Common Indications for Tracheostomy

• Upper airway obstruction (tumour, trauma, severe swelling)
• Prolonged ventilator dependence or weaning from mechanical ventilation
• Recurrent aspiration or need for long-term airway protection
• Severe facial or neck trauma preventing oral intubation
• Anatomic airway abnormalities or congenital conditions

Types of Tracheostomy

1. Surgical Tracheostomy

Performed in the operating room under general anaesthesia; standard technique for planned, controlled airway access with direct visualization.

2. Percutaneous Dilatational Tracheostomy

Bedside technique using serial dilators or dilating balloons, often performed in intensive care units for patients already intubated.

3. Temporary vs Permanent Tracheostomy

Temporary tracheostomies are used for short- to medium-term needs and can be reversed; permanent tracheostomies may be considered when long-term airway access is required.

Preoperative Assessment

Careful evaluation helps plan the safest approach and anticipate complications.

• Detailed airway assessment and review of prior intubation
• Neck anatomy evaluation, imaging (neck ultrasound/CT) if distorted anatomy suspected
• Review of coagulation status and correction of bleeding risk
• Multidisciplinary planning with anaesthesia, ICU, and nursing teams

How the Procedure Is Performed

Technique varies by setting and indication, but core steps include:

• Position patient with neck extended; sterile prep and local or general anaesthesia
• Identify tracheal rings and make a small horizontal or vertical incision
• Create a tracheal window between rings and insert appropriate tracheostomy tube
• Secure tube, confirm position (capnography, chest rise, imaging if needed), and connect to ventilator or oxygen

Percutaneous techniques use guidewires and dilators to form the stoma without a formal incision and are often quicker in experienced hands.

Post-Operative Care & Cannula Management

• Regular suctioning to clear secretions and maintain patency
• Humidification to prevent crusting and mucous plugs
• Stoma and skin care to prevent infection and irritation
• Routine tube changes as per protocol and patient needs
• Swallow and speech assessment; speaking valves (e.g., Passy-Muir) may enable communication in appropriate patients

Risks & Possible Complications

• Bleeding or hematoma formation
• Infection at stoma site or deep neck infection
• Tube displacement or accidental decannulation — a life-threatening emergency if not managed immediately
• Tracheal stenosis, tracheomalacia, or persistent fistula with long-term tracheostomy
• Granulation tissue formation at the stoma

Benefits of Tracheostomy

• Safer long-term airway access compared to prolonged oral intubation
• Improved patient comfort, easier oral care, and reduced sedation needs
• Facilitates pulmonary toilet and weaning from ventilator support
• Enables speech with appropriate valves and rehabilitation

Multidisciplinary Support & Rehabilitation

Optimal tracheostomy care involves ENT surgeons, intensivists, respiratory therapists, speech-language therapists, and nursing staff for safe management, decannulation planning, and rehabilitation.

Why Choose Dr. Shrekha Padmakshan?

Dr. Shrekha Padmakshan provides experienced airway management and tracheostomy services with a focus on patient safety, airway protection, and coordinated multidisciplinary follow-up.

• Expertise in both surgical and percutaneous tracheostomy techniques
• Strong emphasis on airway safety and emergency preparedness
• Integrated care with ICU teams, respiratory therapy, and rehabilitation services
• Individualised planning for decannulation and long-term airway needs

If you or a loved one are facing airway compromise, prolonged ventilation, or recurrent aspiration, consult for a detailed airway assessment and personalised tracheostomy plan. Early specialist involvement ensures safe outcomes and a clear rehabilitation pathway.