Editing Tracheotomy (section)

==Indications==
There are four main reasons why someone would receive a tracheotomy:<ref name=":1" />

# Emergency airway access
# Airway access for prolonged mechanical ventilation
# Functional or mechanical upper airway obstruction
# Decreased/incompetent clearance of tracheobronchial secretions

In the acute (short term) setting, indications for tracheotomy include such conditions as severe [[facial trauma]], tumors of the head and neck (e.g., [[Head and neck cancer|cancers]], [[branchial cleft cyst]]s), and acute [[angioedema]] (swelling) and [[inflammation]] of the head and neck. In the context of failed [[tracheal intubation]], either tracheotomy or [[cricothyrotomy]] may be performed.{{citation needed|date=January 2022}}

[[File:VIP Bird2.jpg|thumb|left|Tracheotomy tubes and [[endotracheal tube]]s are often attached to [[Medical ventilator|ventilator]]s to assist in breathing.]]
In the chronic (long-term) setting, indications for tracheotomy include the need for long-term mechanical ventilation and [[Pulmonary toilet|tracheal toilet]] (e.g., [[coma]]tose patients, extensive surgery involving the head and neck). Tracheotomy may result in a significant reduction in the administration of [[sedative]]s and [[Antihypotensive agent|vasopressors]], as well as the duration of stay in the [[intensive care unit]] (ICU).<ref>{{cite thesis|last1=Eberhardt|first1=Lars Karl|title=Dilatational Tracheostomy on an Intensive Care Unit|date=2008|url=http://vts.uni-ulm.de/doc.asp?id=6821|publisher=Universität Ulm|type=Dissertation}}</ref>

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 tracheostomy works well for OSA is that 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.

If prolonged ventilation is required, tracheostomy 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 tracheostomy was 11 days.<ref>{{cite journal | vauthors = Esteban A, Anzueto A, Alía I, Gordo F, Apezteguía C, Pálizas F, Cide D, Goldwaser R, Soto L, Bugedo G, Rodrigo C, Pimentel J, Raimondi G, Tobin MJ | title = How is mechanical ventilation employed in the intensive care unit? An international utilization review | journal = American Journal of Respiratory and Critical Care Medicine | volume = 161 | issue = 5 | pages = 1450–8 | date = May 2000 | pmid = 10806138 | doi = 10.1164/ajrccm.161.5.9902018 }}</ref> Although the definition varies depending on hospital and provider, early tracheostomy can be considered to be less than 10 days (2 to 14 days) and late tracheostomy to be 10 days or more.