Tracheostomy Workup

  • Author: Jonathan P Lindman, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: May 19, 2011
 

Laboratory Studies

  • So many tracheostomies are performed electively in patients with secure airways (eg, for prolonged intubation) that to obtain the hematocrit and coagulation factors preoperatively is reasonable so that adequate correction can be made.
  • As with any emergent procedure, the decision to perform an emergent tracheostomy is not altered by any laboratory values.
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Jonathan P Lindman, MD  Otolaryngology-Head and Neck Surgeon, Piedmont Ear, Nose, Throat and Related Allergy

Jonathan P Lindman, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American College of Surgeons, Phi Beta Kappa, and Triological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Charles E Morgan, DMD, MD  Assistant Professor, Department of Surgery, Division of Otolaryngology, University of Alabama at Birmingham

Charles E Morgan, DMD, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

John Schweinfurth, MD  Professor, Department of Otolaryngology, University of Mississippi Medical Center

John Schweinfurth, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Laryngological Association, American Medical Association, and Triological Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Karen Hall Calhoun, MD  William E Davis Professor and Chair, Department of Otolaryngology-Head and Neck Surgery, University of Missouri-Columbia School of Medicine

Karen Hall Calhoun, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, Association for Research in Otolaryngology, Society of University Otolaryngologists-Head and Neck Surgeons, Southern Medical Association, Texas Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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Anterior anatomy of the larynx and trachea (in situ).
Posterior view of paratracheal structures. The asterisk indicates structures at risk from paratracheal dissection.
Parasagittal view through larynx. The asterisk indicates structures at risk during cricothyrotomy.
Operative view of tracheostomy. The thyroid isthmus is divided with electrocautery.
Operative view of tracheostomy. These are options for tracheal incision.
Operative view of tracheostomy. These are special techniques in the patient with obesity.
This video demonstrates the results of rigid direct laryngoscopy and flexible tracheal endoscopy in a patient with significant tracheal stenosis.
This video demonstrates the 90º endoscopic view in 2 patients with tracheal stenosis.
This video of a 90º endoscopic tracheal view was obtained from a patient with postintubation tracheal stenosis.
This video demonstrates the 90º endoscopic view in 2 patients with tracheal stenosis.
This video contains the surgical technique for a tracheostomy. The patient is intubated with an endotracheal tube and then prepared and draped in a sterile manner with a shoulder roll to gently extend the neck. An incision is then made through the skin just below the level of the cricoid ring. The underlying subcutaneous fat is removed. The infrahyoid muscles (strap muscles) are then split midline, identifying the trachea. The thyroid isthmus sometimes overlies the area of the planned tracheotomy and has to be divided to expose the trachea. Two Prolene stay sutures are placed in a vertical mattress style on each side of the planned tracheotomy. The tracheotomy is generally made through trachea rings 3 and 4. Prior to making the tracheotomy, the edges of the skin incision are approximated to the trachea to mature the tracheal stoma. A vertical tracheotomy is made, the endotracheal tube is backed up to the superior edge of the tracheotomy, and an appropriate size endotracheal tube is inserted into the tracheotomy. The tracheotomy tube is then secured to the neck using ties. The stay sutures are labeled "left" and "right" and taped to the chest. Video courtesy of Ravindhra G Elluru, MD, PhD.
 
 
 
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