Tracheostomy

Overview:

Tracheostomy is a medical treatment procedure in which a surgical incision is made at the windpipe for relieving an obstruction that causes breathing difficulties. It is done mainly during emergency conditions. The procedure can be done either temporarily or permanently in certain patients who are suffering from chronic illnesses.

In this procedure, an opening is made in the anterior portion of the neck known as the cricoid cartilage as a viable route for the entry of a tube into the affected person's trachea. The tube that is inserted is known as an endotracheal tube. This enables the passage of air to enter the lungs artificially. Air passes through this tube, bypassing the mouth, nose, and then the trachea. A tracheostomy procedure is usually called a stoma. This term is the particular name for the hole that is made at the neck through which the tube passes.

What Are the Conditions in Which Tracheostomy Is Required?

A tracheostomy is performed for many reasons. The main reason is to enable the passage of the air into the restricted airways. It might be done during emergency conditions when a person's airway is blocked suddenly. It could also be done in chronic disease conditions or any other problem that makes the regular breathing of the affected person so challenging to do it by their efforts.

The various clinical conditions which might require a tracheostomy procedure are:

• Anaphylactic shock.

• Congenital disabilities that affect the baby's trachea.

• Burns particularly at the air passages. It might occur due to the inhalation of corrosive material.

• Presence of cancer in the neck.

• Chronic lung diseases like pulmonary fibrosis and pneumonia.

• The comatose state of the patient.

• Dysfunction of the diaphragm.

• Facial burns that affect the nasal passages or surgery.

• Infections to the trachea.

• Any accidental damages to the larynx.

• Laryngectomy procedure.

• Injuries that damage the natural anatomy of the chest wall.

• Situations when there is a need for long-term respiratory support by a mechanical ventilator.

• Obstruction of the tracheal passages by a foreign body, especially in the case of children,

• Obstructive sleep apnea.

• Paralysis of the masticatory muscles that are used in swallowing.

• Severe mouth injuries are affecting the nasopharynx.

• Paralysis of the vocal cord.

What Are the Methods of Tracheostomy?

• In many scheduled tracheostomy procedures, the patient will be put under general anesthesia. Due to the anesthesia, the patient will fall asleep throughout the procedure and will not feel any pain. In emergency conditions, the patient will be given local anesthesia at the anterior portion of the neck, and the procedure will be rushed and is done before the other scheduled procedures.

• The local anesthesia would make the sensory nerves in the area of your neck so numb. The procedure will be started once the doctors ensure there is a total absence of pain once the anesthesia starts to work.

• The surgeon will initially make an incision at the anterior portion of the neck exactly below the cricothyroid cartilage. The incision will pass through the cartilaginous rings that are significantly present at the trachea's surrounding wall. The hole is then opened into a wide hole that could afford the passage of a tracheostomy tube through it. After that, the surgeon hooks the patient to a mechanical ventilator, a machine that enables breathing artificially instead of the person's lungs. The tube will be secured strongly in place with a strong brown band that will stick around the person's neck.

• These protective measures will keep the endotracheal tube in place without unnecessary movement so that the skin around the stoma heals adequately. In the case of conscious patients, there would be proper advice given regarding how to take care of the tracheostomy wound and the hygiene measures to protect infection through the endotracheal tube.

Do People Usually Adapt to Tracheostomy?

Almost all individuals who undergo this procedure will take a certain time to adapt mentally and physically to the tracheostomy tube. People will take a minimum of one to three days to adapt to the artificial breathing by a tracheostomy tube and being always fit to a mechanical ventilator. Talking consumes a lot of time and takes some practice. This is because the air the person breathes now does not pass through your larynx, making sound through phonation. Certain people talk by covering the tube. By recent advances, special valves could be attached along with the tracheostomy tube. This advancement enables the person to talk even while still in the air passing through the tube; these additional valves allow air to exit through the mouth and nose. As a result, speech is permitted.

What Are the Factors to Be Considered for Tracheostomy?

Every surgical procedure or accidental injury where the skin is opened increases the risk of infections as well as excessive bleeding. There are chances for the anesthesia to cause allergic reactions. It is usually very rare. However, it is seen more in emergencies where thorough history taking is not possible. In the case of conscious patients, it is always important for the patient or at least the relatives of the patient to inform their doctor if they had a previous history of allergic reaction to the administration of any anesthesia.

What Are the Risk Factors for Tracheostomy?

The following are the common risks that are associated with a patient who undergoes tracheostomy postoperatively.

• The incision is made very near to the thyroid gland, so there is a risk of damage to the thyroid gland.

• In very rare instances, there could be erosion at the trachea.

• Any mistakes in the procedure, like the surgeon's slow operating speed, can lead to lung collapse.

• The incision site at the trachea might produce permanent scar tissue.

Do They Require Home Care?

It is very important to provide adequate home care in patients who have a permanent tracheostomy. Cleaning the tube by using sterile solvents along with the skin around the stoma is needed to prevent infections at the incision site. The person who is going to clean must always wash their hands with antibacterial soap and water beforehand. It is essential to clean the skin around the stoma at least twice a day with a mix of distilled water and hydrogen peroxide. The suction catheters or other equipment used to remove aspirated fluid should also be cleaned very frequently.

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