tracheostomie

Tracheostomie (tracheostomy) is a surgical procedure that creates a direct opening through the neck into the trachea to establish and maintain an airway. A tracheostomy tube is placed through the opening and connected to a ventilator or to humidified oxygen.

Indications include the need for prolonged airway support when conventional endotracheal intubation is not feasible, chronic upper airway obstruction from tumors or swelling, trauma or burns, and conditions such as coma or neuromuscular disease that impair airway protection or secretion management.

The procedure can be surgical, usually performed in an operating room, or percutaneous dilational tracheostomy performed at the bedside in the intensive care unit. In both approaches, a stoma is created in the trachea, and a tube is inserted and secured. Percutaneous techniques often use a guidewire and sequential dilation under bronchoscopic or imaging guidance.

Postoperative care involves keeping the airway humidified, regular cleaning of the stoma, and monitoring for tube blockage or infection. The cuffed tracheostomy tube is managed to balance a seal for ventilation with the ability to speak and swallow; decannulation is considered when airway protection and spontaneous breathing are adequate.

Complications include bleeding, infection, pneumothorax, tube misplacement or blockage, accidental decannulation, and late risks such as tracheal stenosis or fistula. The choice of technique and patient-specific factors influence risk.

Prognosis depends on the underlying condition; tracheostomie can improve comfort and facilitate ventilation or airway protection, and many patients undergo decannulation once airway function has recovered.