History of Tracheostomy

There is evidence that surgical incision into the trachea in an attempt to establish an artificial airway was performed by a Roman physician 124 years before the birth of Christ. Three hundred years later, two physicians, Aretaeus and Galen, gave inflammation of the tonsils and larynx as indications for surgical tracheostomy.

There are few references to tracheostomy before the 11th century, but one must remember that this was during the Dark Ages. During the 11th century, Albucasis of Cordova successfully sutured the trachea of a servant who had attempted suicide by cutting her throat.

The first record of a tracheostomy being performed in Europe was in the 16th century when Antonius Musa Brasavola saved a patient who was suffering from acute edema of the larynx and was in severe respiratory distress. In 1540, Vesalius recorded his success in positive pressure ventilation of an animal through a tracheostomy.

As popularity of the operation increased, it was found that although asphyxia was immediately relieved, better long-term results were achieved if the stoma was kept patent for several days. To maintain an open airway, a simple cannula was designed by Fabricius of Aquapendente. This early tracheostomy tube consisted of a short, straight cannula having two wings to prevent it from slipping into the trachea and to secure it around the neck with tapes. The tube was left in place for three or four days.

Casserius, a student of Fabricius, suggested using a curved cannula to fit the anatomy of the throat. By the 19th century, successful operations had been reported for trauma, foreign bodies,

Tracheostomy tube circa 1860-1865

or inflammation to the airway causing acute obstruction of the upper airway.

During the diphtheria epidemic in France in 1825, tracheostomies gained further recognition. Improvements followed: In 1852 Bourdillat developed a primitive pilot tube; in 1869 Durham introduced the famous lobster-tail tube; and in 1880 the first pediatric tracheostomy tube was introduced by Parker.

Tracheostomies were performed for patients with severe burns and scalds of the face and neck and for other operative procedures, but diphtheria remained the most important indication until 1936, when Davidson described this procedure for poliomyelitis.

With early recognition of respiratory failure, improved surgical technique, modern tracheostomy tubes, ventilators, and improved nursing care in state-of-the-art intensive care units, this procedure has become commonplace.

In the mid-1980s, the first significant advancement in the surgical management of the airway in 90 years was introduced. This procedure, percutaneous tracheostomy, had been described in 1957 by Sheldon, and it has just recently gained in popularity and may soon become the preferred technique for managing the airway. Percutaneous tracheostomy has all but eliminated the complications that are common with the surgical tracheostomy. This relatively new procedure has been shown to have many advantages over translaryngeal intubation and the surgical approach to tracheostomy.