Tracheostomy

A tracheostomy is a medical procedure that involves creating an airway in the neck, allowing a person to breathe without using their mouth or nose. The procedure involves making an incision in the neck and inserting a tube into the trachea (windpipe) to provide a direct pathway for air to enter the lungs.

Types of Tracheostomy

• Temporary Tracheostomy: A temporary tracheostomy is performed in emergency situations, such as when a person's airway is blocked or they are unable to breathe on their own. The tube is typically removed once the underlying condition has been resolved.
• Permanent Tracheostomy: A permanent tracheostomy is performed when a person requires long-term ventilation support, such as in cases of chronic respiratory failure or neurological disorders that affect breathing.
• Pediatric Tracheostomy: Pediatric tracheostomy is performed on children who require long-term ventilation support due to conditions such as congenital anomalies, respiratory distress syndrome, or other respiratory disorders.

Indications for Tracheostomy

Tracheostomy may be indicated in the following situations:

• Respiratory failure: When a person is unable to breathe on their own due to conditions such as chronic obstructive pulmonary disease (COPD), pneumonia, or acute respiratory distress syndrome (ARDS).
• Neurological disorders: Conditions such as amyotrophic lateral sclerosis (ALS), muscular dystrophy, or spinal cord injuries that affect breathing.
• Head and neck cancer: Tracheostomy may be performed to bypass a tumor that is obstructing the airway.
• Severe trauma: Tracheostomy may be performed in emergency situations where the airway is compromised due to trauma, such as a gunshot wound or severe laryngeal injury.

Procedure

The tracheostomy procedure typically involves the following steps:

1. The patient is given general anesthesia to ensure they are comfortable and pain-free during the procedure.
2. A surgical incision is made in the neck, usually about 1-2 inches long.
3. The trachea is located and a small opening is made in the front of the windpipe.
4. A tracheostomy tube is inserted into the opening, which provides a direct pathway for air to enter the lungs.
5. The tube is secured in place with sutures or tape.

Post-Operative Care

After the procedure, the patient will require close monitoring and care to ensure the tracheostomy site heals properly and the tube functions correctly. This may include:

• Suctioning: Regular suctioning of the tracheostomy tube to remove secretions and maintain a clear airway.
• Humidification: Using a humidifier to add moisture to the air, which helps to prevent dryness and irritation in the trachea.
• Cleaning: Regular cleaning of the tracheostomy site and tube to prevent infection.

Risks and Complications

As with any surgical procedure, there are risks and complications associated with tracheostomy, including:

• Bleeding or hemorrhage: Excessive bleeding during or after the procedure.
• Infection: Bacterial or fungal infections can occur at the tracheostomy site or in the lungs.
• Accidental decannulation: The tube becomes dislodged, which can lead to respiratory distress or arrest.
• Tracheal stenosis: Narrowing of the trachea due to scarring or inflammation.

Long-Term Care and Management

Patients with a tracheostomy require ongoing care and management to ensure the tube functions correctly and the tracheostomy site remains healthy. This may include:

• Regular follow-up appointments with a healthcare provider.
• Tracheostomy tube maintenance: Regular cleaning, suctioning, and replacement of the tube as needed.
• Respiratory therapy: Ongoing respiratory support and therapy to maintain lung function and overall health.

Frequently Asked Questions (FAQs)

What is a tracheostomy?
A surgical procedure creating an airway in the neck.

Why is a tracheostomy performed?
To bypass upper airway obstruction or assist breathing.

How is a tracheostomy done?
Through surgery, making an incision in the neck.

What is the tracheostomy tube?
A tube inserted into the trachea to facilitate breathing.

Is a tracheostomy permanent?
Not always, it can be temporary or permanent.

Can a person speak with a tracheostomy?
Possibly, with a special valve or device.

What are complications of tracheostomy?
Infection, bleeding, and tube obstruction.

How is a tracheostomy cared for?
Regular cleaning and maintenance of the tube.

Can a person eat with a tracheostomy?
Yes, but may require special precautions.

Is a tracheostomy reversible?
Sometimes, the tube can be removed and the hole closed.