Critical care surgical tracheotomy

Abstract

Evaluating and performing open surgical tracheotomy for critical care patients requires special considerations and techniques. Although percutaneous dilational tracheotomy is largely performed in critical care patients, it has not completely eliminated the need for the open surgical approach. A preoperative evaluation with a safety checklist derived from expert recommendation is presented to aid the consulting otolaryngologist. Tracheotomy in an endotracheally intubated patient should be performed in a controlled, safe fashion with clear communication between the anesthesia provider and the surgeon. Rupture of the endotracheal tube cuff can turn a deliberate controlled operation into an emergency situation if the patient can no longer be properly ventilated. A widely known but infrequently discussed strategy for prevention of this complication is reviewed in this manuscript.