Tracheostomy is the most commonly performed (elective) surgical procedure in critically-ill patients. Compared with translaryngeal intubation, tracheostomy improves patient comfort, and leads to shorter length of intensive care unit and hospital stay. It relieves upper airway obstruction, protects the larynx and upper airway from damage, allows access to the lower airway for secretion removal, and provides a stable airway for patients requiring prolonged mechanical ventilation or oxygenation support. Timing of tracheostomy remains controversial and should be individualized; however, early tracheostomy (within 7 days) seems to be beneficial in certain patient populations (head injury, medically critically ill). The evolution of percutaneous techniques are rapidly reducing need for surgical tracheostomy and bedside techniques are safe and efficient, allowing timely tracheostomy with low morbidity. Cricothyrotomy is an emergency surgical airway used to save a life when all attempts at securing a patent airway fail and arrest is eminent. Techniques, timing, risks, benefits, as well as contraindications of the surgical airway in critically-ill patients are discussed in this chapter.
Current Trends in Surgical Airway Management of Neonates with Robin Sequence
