from endotracheal intubation, and as an elective airway before major head and neck surgery.

Surgical tracheostomy: incision between the 2nd and 3rd tracheal rings; a tracheal window is created and the tracheostomy tube inserted. Percutaneous dilational technique (Seldinger method): needle, guidewire, and serial dilators used under bronchoscopic guidance at the ICU bedside.

Tracheostomy care includes regular suctioning, humidification of inspired gas, and tube changes (first change at 5–7 days by an experienced team). Weaning from ventilation and decannulation proceed once the underlying clinical condition stabilises.

Early risks: haemorrhage, subcutaneous emphysema, tube displacement, and pneumothorax. Late risks include tracheal stenosis (1–2%), tracheomalacia, stomal infection, tracheo-innominate fistula (rare but life-threatening), and swallowing dysfunction.

Percutaneous dilational tracheostomy has fewer wound infections and lower cost than surgical tracheostomy in ICU patients, with equivalent safety in experienced hands under bronchoscopic guidance. Decannulation is achieved in most survivors once weaning criteria are met.