Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013 Jan. 148(1):6-20. [QxMD MEDLINE Link].
Young D, Harrison DA, Cuthbertson BH, Rowan K, TracMan Collaborators. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA. 2013 May 22. 309 (20):2121-9. [QxMD MEDLINE Link].
MacIntyre NR, Cook DJ, Ely EW Jr, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest. 2001 Dec. 120(6 Suppl):375S-95S. [QxMD MEDLINE Link].
Cheng E, Fee WE Jr. Dilatational versus standard tracheostomy: a meta-analysis. Ann Otol Rhinol Laryngol. 2000 Sep. 109(9):803-7. [QxMD MEDLINE Link].
Lai HH, Tseng PY, Wang CY, Wang JY. Long-Term Survival and Medical Costs of Patients with Prolonged Mechanical Ventilation and Tracheostomy: A Nationwide Cohort Study. Int J Environ Res Public Health. 2021. 18(19):10272. [QxMD MEDLINE Link].
Koitschev A, Simon C, Blumenstock G, Mach H, Graumuller S. Suprastomal tracheal stenosis after dilational and surgical tracheostomy in critically ill patients. Anaesthesia. 2006 Sep. 61(9):832-7. [QxMD MEDLINE Link].
Kost KM. Endoscopic percutaneous dilatational tracheotomy: a prospective evaluation of 500 consecutive cases. Laryngoscope. 2005 Oct. 115(10 Pt 2):1-30. [QxMD MEDLINE Link].
Henderson JJ, Popat MT, Latto IP, Pearce AC. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia. 2004 Jul. 59(7):675-94. [QxMD MEDLINE Link].
New disposable tracheostomy tube for positive-pressure ventilation. Br Med J. 1966 Oct 29. 2(5521):1063. [QxMD MEDLINE Link].
Myers EN, Johnson JT. Tracheostomy. Airway Management, Communication and Swallowing. 2nd ed. San Diego, Calif: Plural Publishing, Inc; 2008.
Tibballs J, Robertson C, Wall R. Tracheal ulceration and obstruction associated with flexible Bivona tracheostomy tubes. Anaesth Intensive Care. 2006 Aug. 34(4):495-7. [QxMD MEDLINE Link].
Tippet DC. Tracheostomy and Ventilator Dependency. New York, NY: Thieme; 2000.
Young PJ, Pakeerathan S, Blunt MC, Subramanya S. A low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration. Crit Care Med. 2006 Mar. 34(3):632-9. [QxMD MEDLINE Link].
Young PJ, Burchett K, Harvey I, Blunt MC. The prevention of pulmonary aspiration with control of tracheal wall pressure using a silicone cuff. Anaesth Intensive Care. 2000 Dec. 28(6):660-5. [QxMD MEDLINE Link].
Scalabrino N, Crespi L, Bosco M, Troisi E, Vezzaro G, Baravelli M. [Diagnosis and management of dysphagia in patients with tracheostomy tube after cardiac surgery: an early screening protocol]. Monaldi Arch Chest Dis. 2010 Jun. 74(2):70-5. [QxMD MEDLINE Link].
Bontempo LJ, Manning SL. Tracheostomy Emergencies. Emerg Med Clin North Am. 2019 Feb. 37 (1):109-119. [QxMD MEDLINE Link].
Cramer JD, Graboyes EM, Brenner MJ. Mortality associated with tracheostomy complications in the United States: 2007-2016. Laryngoscope. 2018 Nov 19. [QxMD MEDLINE Link].
Kashlan KN, Williams AM, Chang SS, Yaremchuk KL, Mayerhoff R. Analysis of patient factors associated with 30-day mortality after tracheostomy. Laryngoscope. 2018 Nov 22. [QxMD MEDLINE Link].
Mesalles-Ruiz M, Hamdan M, Huguet-Llull G, Penella A, Portillo A, Bagudà E, et al. Outcomes and survival of tracheostomised patients during the COVID-19 pandemic in a third level hospital. Eur Arch Otorhinolaryngol. 2021 Oct 12. [QxMD MEDLINE Link].
Villarroya Gonzalez A, Longas Valien J, Vicente Armijo JJ, Cuartero Lobera J. [Orotracheal tube ignited by an electrocautery device during tracheostomy]. Rev Esp Anestesiol Reanim. 2009 Jan. 56(1):47-9. [QxMD MEDLINE Link].
Tobin AE. Tracheostomy teams - filling a void. Crit Care Resusc. 2009 Mar. 11(1):3-4. [QxMD MEDLINE Link].
Freeman BD, Isabella K, Lin N, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest. 2000 Nov. 118(5):1412-8. [QxMD MEDLINE Link].
Higgins KM, Punthakee X. Meta-analysis comparison of open versus percutaneous tracheostomy. Laryngoscope. 2007 Mar. 117(3):447-54. [QxMD MEDLINE Link].
Fernandez R, Tizon AI, Gonzalez J, Monedero P, Garcia-Sanchez M, de-la-Torre MV, et al. Intensive care unit discharge to the ward with a tracheostomy cannula as a risk factor for mortality: a prospective, multicenter propensity analysis. Crit Care Med. 2011 Oct. 39(10):2240-5. [QxMD MEDLINE Link].
Terragni PP, Antonelli M, Fumagalli R, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA. 2010 Apr 21. 303(15):1483-9. [QxMD MEDLINE Link].
Scales DC, Thiruchelvam D, Kiss A, Redelmeier DA. The effect of tracheostomy timing during critical illness on long-term survival. Crit Care Med. 2008 Sep. 36(9):2547-57. [QxMD MEDLINE Link].
Reed JP, Kemph JP, Hamelberg W, Hitchcock FA, Jacoby J. Studies with transtracheal artificial respiration. Anesthesiology. 1954 Jan. 15(1):28-41. [QxMD MEDLINE Link].
Toy FJ, Weinstein JD. A percutaneous tracheostomy device. Surgery. 1969 Feb. 65(2):384-9. [QxMD MEDLINE Link].
Brantigan CO, Grow JB Sr. Cricothyroidotomy: elective use in respiratory problems requiring tracheotomy. J Thorac Cardiovasc Surg. 1976 Jan. 71(1):72-81. [QxMD MEDLINE Link].
Flory FA, Hamelberg W, Jacoby JJ, Jones JR, Ziegler CH. Transtracheal resuscitation. J Am Med Assoc. 1956 Oct 13. 162(7):625-8. [QxMD MEDLINE Link].

