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Percutaneous dilatational tracheostomy


Before the procedure

Indications

  • Requirement of a temporary or long-term artificial airway for prolonged mechanical ventilation

  • Management of secretions

  • Nonemergency airway obstruction

Contraindications

  • Inability to clearly palpate and identify tracheal landmarks

  • Enlarged thyroid or other neck mass

  • Active infection at the site

  • Emergency need for airway

  • High ventilatory requirements (FiO 2 ≥70%, positive end-expiratory pressure [PEEP] greater than 15 cm H 2 O)

  • Bleeding

  • Increased intracranial pressure

  • Clinically significant coagulopathy or supratherapeutic international normalized ratio (INR) or partial thromboplastin time (PTT)

  • Documented tracheomalacia

  • Cervical irradiation

  • Morbid obesity

  • Maxillofacial or neck trauma

  • Lack of cervical spine clearance

  • Inability to extend the neck because of a cervical spine fracture

  • In addition, we do not perform the procedure in patients younger than 16 years of age because of the scarcity of experience reported in pediatric patients

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