There are four main reasons why someone would receive a<unk> : # Emergency airway access # Airway access for prolonged mechanical ventilation # Functional or mechanical upper airway obstruction # Decreased/incompetent clearance of tracheobronchial secretions Bypassing upper airway blockages In the acute (short term) setting, indications for<unk>  include such conditions as severe facial trauma, tumors of the head and neck (e.g., cancers, branchial cleft cysts), and acute angioedema and inflammation of the head and neck. In the context of failed tracheal intubation, either<unk>  or cricothyrotomy may be performed. Long-term ventilation<unk>  tubes and endotracheal tubes are often attached to ventilators to assist in breathing. In the chronic (long-term) setting, indications for<unk>  include the need for long-term mechanical ventilation and tracheal toilet (e.g., comatose patients, extensive surgery involving the head and neck).<unk>  may result in a significant reduction in the administration of sedatives and vasopressors, as well as the duration of stay in the intensive care unit (ICU). In extreme cases, the procedure may be indicated as a treatment for severe obstructive sleep apnea (OSA) seen in patients intolerant of continuous positive airway pressure (CPAP) therapy. The reason<unk>  works well for OSA is because it is the only surgical procedure that completely bypasses the upper airway. This procedure was commonly performed for obstructive sleep apnea until the 1980s, when other procedures such as the uvulopalatopharyngoplasty, genioglossus advancement, and maxillomandibular advancement surgeries were described as alternative surgical modalities for OSA. Timing (early vs late) If prolonged ventilation is required,<unk>  is usually considered. The timing of this procedure is dependent on the clinical situation and an individual's preference. An international multicenter study in 2000 determined that the median time between starting mechanical ventilation and receiving a<unk>  was 11 days. Although the definition varies depending on hospital and provider, early<unk>  can be considered to be less than 10 days (2 to 14 days) and late<unk>  to be 10 days or more. A meta-analysis in 2015 revealed improved outcomes from early<unk>  compared to late<unk> , including decreased number of days in the intensive care unit (ICU), decreased use of sedative medications, and decreased mortality rates. However, another meta-analysis done the same year did not find any significant differences between early and late<unk>  other than decreased amount of time on sedative medications. Given the minimal or unproven benefit of early<unk> , many health care providers opt to wait at least 10 days to prevent unnecessary surgeries or prolonged mechanical ventilation if extubation, removal of the breathing tube, is an option.
Tracheotomy
Cricothyrotomy
Trachelectomy
Tracheal intubation
Lobotomy
Blind insertion airway device
Thoracostomy
Elastomeric respirator