[Tracheotomy - surgical and percutaneous]

Abstract

Modern indications for tracheostomy are the following: support of mechanical ventilation and weaning from mechanical ventilation, prevention of complications due to prolonged endotracheal tube ventilation. Surgical tracheostomy (ST) still plays an important role in the management of respiratory failure despite the wide use of percutaneous dilatational tracheostomy (PDT). Peri- and postoperative complication rates as well as lethality rates of these competing procedures are similar according to the literature. However, there are more contraindications to PDT to be considered. In case of technical difficulties or failure of the PDT, a conversion to the open procedure may be necessary either after PDT attempt or later on. Therefore, technical expertise should be available in the intensive care setting. Indications, technical aspects, including closure of stoma, of both methods are presented in detail. Moreover, specific complications are presented, as well as results of meta-analyses comparing ST with PDT.