Percutaneous tracheotomy

Case presentation An older man with multiple broken ribs and lung injury has been intubated and ventilated in the intensive care unit of a busy urban hospital for 12 days. Although it is clear that he should undergo a tracheotomy, operating room time is at a premium, and he has been “bumped” from the schedule several times due to cases that are more urgent and other surgeries that have gone on longer than originally scheduled. His case is elective, but it is increasingly apparent that a tracheotomy will let him proceed to the next phase of his care and it should be performed sooner rather than later. Introduction Interest in a percutaneous approach to tracheotomies first began in 1955 when Shelden et al. performed the first modern percutaneous tracheotomy (PT) [1]. The complication rate, however, was very high due to traumatic lacerations of surrounding structures by the trocar [2–4]. Thus, safer and more efficient methods continued to be developed.