Critical care surgical tracheotomy

• Published in: Operative techniques in otolaryngology--head and neck surgery 2020-09, Vol.31 (3), p.e23-e28
• Main Authors: Kram, Yoseph A., Song, Sungjin A., Camacho, Macario, Juang, Jeremy, Russell, Matthew S.
• Format: Article
• Language: English
• Subjects: Critical care otolaryngology; Endotracheal tube; Pulmonary edema; Tracheostomy; Tracheotomy
• ISSN: 1043-1810; 1557-9395
• DOI: 10.1016/j.otot.2020.05.002

•Bedside Percutaneous Dilational Tracheotomies have not replaced formal open tracheotomies in all critical care patients.•Tracheotomy consultations from the Intensive Care Unit should be systematic with special attention to pulmonary, cardiac, and laboratory evaluation. A sample safety checklist for consultation is provided.•Maintenance of a definitive airway with ventilation during tracheotomy requires the anesthesia provider to closely manage the endotracheal tube, including adjusting the tube position and cuff inflation. 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.