Tracheostomy

Overview

A tracheostomy is a surgical procedure in which a surgeon creates a breathing hole through the neck into the trachea. The objective is to facilitate the smooth and secure delivery of oxygen to your lungs. If a patient has an upper airway obstruction or an underlying medical problem, they may require a tracheostomy. A tracheostomy is frequently necessary when breathing assistance from a machine (ventilator) is required on a long-term basis due to health issues.

The duration of a tracheostomy may vary depending on the specific conditions. The healthcare provider can remove the tracheostomy tube when the patient’s tracheostomy is no longer required. Usually, the hole closes by itself. However, the surgeon may close it up if it doesn’t.

It will require some practice for the patient to speak while they have a tracheostomy. They can make sounds by pressing air out of their mouth and plugging the tracheostomy hole with their finger. With the use of speech therapy procedures, a speech-language pathologist can instruct them on how they should proceed. Speaking valves are another tool that can assist those who suffer in speaking. They can now talk without covering their tracheostomy hole with their finger because of devices. Discuss with the healthcare provider if the patient is qualified to have those assistive devices.

Types

The specific procedure you undergo varies based on the reason for requiring a tracheostomy and whether the procedure was scheduled. Essentially, there are two main options available.

• Surgical tracheotomy: Typically, the lower front portion of the neck’s skin is cut horizontally by the surgeon. The windpipe (trachea) is made visible by carefully pulling back the surrounding muscles and cutting a little part of the thyroid gland. The surgeon makes a tracheostomy hole at a specified location at the base of their neck on their windpipe.
• Minimally invasive tracheotomy: Also known as percutaneous tracheotomy. A small incision is made by the healthcare provider close to the base of the front neck. The surgeon inserts a special lens into the mouth to observe the inside of the throat. The tracheostomy hole is made by the surgeon using this image of the neck to insert a needle into the windpipe and then extend it to the proper size for the tube.

Reasons for undergoing the procedure

If a patient has any of the following, a tracheostomy may be necessary:

• Conditions that require the prolonged use of a breathing machine (ventilator), typically longer than one or two weeks.
• Conditions include paralysis, neurological issues, or others that make it difficult to cough up secretions from the throat and necessitate direct tracheal suctioning to clearthe airway.
• Getting ready for major surgery on the head or neck to help with breathing while recovering.
• Patient having problem in swallowing.
• Experience difficulty in breathing due to injury, swelling, or lung diseases.
• Undergo airway reconstruction subsequent to surgical intervention on your larynx (voice box) or pharynx (throat).
• Encounter medical issues that obstruct or constrict your airway, such as vocal cord paralysis or throat cancer.
• Face other urgent scenarios where breathing is hindered and emergency responders are unable to insert a breathing tube through your mouth into your trachea.

Risk

While tracheostomies are generally safe, there are certain risks involved. Certain problems are more likely to occur during or soon after surgery. Possible risk may include:

• Bleeding.
• Infection.
• Damage to the esophagus, trachea, thyroid gland, or nerves in the neck.
• Unusual opening between the trachea and esophagus known as a tracheo-esophageal fistula.
• Tracheostomy tube displacement or misplacement.
• Subcutaneous emphysema, or air trapped in tissue beneath the skin of the neck, can harm the esophagus or trachea, leading tobreathing difficulties.
• Accumulation of air between the chest wall and lungs (pneumothorax), resulting in pain, breathing difficulties, or lung collapse.
• Formation of a blood collection (hematoma) in the neck, which can compress the trachea and lead to breathing complications.
• Tracheostomy obstruction. (The tracheostomy tube may become blocked by blood clots or mucus.)

The chance of experiencing these problems can be reduced by maintaining a clean tracheostomy tube and by following to all advised instructions.

Before the procedure

The healthcare provider will provide instructions to the patient regarding preparation for their tracheostomy surgery. This may include fasting for several hours before the appointment if general anesthesia will be administered, as well as discontinuing certain medications.

During the procedure

Tracheostomy procedures typically require general anesthesia. Once the patient is unconscious, the surgeon will make an incision just below the Adam’s apple, cutting into the trachea (windpipe). This incision is then enlarged to accommodate the tracheostomy tube.

Following tube insertion, the surgeon secures it in place with a neck band to ensure stability during the healing phase.

If the patient cannot breathe independently, the surgeon will connect the tracheostomy tube to a ventilator (breathing machine).

After the procedure

The healthcare team will monitor the patient’s recovery following the tracheostomy in order to guarantee a full recovery. They will communicate through written messages until they have an appointment with a speech-language pathologist.

The patient will get post-operative instructions from the healthcare provider that include cleaning instructions for the tracheostomy tube and advice on how to take care of the surgical site. They could have to stay in the hospital for a few days to a few weeks following their operation, depending on their situation.

Outcome

Recovery times following a tracheostomy can vary among individuals, but it typically takes about two weeks to fully heal. After the initial recovery period, patients will undergo communication improvement sessions with a speech-language pathologist. Before discharge from the hospital, the healthcare provider will provide instructions on tracheostomy tube care. Generally, cleaning the tube once daily is recommended at minimum.

Research indicates that tracheostomy does not reduce life expectancy. Consult with the healthcare provider to find out more about the particular circumstances.

If the patient experiences any of the following, get in touch with the healthcare provider straight away:

• Experience irregular heartbeats.
• Feel excruciating pain that is unresponsive to medicine.
• Difficulty breathing.
• Form mucous plugs, crusting, or thick secretions.
• Exhibit fever, pus discharge, or other infection-related symptoms.