A tracheostomy is a surgical procedure to create an artificial opening (stoma) in the anterior wall of the trachea, just below the cricoid cartilage. A small and curved tracheostomy tube is placed into the trachea, via the newly created stoma, sitting just above the level of the carina (Figure 10.1). Up to 15 000 tracheostomies are performed each year in England with common indications given in Box 10.1. Most patients have their tracheal tubes removed (known as decannulation) prior to discharge from ITU/HDU to the ward environment. However, this is not always possible. The Intensive Care Society (2014)^1, informed by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2014)^2, published standards and guidelines for the care of adult patients with a temporary tracheostomy, to inform safe practice in any care setting.

The majority of tracheostomies will be planned, using a variety of approaches, depending on the reasons for tracheostomy formation:

• A surgical tracheostomy is performed in a theatre environment by a surgeon for patients with difficult anatomy who require permanent or long-term airway protection. This type of tracheostomy can be permanent or temporary.
  
• A percutaneous tracheostomy is temporary. This procedure is usually performed in critical care by an anaesthetist. A small hole is made and dilated using specialised equipment, until the tracheostomy tube can be inserted. Usually the site heals more quickly and with less scarring than surgical tracheostomy.

A cricothyroid/mini-tracheostomy