The tracheotomy is one of the oldest surgical procedures. Amazingly, a tracheotomy was portrayed on Egyptian tablets dated back to 3600 BC. Asclepiades of Persia is credited as the first person to perform a tracheotomy in 100 BC. The first successful tracheotomy was performed by Prasovala in the 15th century. In the 16th century, Guidi invented an original method for tracheotomy (see rare images). Reports of tracheotomies can be found in medical literature sporadically from the second to the eighteenth centuries. However, well documented studies do not appear until the early 1900's.
Antonio Musa Brasavola, an Italian physician, performed the first documented case of a successful tracheotomy. He published his account in 1546. The patient, who suffered from a laryngeal abscess and recovered from the procedure.
Antonio Musa Brasavola (1490-1554)
The National Library of Medicine
The tracheotomy has gone by several different names, including pharyngotomy, laryngotomy, bronchotomy, tracheostomy and tracheotomy. The word tracheotomy first appeared in print in 1649, but was not commonly used until a century later. Tracheostomy refers to the opening created by the tracheotomy procedure. Sometimes this term is used interchangeably, but tracheotomy usually refers to the operation itself.
Tracheotomies were originally used for emergency treatment of upper airway obstruction, but with little success. Upper airway obstruction in children was first discussed as a clinical entity in 1765. It was suggested that a tracheotomy be performed as an emergency treatment to prevent children from suffocating due to throat inflammation.
In 1799, George Washington died of an upper airway obstruction, probably due to acute epiglottitis or an abscess. Washington's physician was familiar with the tracheotomy procedure, but had not actually performed one himself. He apparently was unwilling to do his first tracheotomy on a person of Washingtons stature.
Tracheotomies were used in the early 1800's for airway inflammation in children due to Diphtheria. The first documented successful tracheotomy performed on a child was reported in 1808.
- The Tracheotomy Tube, short story of a child with a trach in 1892.
- Photo's of Antique Tracheostomy Tubes
In 1909, a lower tracheotomy technique was introduced in which the tracheal incision extends to the 4th or 5th tracheal ring. This operative technique was refined by Chevalier Jackson when faced with the challenge of the polio epidemic of the 1940's. This technique is basically the same today.
Christmas in the bronchoscopic clinic ward.
Children with tracheostomies usually lived in the hospital.
Photo from The Life of Chevalier Jackson, An Autobiography
Copyright 1938 by MacMillan Company
T.C. Galloway further expanded the uses for the tracheotomy from airway obstruction to the treatment of paralysis requiring artificial ventilation and management of secretions.
Recently, the development of synthetic materials and low pressure/high volume cuffs have improved the tracheostomy tubes and reduced the complication rate of the tracheotomy procedure (e.g. stenosis and erosion of large blood vessels).
In 1965, the use of intubation and respiratory support for neonatal patients was described by McDonald and Stocks. This revolutionized neonatal care; but, at the same time it has lead to many more children surviving with tracheostomies due to subglottic stenosis.
- Evolution of an Airway - tracheostomy history article by Steven E. Sittig, RRT and James E. Pringnitz, RRT from AARC Times February 2001 Vol. 25, Issue 2.
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