Diversionary tracheostomy

Abstract

Tracheostomy has been a useful technique in the management of airway obstruction for more than 150 years. Since then, its indications have been extended to include bronchopulmonary toilette, long-term ventilatory support, and the management of intractable aspiration. In this latter application, traditional tracheostomy alone is usually inadequate, because it does not by itself prevent ongoing aspiration of secretions, food, and / or foreign material. In such a situation, it is imperative that something be done to temporarily or permanently prevent further soilage of the tracheobronchial tree. Of the several techniques available for this purpose, diversionary tracheostomy is often the most useful, because it involves only one surgical procedure, completely obviates any further aspiration, and is reversible. Indications for the procedure, technique, and avoidance and management of complications are described in this article. Tracheostomy has been a useful technique in the management of airway obstruction for more than 150 years. Since then, its indications have been extended to include bronchopulmonary toilette, long-term ventilatory support, and the management of intractable aspiration. In this latter application, traditional tracheostomy alone is usually inadequate, because it does not by itself prevent ongoing aspiration of secretions, food, and / or foreign material. In such a situation, it is imperative that something be done to temporarily or permanently prevent further soilage of the tracheobronchial tree. Of the several techniques available for this purpose, diversionary tracheostomy is often the most useful, because it involves only one surgical procedure, completely obviates any further aspiration, and is reversible. Indications for the procedure, technique, and avoidance and management of complications are described in this article.