الفهرس 
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Abstract
The first successful surgical tracheostomy was recorded in 1546 by an Italian physician. Percutaneous tracheostomy was introduced as a new non invasivetechnique in 1955 to facilitate rapid tracheostomy. Guide wires and flexible dilators/introducers were added later on for more benefit.
Trachea is made up of 18-22 C-shaped rings normally consisting of rigid cartilage anteriorly and laterally. There is a difference of the tracheal position between youth and old people. Tracheal position is extended in youth and is flexed in old people in normal standing and sitting positions.
There are many advantages of tracheostomy over endotracheal intubation such as improvement of respiratory mechanics, reduced laryngeal ulceration,improved patient comfort, improved nutrition and enhanced mobility and speech.
Upper airway obstruction due to different causes such as trauma, infection, laryngeal or subcricoid stenosis is an indication of tracheostomy.Tracheostomy in the proper timing avoids the numerous complications of prolonged endotracheal intubation.
Equipments and techniques of tracheostomy differ between surgical tracheostomy and percutaneous tracheostomy. Pediatricpopulation have some anatomical differences which necessitate variations in the technique and equipments.
Being a non invasive technique, percutaneous tracheostomy has much less intraoperative complications than surgical tracheostomy. Other early and late postoperative complications exist.
There are no absolute contraindications to surgical tracheostomy. Contraindications to percutaneous tracheostomy are either absolute or relative.
There are some anaesthetic considerations during performing the procedure. Suggested anaesthetic equipments must be prepared before the technique for a safer outcome.
Some practical aspects for aftercare should be considered when planning a tracheostomy procedure. The intensive care staff is responsible for organizing and providing the appropriate aftercare for patients with a tracheostomy in situ.The referring specialists should share this responsibility when the patient leaves the ICU/HDU to lower depending areas. A speech and language therapist may be needed especially in the pediatric age group.
Timely percutaneous tracheostomy has revolutionized airway management and follow-up in the intensive care unit, making weaning and discharge much easier for the sicker patient.