Media Gallery

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 90-degree endoscopic view in 2 patients with tracheal stenosis.
This video of a 90-degree endoscopic tracheal view was obtained from a patient with postintubation tracheal stenosis.
This video demonstrates the 90-degree endoscopic view in 2 patients with tracheal stenosis.
Surgical technique for a tracheostomy. Video courtesy of Ravindhra G Elluru, MD, PhD.
Percutaneous Tracheostomy. Video courtesy of Yassir Adbulrahman, MD, Ashok Parchani, MD, and Ruben Peralta, MD, FACS, FCCM, FCCP, Hamad Medical Corporation.
Surgical cricothyroidotomy Seldinger. Video courtesy of Therese Canares, MD, and Jonathan Valente, MD, Rhode Island Hospital, Brown University.
Uncuffed (A) and cuffed (B) single-cannula tubes.
Double-cannula tube shown with choice of fenestrated and nonfenestrated inner cannulae. Obturator for insertion is also included at the bottom.
Inner cannulae shown with and without 15-mm connector, fenestrated and nonfenestrated designs.
Cuffed tube with pilot balloon.
Fenestrated cuffed and uncuffed tubes.
Adult swivel, neonatal, and pediatric neck flanges.
Bivona and Portex adjustable-neck-flange tubes.
Decannulation cap (top). Decannulation caps attached to inner cannulae of cuffed and uncuffed tubes.
Single-cannula tube made of silver with speaking valve.

