Perioperative management - Percutaneous tracheostomy

• Long-term ventilation (> 10 days)

Advantages over intubation:

• no damage to the arytenoid cartilages
• Avoidance of mucosal lesions (nose/mouth, vocal cords, trachea)
• lower airway resistance (reduction of respiratory work)
• lower dead space
• better fixation
• better oral care
• reduced need for analgesics/sedatives
• higher patient comfort
• Facilitation of weaning from ventilation

• Emergency situations
• Indications of a difficult airway
• Significantly impaired or impossible conventional intubation
• Infections in the area of the puncture site
• Impaired anatomical conditions (e.g. large goiter, head not reclinable)
• Unstable C-spine
• Coagulation disorders
• Necessity of a permanent tracheostoma or the discharge of a tracheotomized patient to home > Creation of an epithelialized tracheostoma

• Determination of blood coagulation parameters
• Bronchoscopy

Fiberoptic monitoring of the tracheal puncture is strongly recommended.

• Bleeding
• Infection
• Injury to the Trachea
• Surgical Revision
• Pneumothorax
• Injury to the Recurrent Laryngeal Nerve
• Subcutaneous Emphysema (up to Mediastinal Emphysema)
• Scar Formation of the Tracheostoma