Trachiostomy

Indications

1.     The long-term ventilation for more than 21 days
2.     The airway obstruction; for example, by injury or tumors
3.     The advantages over a trans laryngeal intubation.

Advantages

1.     The avoidance of damage to the arytenoid cartilages
2.     The avoidance of mucosal lesions on the vocal cords, trachea and mouth and nose
3.     A lower airway resistance (decrease the work of breathing)
4.     A smaller dead space
5.     The possibility of better fixation
6.     The better possible oral care
7.     The reduced need for analgesics and sedatives
8.     The higher patient comfort (speaking and oral feeding are possible, foreign body sensation is missing)
9.     Weaning from the ventilator is made easier or even possible in the first

Contraindications

1.     Infections of the incision site
2.     Unstable cervical spine
3.     Bleeding disorders
4.     Severe gas exchange disorders

Intraoperative complications

1.      Anesthesia
2.      Surgery-related bleeding
3.      Drug-induced bleeding (anticoagulant)
4.      Endogenous bleeding (hemophilia, liver disease)
5.      Pneumothorax / pneumomediastinum
6.      Injury to the recurrent laryngeal nerve
7.      Violation of the cricoid cartilage
8.      Cardiac arrest by Vagusreiz

Postoperative Complications

1.      Bleeding from the tracheostomy
2.      subcutaneous emphysema
3.      Erosion of major vessels

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