The patient has an obstructed upper airway
Acute upper airway obstruction, for example by a foreign object or oedema of the soft tissues, may make emergency short-term tracheostomy essential. More lasting damage to the upper airway (for example from chemical or inhalation burns) may require long-term tracheostomy.
The patient is likely to need prolonged artificial ventilation
Prolonged endo-tracheal intubation carries a high risk of damage to the soft tissues of the mouth, pharynx and trachea. It reduces the patient’s ability to communicate and increases the work of breathing by extending the dead space. Tracheostomy reduces or removes the risk of tissue damage, facilitates lip-reading and reduces the work of breathing by shortening the dead space, so promoting the process of weaning from artificial ventilation.
The patient is unable to maintain an airway independently
Patients with reduced function in cranial nerves V, VII, IX, X or XII, with damage to the brain stem, or with poor conscious levels may be unable to maintain a patent airway or protect their airways from aspiration of food, drink and saliva. In these patients tracheostomy may be short- or long-term.
The patient’s bronchial secretions cannot be cleared normally
A patient who is likely to be able to maintain an airway but has a poor cough may benefit from a tracheostomy.
The patient is undergoing surgery to or around the upper airway
Some maxillo-facial or ENT procedures make it necessary to secure the patient’s airway without obstructing the mouth and pharynx.
Indications for laryngectomy
Laryngectomy, the removal of the larynx and diversion of the lower trachea to a permanent stoma on the lower neck, is carried out in cases of advanced laryngeal cancer which cannot be controlled with radiation therapy.