Jitendar P Vij

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© 2010, Jaypee Brothers Medical Publishers (P) Ltd.

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First Edition: 2010

Typeset at JPBMP typesetting unit

The development of the percutaneous tracheostomy over the last two decades has revolutionized tracheostomy in critically ill patients. It has become an established procedure facilitating weaning from ventilatory support and shortening intensive care stay. Operative time is reduced and an operating theatre is not required. The risk of transferring a critically ill patient from ITU to theatre is also eliminated. It appears that long term sequelae are likely to be no more frequent than with surgical tracheostomy. There is no doubt that the development of the percutaneous tracheostomy will have proved to have been a major development in the management of critically ill patients.

Tracheostomy is one of the most commonly performed surgical procedures in intensive care unit patients and is indicated when airway protection, airway access or mechanical ventilation are needed for a prolonged period. Tracheostomy also facilitates weaning from the ventilator. Since its inception tracheostomy has remained in the domain of surgeons. Many a times the anesthesiologists or intensive care physicians looking after these patients get frustrated due to non-availability of the surgeon, operation room or encountered difficulties in shifting critically ill patients to operation room. This may have delayed timely formation of tracheostomy in needy patients. Anesthesiologists are supposed to be master in the art of airway management; however, dependency on surgeons to establish airway by surgical means gives a sense of incompleteness. With the advent of percutaneous dilatational tracheostomy (PDT), a bedside procedure, another much needed tool in airway management has been added in the armamentarium of anesthesiologists and intensive care physicians. Not only this, the PDT is gradually proving its superiority over surgical tracheostomy in many ways.

To my beloved wife Shashi and my two sons Paurush and Sahitya, without their constant encouragement, understanding and love this work could not have been possible.