Tracheostomy. Indications and operative techniques

Tracheostomy is one of the most ancient procedures in surgery. Although it was traditionally used for treatment of upper airway stenosis, its primary surgical indication is now in the long-term intensive care unit patient. He re, the aims are avoidance of damage to the larynx, earlier weaning from ar tificial respiration, and improved nursing care. Apart from the conventiona l operating method, minimally invasive procedures have been increasingly em ployed. More than 20,000 ICU patients per annum are now treated in Germany by these modern methods. Common features of these procedures are the initia l puncture of the trachea with subsequent dilatation of the puncture channe l. Current meta-analyses of prospectively randomised studies show a lower c omplication rate than with conventional methods. Furthermore, serious seque lae such as tracheal stenosis are rare in the long-term course. However, co nventional operative tracheostomy still has its place, particularly in circ umstances where the new methods are contraindicated.