Tracheotomy

Abstract

Indications for tracheotomy are on the increase. The physician cannot rely on laboratory tests to point to the need for the procedure and must be guided by clinical observation. The devastating effects of respiratory anoxia, acidemia and hypercapnia are well known and must be prevented. These conditions develop from many causes: a greatly increased respiratory work load, reduced tidal air, reduced alveolar oxygen-carbon dioxide exchange, loss of the cough reflex, and increased intrathoracic or intracerebral venous pressure. Tracheotomy is best done after an airway is established from above through the larynx; emergency tracheotomy should be avoided whenever possible.