Tracheostomy: The Dynamics of Indications in an Old Procedure

Abstract

Background: Securing a surgical airway remains one of the fundamental components of critical care medicine as an obstructed airway for more than three minutes is not compatible with life. Purpose: Critical appraisal of the dynamics of the indications for tracheostomy in a developing country. Study design: Retrospective Methods: Analyzed tracheostomy patients’ data over a 3-year period. Results: We studied 41 tracheostomy cases of the 235 Ear Nose Throat operations, constituting 17.4%. The M:F = 2.2:1, mean age = 33.2 yrs ± 20.3. The relief of upper airway obstruction (n = 30, 73.2%) was the main indication with tumors accounting for 50% (n = 15, 36.6%). Ventilatory support was the next main indication (n = 9, 22.0%). Of this, 4 (9.8%), representing 1.6% of the intubated who developed laryngotracheal stenosis. Emerging indications included Cut throat and infective causes that had a tie (n = 4, 9.8%). Twentynine (70.7%) were successfully decannulated. The study recorded 12.2% complications while perioperative mortality was 4.9%. Conclusion: Indications for elective tracheostomy is well established, however, an algorithm describing the indications and timing for a surgical airway in emergency cannot be drawn due to the multiplicity of variables and the inapplicability in the context of life-threatening critical emergency.