Urgent awake tracheotomy for impending airway obstruction

Awake tracheotomy is performed for patients with impending airway obstruction. Few studies to date have addressed the issues surrounding awake tracheotomy. We sought to review the indications, complications, and outcome of awake tracheotomy for urgent airway control.

We conducted a retrospective review of patients who underwent awake tracheotomy over a 4-year period from 2001 to 2004 at an urban tertiary medical center. Data were obtained from inpatient records and operative charts.

We obtained data on 54 men and 19 women, with a mean age of 61 years. The majority of patients presented with hoarseness, dyspnea, and stridor. Twenty patients had obstruction from head and neck cancers. Nonmalignant causes included deep neck infections (n = 18), bilateral vocal cord paralysis (n = 17), trauma (n = 9), and laryngeal edema (n = 6). Other causes include laryngeal cyst, subglottic stenosis, and vocal cord granuloma. Six (8.2%) patients experienced complications, including postoperative hemorrhage, pneumothorax, and chest and wound infections. There were no long-term complications or deaths.

Awake tracheotomy is efficacious and safe and has a low complication rate.

Awake tracheotomy should be performed for impending airway obstruction and in a timely manner before complete obstruction occurs.