Open tracheostomy—when do we need it and how we should do it?

Tracheostomy, a rather common surgical operation, is most often indicated for prolonged mechanical ventilation in intensive care unit (ICU) patients with respiratory failure. There are two main surgical approaches for tracheostomy: open (or conventional or surgical) tracheostomy and percutaneous tracheostomy. The latter was introduced by Ciaglia in 1985 (1) and rapidly accepted worldwide. Today, percutaneous tracheostomy is the method of choice in majority of cases (2), despite that it actually possesses only a few proven advantages over the open method. In addition to the obvious i.e., smaller skin incision and less tissue trauma, a few meta-analyses have proved percutaneous tracheostomy to be related to lower rate of wound infection and shorter procedure duration (3,4). Percutaneous tracheostomy is performed at bed-side, therefore does not imply patient transfer to and utilization of the operating theatre. Considering intra- and postoperative haemorrhage and postoperative mortality, no difference between the two techniques has been observed (3).