Tracheostomy is a surgically created hole through the front of the patient’s neck into the windpipe (trachea). The term used for the surgical procedure which is used to create this opening is known as a tracheostomy.
A tracheostomy will provide a way to help the patients breathe when the usual route for breathing is somehow obstructed or impaired. A tracheostomy is often performed when health problems require long-term use of a machine (ventilator) to help the patient breathe.
In some cases, an emergency tracheostomy procedure is performed when the airway is suddenly blocked, such as after a traumatic injury to face or neck.
When a tracheostomy is no longer needed, it's allowed to heal shut or is surgically closed. For some people, a tracheostomy is permanent.
Why is tracheostomy done?
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Situations that may call for a tracheostomy include:
- Such type of medical conditions that require the use of a breathing machine (ventilator) for an extended period, usually for more than one or two weeks
- Medical conditions that block or narrow the airway, such as vocal cord paralysis or throat cancer
- Paralysis, neurological problems or other conditions that make it difficult to cough up secretions from the throat and require direct suctioning of the windpipe (trachea) to clear the patient’s airway
- Preparation for major head or neck surgery to assist breathing during recovery
- Major trauma to the head or neck that blocks breathing
- Other emergency situations when breathing is obstructed and emergency personnel can't put a breathing tube through the mouth into the trachea
What are the various risks related to Tracheostomy
Tracheostomies are mostly safe, but they do have some sort of risks available. Some complications are particularly likely during or shortly after surgery.
The risk of such problems greatly increases when the tracheotomy is performed as an emergency procedure. Immediate complications include:
- Bleeding
- Damage to the trachea
- Air trapped in tissue under the skin of the neck, which can further cause breathing problems and damage to the trachea or food pipe (esophagus)
- The buildup of air between the chest wall and lungs (pneumothorax), which causes pain, breathing problems or lung collapse
- A little amount of blood can be formed in the neck and compress the trachea, which causes breathing problems
- Misplacement or displacement of the tracheostomy tube
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Long-term complications are more likely the longer a tracheostomy is in place. These problems include:
- Displacement of the tracheostomy tube from the trachea
- Narrowing of the trachea
- Abnormal tissue formation in the trachea
- Obstruction of the tracheostomy tube
- Development of a passage between the trachea and the innominate artery (tracheoinnominate fistula), which can generate life-threatening bleeding
- Infection
- Bacterial colonization, which may cause illness, such as pneumonia
What the patient can expect during Tracheostomy
A tracheostomy is most commonly performed in an operating room with general anesthesia, which makes the patient unaware of the surgical procedure. A local anesthetic to numb the neck and throat is used if the surgeon is worried about the airway being compromised from general anesthesia or if the procedure is being done in a hospital room rather than an operating room.
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The type of procedure the patient undergoes depends on why he needs a tracheostomy and whether the procedure was planned. There are essentially two options:
- Surgical tracheostomy can be performed in an operating room or in a hospital room. During a surgical tracheostomy, the surgeon usually makes an incision through the skin at the lower part of the front of the neck. The surgeon carefully pulls back the surrounding muscles and cuts through a small portion of the thyroid gland, exposing the windpipe (trachea). At a certain spot on the windpipe near the base of the neck, the surgeon creates a hole and inserts a tracheostomy tube into the hole. A neck strap attached to the face plate of the tube keeps it from slipping out of the hole, and temporary sutures also can be used to secure the faceplate to the skin of the neck.
- Minimally invasive tracheostomy is generally performed in a hospital room. In this, the doctor makes a small cut near the base of the front of the neck. A special lens is fed through the mouth so that the surgeon can view the inside of the throat. By taking this view of the throat, the surgeon guides a needle into the windpipe to create the tracheostomy hole. The hole is then expanded to accommodate the tracheostomy tube. A neck strap attached to the faceplate of the tube keeps it from falling out of the windpipe.
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Results
In most of the instances, a tracheostomy is not permanent, providing an alternative breathing route until other medical issues are resolved. If a person needs to remain connected to a ventilator indefinitely, the tracheostomy is often the best permanent solution.
The medical team will help the patient determine when it's appropriate to remove the tracheostomy tube. The hole may heal shut on its own, or it can be closed surgically.