Temporary tracheostomy: a practical approach to the placement and management of a tracheostomy tube

Abstract

A temporary tracheostomy can be a life-saving intervention when there is a structural or functional obstruction of airflow at, or rostral to, the level of the larynx. In most instances, the intervention is intended for short-term use, with appropriate diagnosis and treatment of the primary underlying condition instigated as soon as possible. Surgery can usually be performed on the stable, anaesthetised and intubated patient. Single-lumen uncuffed tubes are ideal for most instances, unless the patient is to be maintained on a ventilator. If commercial tubes are not available then a cut-down endotracheal tube may be used. The diameter of the tube should not be more than 50% the diameter of the trachea. While a relatively simple technique, temporary tracheostomy can be associated with a high complication rate, including tube dislodgement, obstruction and dyspnoea; coughing/gagging; pneumonia; dysphagia, vomiting/regurgitation; aspiration; tracheal stenosis; tracheocutaneous fistula; and laryngeal nerve injury.