Tracheostomy Overview and Indications

Tracheostomy Overview

• Surgical procedure creating an opening in the trachea to bypass obstructed airways.
• Involves inserting a tube into the trachea through the neck for ventilation support.
• Can be performed as an emergency or as a planned procedure for long-term respiratory needs.

Indications for Tracheostomy

• Airway obstruction due to tumors, trauma, or swelling.
• Prolonged mechanical ventilation needs, especially in intensive care units.
• Neuromuscular disorders impacting breathing, such as ALS or Guillain-Barré syndrome.
• Severe sleep apnea not responding to other treatments.
• Congenital airway anomalies.
• Severe neck or facial trauma.
• Managing secretions in patients unable to clear airways effectively.
• Protecting airways in emergencies, such as anaphylaxis or burns.

Surgical Procedure

• Preparation: Patient receives anesthesia (general or local for emergencies).
• Incision: A horizontal or vertical incision is made over the trachea, usually between the second and third rings.
• Separation of Tissues: Layers of skin, subcutaneous tissue, and muscles are carefully dissected to reach the trachea.
• Tracheal Opening: A small incision is made in the trachea for tube insertion.
• Tube Insertion: Tracheostomy tube is placed and secured with sutures or a neck tie.
• Closure and Dressing: Partial closure of the incision with a sterile dressing applied around the stoma.

Tracheostomy Care

• Essential for preventing infections and maintaining airway patency.
• Cleaning Cannula: Regularly clean or replace the inner cannula to avoid blockages.
• Suctioning: Necessary for removing secretions obstructing the airway.
• Dressing Changes: Clean the stoma area and change the dressing to prevent infection.
• Humidification: Use of humidified oxygen or air is crucial since natural humidification is bypassed.
• Monitoring: Regular checks for infections, tube displacement, or other complications.

Complications of Tracheostomy

• Early Complications:
  • Bleeding and infection risk.
  • Pneumothorax: air trapped between lung and chest wall.
  • Subcutaneous emphysema: air trapped beneath the skin.
  • Tube displacement or blockage can occur.
• Late Complications:
  • Tracheal stenosis: narrowing of the trachea over time.
  • Tracheoesophageal fistula: abnormal connection between trachea and esophagus.
  • Granulomas may form around the stoma.
  • Potential difficulty swallowing and persistent infections can arise.

Decannulation Process

• Involves removing the tracheostomy tube once airway support is no longer needed.
• Typically performed when patients can maintain adequate ventilation and secretion clearance independently.
• The stoma may close on its own or require surgical closure based on circumstances.

Indications for Decannulation

• Resolution of the underlying condition necessitating the tracheostomy.
• Patient can breathe effectively without the tracheostomy tube.
• Sufficient cough and clearance capabilities are present.
• Clinically stable respiratory function confirmed through assessment.