of 22

Table. Tracheostomy Tube Materials

Table. Tracheostomy Tube Materials

Material	Description	Comments	Examples
Polyvinyl chloride (PVC)	PVC is produced by polymerization of vinyl chloride monomer Depending on the additives used, properties such as flexibility, opacity, color, heat stability, density, and chemical resistance can be controlled and modified	Has a high degree of biocompatibility and flexibility under changing temperatures and humidity^[9] Easily sterilized but prone to retention of bacteria and is therefore for single use/disposable Excellent water and chemical resistance	Portex Blue Line Ultra, RÜSCH
Silicone	Silicone is a synthetic polymer and is produced by a cross-linked polymer reinforced with silica Further cross-linking takes place by heating with a particular catalyst (ie, peroxide), to produce the required properties	Reduces adherence of secretions and bacteria to the tube by promoting easier passage for mucus Can be sterilized but confined to single patient use Cost effective for long-term use	Bivona range
Siliconized PVC	PVC with silicone coating	Thermosensitive PVC, provides sufficient rigidity for initial insertion, and then softens at body temperature to accommodate to individual patient’s anatomy With proper humidification, secretions are less likely to adhere to the tube, making it easier to clean	Portex Blue Line range
Silver	Pure silver or other alloys with silver coating are used	Metal walls can be kept thin, allowing double-lumen construction designs Some antibacterial property Cost effective in long term May need changing every 5 years	Negus, Chevalier, Jackson, and Alderhey
Silastic	Silicone elastomers and some cross-linked polydimethylsiloxane materials	Offer great comfort and flexibility; easily conforms to the anatomy Autoclavable; for single patient use Lack sufficient rigidity	Kapitex, Moore
Armored tubes	Combination of siliconized PVC tube reinforced with stainless steel	Soft and flexible but stable Prevents kinking and compression	RÜSCH Tracheoflex, Tracflex

Back to List

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 College of Surgeons, Phi Beta Kappa, American Academy of Sleep Medicine, Triological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Ruben Peralta, MD, FACS, FCCM, FCCP Deputy Trauma Medical Director, Professor and Director of Trauma, Emergency and Critical Care Fellowship Program, Senior Consultant in Surgery, Trauma, Emergency and Critical Care Medicine, Associate Director of Trauma Intensive Care Unit, Hamad General Hospital and Hamad Medical Corporation, Weill Cornell Medical College in Qatar

Ruben Peralta, MD, FACS, FCCM, FCCP is a member of the following medical societies: American Association of Blood Banks, American College of Healthcare Executives, American College of Surgeons, American Medical Association, Association for Academic Surgery, Eastern Association for the Surgery of Trauma, Massachusetts Medical Society, Society of Critical Care Medicine, Society of Laparoscopic and Robotic Surgeons

Disclosure: Nothing to disclose.

Ravindhra G Elluru, MD, PhD Professor, Wright State University, Boonshoft School of Medicine; Pediatric Otolaryngologist, Department of Otolaryngology, Dayton Children's Hospital Medical Center

Ravindhra G Elluru, MD, PhD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Bronchoesophagological Association, American College of Surgeons, American Medical Association, Association for Research in Otolaryngology, Society for Ear, Nose and Throat Advances in Children, Triological Society, American Society for Cell Biology

Disclosure: Nothing to disclose.

Muhammad Kamaal Khan, MBBS, MRCSEd, DOHNS, FRCS(ORL-HNS) Consultant ENT, Department of ENT Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, UK

Muhammad Kamaal Khan, MBBS, MRCSEd, DOHNS, FRCS(ORL-HNS) is a member of the following medical societies: Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Karen H Calhoun, MD, FACS, FAAOA Professor, Department of Otolaryngology-Head and Neck Surgery, Ohio State University College of Medicine

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

Disclosure: Nothing to disclose.

Chief Editor

Guy W Soo Hoo, MD, MPH Professor of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Medical Intensive Care Unit, Chief, Pulmonary, Critical Care and Sleep Section, West Los Angeles VA Healthcare Center, Veteran Affairs Greater Los Angeles Healthcare System

Guy W Soo Hoo, MD, MPH is a member of the following medical societies: American Association for Respiratory Care, American College of Chest Physicians, American College of Physicians, American Thoracic Society, California Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Additional Contributors

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

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.

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 Laryngological Association, Triological Society, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Susan Dixon, MD, to the development and writing of this article.

Medscape Reference also thanks Ravindhra G Elluru, MD, PhD, Associate Professor, Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine; Pediatric Otolaryngologist, Department of Otolaryngology, Cincinnati Children's Hospital Medical Center, for assistance with the video contribution to this article.

Tracheostomy Questions & Answers

References

Tables

Contributor Information and Disclosures

What would you like to print?