Tracheostomy

• Tracheostomy


  A surgical procedure by which an opening is made into the tracheal lumen in the anterior part of the neck and maintaining it with a tracheostomy tube
• Tracheotomy


  When the tracheostomy tube is removed, the opening is called a tracheotomy
• Laryngotomy (cricothyroidotomy)


  An emergency life saving procedure in which airway is achieved through cricothyroid membrane
• Peculiarity of infant's larynx

  • Higher in position, Smaller in size, Softer cartilages, Omega-shaped epiglottis, Loosely attached epithelium, Richer lymphatic supply, Weaker cough reflexes, Unstable neuro-muscular mechanism
• Functions of tracheostomy


  • Bypassing upper airway obstruction, Decrease dead space, Reduce resistance to airflow, Protect against aspiration, Enable swallowing, Access for cleaning, Deliver medication and humidification, Allow intermittent positive pressure respiration
• Types of Tracheostomy


  • Permanent, Temporary, Elective, Emergency, High, Middle, Low
• Indications for tracheostomy


  • Relieve upper airway obstruction (congenital, inflammatory, trauma, neoplastic, neuroparalytic, idiopathic), Tracheobronchial toileting (retained secretion, respiratory muscle paralysis/spasms, aspiration), Respiratory insufficiency (chest injury, emphysema), Part of another operation
• Physiologic alterations/problems following tracheostomy

  • Affected humidification and warming, Phonation not possible, Loss of olfaction, Affected ciliary activity and tracheal mucosal integrity, Prone to atelectasis, Affected swallowing and coughing, Cannot swim/shower/bathe, Difficulty in straining
• Technique of Tracheostomy


  Anaesthesia, Position, Procedure, Post operative care
• Complications of tracheostomy


  • Anaesthesia complications, Immediate surgical complications (haemorrhage, damage to structures, apnoea), Intermediate complications (tube blockage/obstruction, accidental decannulation, tracheal erosion, surgical emphysema, infections, granulation tissue, dysphagia), Late complications (tracheomalacia, difficult decannulation, fistulas, stenosis, scar, foreign body)
• Decannulation


  The process of gradually weaning a patient out of tracheostomy
• Requirements for decannulation


  • Indication for tracheostomy no longer present, No granulation tissue on X-ray
• Methods of decannulation


  • Serial gauze blockage, Surgical decannulation
• Types of tracheostomy tubes

  • Metallic (single lumen, double lumen), Plastic (cuffed, non-cuffed, single cannula, double cannula), Fenestrated (metallic/plastic)