The technique of tracheotomy and cricothyroidotomy. When to operate--and how to manage complications.

Tracheotomy can relieve upper airway obstruction, improve pulmonary hygiene, and support long-term mechanical ventilation. Consider performing a tracheotomy whenever the need for more than 14 days of ventilatory support is anticipated. When emergent airway access is needed and translaryngeal intubation is not possible, consider cricothyroidotomy. For a tracheotomy, make a transverse incision 1 cm above the suprasternal notch or, for cricothyroidotomy, through the superficial cricothyroid membrane. Accidental tube displacement within 5 days of surgery is potentially tracheotomy's most lethal early complication. Many late complications can be prevented by careful management and expert nursing support.