General Information about Tracheostomy
Tracheostomy (Tray-kee-AH-stuh-mee) is a surgical opening in the trachea (windpipe) that forms a temporary or permanent opening to make breathing easier.
The terms "tracheotomy" and "tracheostomy" are used interchangeably
The opening is called a stoma.
A tracheotomy tube is inserted in the opening to keep it open.
Emergency tracheostomy is performed as a lifesaving procedure
Tracheostomy in early days was considered slashing of the neck to save a life.
Even though tracheostomy procedure existed right from the Rig Vedas it was
In 1718 that Lorenz Heister coined the term tracheotomy
In 1921 Chevalier Jackson described the indications and techniques for modern tracheostomy.
Tracheostomy - Anatomy
The trachea is also called windpipe
The trachea and esophagus run parallel to each other through the chest cavity.
The esophagus is connected to the stomach, and helps in carrying food and saliva to the stomach.
The trachea, which is connected to the lungs, carries air to the bronchi and the lungs.
As we breathe the air passes through the throat into the trachea (windpipe).
The trachea is then divided into the left and right bronchi.
Each bronchus divides again and again like a branch of a tree, becoming narrower and narrower.
Now a days tracheostomy is done only in those cases in which intubation by a mouth or nasal tube is not a feasible option.
There are broadly four groups of patients on whom tracheostomy needs to be performed:
1. To relieve breathing difficulties by any blockage in the airway passages for example-
· Foreign body Impactation in the airways.
· Acute infection of the airways
· Edema of the airways
· Paralysis of vocal cords following injury
· Tumors of the vocal cords
· Trauma in the region
2. To improve respiratory functions by reducing the length of the airway, which may be required in special lung conditions like- Bronchopneumonia
· Bronchitis with Emphysema
· Chest injury
In these conditions the tracheostomy tube also helps in aspiration of excessive secretion that may be caused due to infection or injury
3. Respiratory nerve damage temporary or permanent causing paralysis of chest muscles that assist in breathing. In these situations performing assisted or positive pressure respirations may be required in conditions like-
· Unconsciousness associated with head injuries
· Barbiturate poisoning
These patients may also aspirate their gastric content into the lungs and a tracheostomy tube may be helpful for aspiration these secretions.
4. As a preliminary step in certain surgeries on the upper airway.
Advantages of Tracheostomy
Tracheostomy has certain advantageous over the temporary tube called endotracheal tube because it-
. Reduces patient discomfort
· Reduces need for sedation
· Improves ability to maintain oral and bronchial hygiene
· Reduces risk of trauma to the windpipe and trachea
· Makes breathing easier with less effort for a sick patient
· Easier to move off assisted breathing using a ventilator.
Tracheostomy - Procedure
The patient is made to lie down on their back with the neck & head extended by keeping a pillow under the shoulder and neck.
Local anaesthesia or general anaesthesia is used for the procedure.
A horizontal cut is made across the neck above the 'sternal notch' using a knife.
The skin is separated and surrounding tissues are dissected to expose the trachea.
The 2nd or 3rd of the tracheal ring is incised for the tracheostomy tube to be placed.
A suitable size tracheostomy tube is then introduced inside. While choosing the tube, the smallest feasible tube should be used. A general rule is that the tube should be three fourths of the diameter of the trachea.
The cuff of the tube is inflated by using 2-5 ml of air and it is held in place by using a necktie.
The incision is closed using skin sutures by the side of the tracheostomy tube.
Dressing is applied for the wound to heal.
Tracheostomy- Post Operative Care