Review of tracheostomy usage: Types and indications. Part I

The use of tracheostomy tubes has become common practice in the last few decades. Early in the twentieth century, tracheostomy tubes were being placed almost exclusively for acute or impending upper airway obstruction. Indications for their placement have now become much broader and include, but are not limited to, mechanical ventilation, both in the setting of prolonged translaryngeal intubation and chronic progressive respiratory insufficiency, as occurs in neuromuscular diseases, excessive pulmonary secretions and airway suctioning, and sleep apnea. There are various types of tracheostomy methods described. Percutaneous dilational tracheostomy can now be performed at the bedside with or without bronchoscopic guidance, with a low complication rate in experienced hands. Minitracheostomy has been used in postoperative situations where airway secretions are excessive. Cricothyrotomy is the procedure of choice in emergency situations. Alternative, less-invasive measures to tracheostomy are widely available. These are used in different clinical settings and include: (1) the use of noninvasive ventilation in weaning after acute respiratory failure, (2) noninvasive ventilation in chronic respiratory failure with a special emphasis on neuromuscular weakness, and (3) noninvasive cough assistance devices in patients with excessive airway secretions.