Case presentation A 76-year-old patient with multiorgan failure has been intubated and ventilated in the intensive care unit (ICU) for 9 days. Of note, it was very difficult to intubate the patient. You are consulted for a tracheotomy. At physical examination, he is obese with moderately palpable cervical landmarks. Informed consent is obtained from his surrogate decision-maker. The laboratory results are checked and there is no coagulopathy. The patient is scheduled for an elective open tracheotomy in the operating room. Introduction A tracheotomy is a surgical procedure in which a direct airway is established by creating an opening in the anterior neck into the trachea. Three main groups of patients that benefit from elective tracheotomy: required prolonged intubation; cannot manage their airway secretions; or have an upper airway obstruction. Conversion from a translaryngeal airway to a tracheotomy minimizes patient discomfort, reduces the amount of analgesics and sedation required, and lowers the rate of long-term complications from translaryngeal airways.
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