Untitled Quiz

Tracheostomy Definition and Objectives

• Tracheostomy is a surgical opening in the anterior wall of the trachea, just below the larynx, which bypasses the upper passages (pharynx and larynx)
• Learning objectives: define tracheostomy, indicate its purposes, recognize types and parts of tracheostomy tubes, identify complications, and understand the role of RT in tracheostomy care

Types of Tracheostomy

• Temporary or permanent tracheostomy
• Emergency or elective tracheostomy
• Surgical (open) tracheostomy: incision to trachea between 2nd and 3rd tracheal rings
• Percutaneous tracheostomy (PDT): can be done in ICU at the bedside
• Mini-tracheostomy and cricothyroidotomy: can be done in emergency situations

Indications of Tracheostomy

• Upper airway obstruction due to infections, trauma, neoplasms, oedema of larynx
• Obstructive sleep apnea (OSA) and obesity hypoventilation syndrome (OHS) when CPAP and medical therapies fail
• Ventilator dependence: prolonged intubation, inability to protect airway, and diaphragm paralysis
• Retained secretions

Contraindications of Tracheostomy

• Skin infection
• Prior major neck surgery which completely obscures the anatomy
• Uncorrected coagulopathies (bleeding tendency)

Role of RT in Tracheostomy

• Managing the trach tube
• Making ventilator changes as needed
• Assisting with bronchoscopist
• Monitoring the patient

Tracheostomy Tubes

• Types: single lumen, double lumen, cuffed, un-cuffed, fenestrated, un-fenestrated
• Parts: outer cannula, inner cannula, obturator, face plate (flanges), inflatable cuff, and pilot balloon

Single Lumen vs Double Lumen Tubes

• Single lumen tubes: require replacement every 5-7 days, disadvantages: short term use, can easily become blocked
• Double lumen tubes: inner lumen can be changed/cleaned frequently, reducing the risk of occlusion, can remain in place for a maximum of 30 days

Cuffed Tubes

• Allow ventilation and prevent aspiration
• Inflatable cuffs are used when an air-tight seal is required around the tube
• Disadvantages: cuff exerts pressure on surrounding tissues, causing damage, and patients cannot speak when the cuff is inflated

Tracheostomy Procedure

• Site of tracheostomy: high, mid, or low
• High tracheostomy: above the level of thyroid isthmus, may cause perichondritis of the cricoid cartilage and subglottic stenosis
• Mid tracheostomy: preferred site, done through the 2nd and 3rd rings, needs division of thyroid isthmus or its retraction
• Low tracheostomy: done below the level of isthmus, trachea is deep, and close to several large vessels

Percutaneous Dilation Tracheostomy (PDT)

• Placement of a tracheostomy tube without direct surgical visualization of the trachea
• Advantages: less tissue trauma, tighter fit between cannula and skin, and less clinically significant wound infection

Complications of Tracheostomy

• Perioperative complications: pneumothorax, wound infection, bleeding, difficult insertion, accidental decannulation, occlusion due to secretions, air embolism, and aspiration
• Long-term complications: subglottic stenosis, tracheal stenosis, oesophago-tracheal fistula, vocal cord dysfunction, and chronic recurrent laryngeal nerve injury