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  1. Student
  2. Tracheostomy management
  3. Tracheostomy management
Student Clinical review

Tracheostomy management

BMJ 2012; 345 doi: https://doi.org/10.1136/sbmj.e6016 (Published 16 October 2012) Cite this as: BMJ 2012;345:e6016
  1. Andrew Cumpstey, final year medical student1,
  2. Stuart J Benzie, specialty doctor in otolaryngology2,
  3. Stuart McKechnie, consultant in intensive care medicine and anaesthetics3
  1. 1 University of Oxford, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford OX3 9DU, UK
  2. 2 Crosshouse Hospital, Kilmarnock, Ayrshire KA2 0BE, UK
  3. 3 John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford

A basic understanding is essential for dealing with emergency blockages and displacements

A tracheostomy (or tracheotomy) is a direct opening in the anterior trachea communicating with a stoma on the surface of the neck. This allows air to pass directly into the trachea below the vocal cords (fig 1). Different forms of this operation have been carried out for over 3000 years, by Alexander the Great and Galen among others.1 The procedure is common in modern medical practice, and doctors are likely to encounter patients with tracheostomies in the early years of their training.2 Junior doctors might find themselves having to manage patients with emergency tracheostomies.⇓

Fig 1 Sagittal section showing a tracheostomy tube in position and the relevant anatomy

A basic knowledge of tracheostomies is therefore essential for all medical practitioners, together with an understanding of how to respond to common life threatening complications related to tracheostomies, particularly displacement and obstruction of the tracheostomy tube.3

This article outlines the main indications for tracheostomy and the different types of tracheostomy tube in widespread use. The initial management of tube displacement and tube obstruction are also discussed.

Indications for tracheostomy

Although tracheostomies are most commonly used to facilitate weaning from mechanical ventilation in patients in critical care, there are numerous indications for both elective and emergency tracheostomies (see table). They are therefore encountered in many areas of hospital practice.⇓

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Table 1 Indications for tracheostomy and some examples of where they may be found in the hospital. Adapted from 4

The indication for tracheostomy will determine whether the procedure is likely to be permanent (for example, bilateral vocal cord paralysis) or temporary (for example, to aid weaning from mechanical ventilation).

Insertion technique

Tracheostomies can be fashioned surgically—usually by an ear, nose, and throat or maxillofacial surgeon in an operating theatre—or percutaneously. Both …

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