TRACHEOTOMY – EVOLVING TECHNIQUE AND CURRENT INDICATIONS
Tracheotomy has been around for thousands of years, having been described in hieroglyphs and texts from ancient Egypt, dating as much as 3000 B.C. However, it was not until the 19th century that this procedure was utilized on a large scale. Its evolution was directly linked to two great epidemics, the diphtheria epidemic of nineteen century Europe, and the poliomyelitis epidemic of North America in the 20th century. Its use as both a life-saving measure and aid in assisted pulmonary ventilation and care have been established by trial and error during these troubled times. The classic, open tracheotomy is not without risks and complications, with important hemorrhage from anterior jugular veins, thyroid vessels and the Lalouette pyramidal thyroid lobe being cited. Possible injury to the subclavian vein or brachio-cephalic venous trunk, although extraordinary, is associated with life-threatening hemorrhage. Because of these possible complications, as well as the need for a ENT surgeon and an operating theatre and instrumentation, modern alternatives have been developed and thus the percutaneous dilatation tracheotomy has been introduced in emergency room and ICU settings. Modern indications for performing a tracheotomy, whatever technique is used, are grouped in 4 main categories: bypassing superior airway obstruction, surgical access, prolonged intubation and mechanical ventilation and pulmonary toilet. Tracheotomy is an essential procedure in the surgical armamentarium of head and neck surgeons, utilized less today as an emergency life-saving intervention and more as a supportive measure in ICU patients.