Percutaneous Tracheostomy in the Intensive Care Unit

Abstract

Tracheostomy is one of the oldest surgical procedures, which was first used by Egyptians in 3600 B.C., and it requires the formation of an opening or ostium into the anterior wall of the trachea. While tracheostomy has been used as a life-saving procedure for the emergency treatment of upper airway obstruction for ages, Jackson brought a different surgical approach to tracheostomy and defined a standardized technique of systemic tracheostomy in 1909. He emphasized a long incision, a wide site, dividing the thyroid isthmus and avoiding the first and second tracheal rings (1). The control of diseases that can lead to airway obstruction through vaccination, development of antibiotics for upper airway infections, improvement of endotracheal intubation and bronchoscope reduced the need for tracheostomy. The emergency of tracheostomy has disappeared over time, and it has become an elective surgery in many cases. At the beginning of the 20th century, tracheostomy began to be re-considered for patients with paralytic poliomyelitis who needed mechanical ventilation, and other methods were investigated as alternatives to surgical procedures. In 1943, tracheostomy was performed to remove bronchial secretions in a patient with bulbar poliomyelitis. The next step was to perform open percutaneous tracheostomy (PT) using the Seldinger guidewire technique. Ciaglia, a thoracic surgeon, successfully performed PT in 1985 and defined it as an elective bedside procedure that can be safely used (2, 3). Percutaneous tracheostomy has recently become a frequently used procedure in the intensive care unit (ICU). In this review, PT indications, timing, techniques, and bronchoscopy and ultrasonography (USG) used for reducing complications in ICUs will be mentioned and an approach diagram will be established for ICU clinicians.