Tracheotomy: Historical Review

Abstract

The authors review the ancient history of tracheotomy and bring the subject up to date (2008) by including the modern history of this procedure. In the past 60 years, there have been many advances in the knowledge of respiratory function that have been utilized to expand applications of the tracheotomy procedure. Improvements in the care of tracheotomized patients and the application of modifications in the available variety of tubes and ancillary equipment and procedures have made this a much more effective and widely utilized way of caring for the pulmonary cripple as well as utilizing it in the classical fixed obstruction of the upper airway.

Which Percutaneous Tracheostomy Method Is Better? A Systematic Review

“…Excellent reviews about this subject show that the procedure was common and had good results even in ancient Egypt. 1,25 The procedure remained unchanged for Ͼ 20 centuries. In the middle of the 20th century, Shelden et al 26 modified and described the first attempt of a less invasive tracheostomy, but it was not successful.…”

“…The first attempt was registered on Egyptian papyrus in 3,100 BC; the procedure evolved in the centuries that followed to open tracheostomy. 1 The open tracheostomy procedure was standardized by Jackson in 1909 1 and underwent minor changes during the 20th century. In 1985, Ciaglia et al 2 described a modification of open tracheostomy and introduced the Seldinger principle for the antegrade percutaneous approach.…”

Technical Improvements of Difficult Tracheotomy

“…In 1909, Chevalier Jackson published a report on tracheotomy indication, application, materials, methods, and standards in clinical applications, and several hospitals carried out tracheotomy. Thereafter, tracheotomy became a necessary measure to rescue critically ill patients with upper airway obstruction, throat infections, prolonged mechanical ventilation, and so on [11].…”

“…Pratt LW, in 2008, summarized PDT relative contraindications in the article "Tracheotomy: Historical Review": relative contraindications to perform percutaneous dilatational tracheotomy are as follows: children younger than 12 years of age, anatomic abnormality of the trachea, pulsating palpable blood vessel over the tracheotomy site, active infection over the tracheotomy site, occluding thyroid mass or goiter over the tracheotomy site, short or obese neck, positive end-expiratory pressure 15 cm H 2 O, platelet count 40,000/mm 3 , bleeding time 10 min, prothrombin time or partial thromboplastin time 1.5 times control, limited ability to extend the cervical spine, and history of difficult intubation [11].…”

“…Despite the rapid evolution and improvements in technique of PDT, there continues to be apprehension in the medical community about its applicability to the high-risk patient [8,9]. In difficult tracheotomy, patients suffered postposture cervical spine injury, chunky neck, anatomic variations, respiratory failure requiring positive end-expiratory pressure (PEEP), and were affected by not tolerating a long time of breathing machine offline and intubation difficulties [10,11]. The above two tracheotomies all have some kinds of incision difficulties or relative contraindications.…”