Indications
- The long-term ventilation for more than 21 days
- The airway obstruction; for example, by injury or tumors
- The advantages over a trans laryngeal intubation.
Advantages
- The avoidance of damage to the arytenoid cartilages
- The avoidance of mucosal lesions on the vocal cords, trachea and mouth and nose
- A lower airway resistance (decrease the work of breathing)
- A smaller dead space
- The possibility of better fixation
- The better possible oral care
- The reduced need for analgesics and sedatives
- The higher patient comfort (speaking and oral feeding are possible, foreign body sensation is missing)
- Weaning from the ventilator is made easier or even possible in the first
Contraindications
- Infections of the incision site
- Unstable cervical spine
- Bleeding disorders
- Severe gas exchange disorders
Intraoperative complications
- Anesthesia
- Surgery-related bleeding
- Drug-induced bleeding (anticoagulant)
- Endogenous bleeding (hemophilia, liver disease)
- Pneumothorax / pneumomediastinum
- Injury to the recurrent laryngeal nerve
- Violation of the cricoid cartilage
- Cardiac arrest by Vagusreiz
Postoperative Complications
- Bleeding from the tracheostomy
- subcutaneous emphysema
- Erosion of major vessels
