Tracheostomy and Its Variants

Introduction Placement of a tracheostomy tube percutaneously is not a new idea; pictures of devices that appear to have been developed for this purpose date back to the Rigveda.1 A modern percutaneous tracheostomy (PCT) device was developed by Toye and Weinstein in 1969, and its use in 100 trauma patients was reported in 1986.2,3 The wireguided technique for percutaneous tracheostomy was developed and reported in the same year by the American surgeon, Ciaglia.4 Primary or secondary respiratory failure is common in the intensive care unit, especially in patients with multiorgan failure that results in prolonged ventilatory support. A consensus conference of the National Association of Medical Directors of Respiratory care recommended that tracheostomy should be performed when the ventilatory support is anticipated to be more than 21 days.5 Ever since the PCT has evolved, the resources required for a surgical tracheostomy (ST), the needs of operating room, and personnel are eliminated. This article reviews the indications, contraindications, equipments and procedure of percutaneous tracheostomy. The details of ST are not described as it is generally performed by the surgeons.