ICU · Airway management

Tracheostomy — Indications, Types, Percutaneous, Decannulation & Emergencies

Also known as Tracheostomy · Percutaneous dilatational tracheostomy · PDT · Surgical tracheostomy · TracMan trial · Speaking valve · Passy-Muir valve · Decannulation · Tracheostomy emergencies · Tracheo-innominate artery fistula · Ciaglia Blue Rhino · Griggs forceps technique · Fenestrated tracheostomy tube · NTSP algorithm · Tracheo-oesophageal fistula · Tracheal stenosis · Percutaneous tracheostomy

A tracheostomy is a surgical airway through the anterior trachea, placed for prolonged ventilation, upper-airway obstruction, airway protection, or secretion clearance. Percutaneous dilatational tracheostomy (Ciaglia Blue Rhino, bronchoscopic-guided, bedside) is the ICU standard; surgical tracheostomy is reserved for difficult anatomy, children, and emergencies. The TracMan trial (JAMA 2013) found early versus late tracheostomy does not change mortality, so timing is individualised. Complications fall into early (bleeding, displacement, pneumothorax), intermediate (infection, obstruction), and late (tracheal stenosis, tracheo-innominate artery erosion with its sentinel bleed, tracheo-oesophageal fistula). A displaced tube in the first week — before the tract matures — is re-intubated from above, not reinserted blindly.