Awake Tracheostomy: Indications, Complications and Outcome

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Critical Care Medicine

Background:

• Awake tracheostomy (AT) is a critical intervention for patients with upper airway obstruction when conventional methods fail.
• Literature on AT procedures and outcomes remains limited, necessitating further clinical review.

Purpose of the Study:

• To review the indications, complications, and outcomes of awake tracheostomy (AT) procedures.
• To analyze the clinical factors influencing AT outcomes, particularly the role of head and neck oncological disease.

Main Methods:

• A retrospective chart review of all ATs performed between 2010 and 2016 across two tertiary medical centers.
• Data collection included patient demographics, indications for AT, surgical techniques, urgency, and postoperative complications.

Main Results:

• Out of 1023 tracheostomies, 37 (3.62%) were performed while the patient was awake. The mean age was 60.3 years, with 86.5% males.
• Head and neck malignancy was the primary indication (70.3%), with laryngeal cancer being most common. Non-oncologic cases were younger and more urgent.
• Major complications included tube dislodgement and pneumothorax, all managed successfully. Immediate survival was 97.3%, with a 5.4% risk of major irreversible complications and 2.7% mortality.

Conclusions:

• Etiology, particularly head and neck oncological disease, significantly impacts AT patient characteristics and outcomes.
• Awake tracheostomy demonstrates a high immediate survival rate with a low incidence of major irreversible complications and mortality.
• The study highlights AT as a viable and relatively safe option for managing complex upper airway obstructions.