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Wednesday, June 4, 2014

What is a tracheotomy? What are the indications?

Tracheotomy is one of the oldest surgeries performed by mankind.  There is written evidence the procedure was performed on a person suffocating from an upper airway obstruction as early as 4,000 B.C. The operation was a last ditch effort to save a life.

Today the procedure is safer and more common than ever before.  The following are some of the basic terms to describe the procedure.

What is a tracheotomy:  An opening or stoma made by the incision in the neck.

What is a stoma:  Any opening between an internal body part and the external environment.  A colostomy is a form of stoma because it allows feces to bypass the rectum and anis so it can be removed from the body into a clostomy bag.  A tracheotomy is another form of stoma because air can bypass the upper airway.  Stoma is Greek for mouth, in when we refer to a stoma we are generally referring to providing a "mouth" to some internal part.  Generally speaking, when an RT refers to a stoma he's referring to a tracheostomy of any form, either when their is a trach present or when there is simply a hole in the neck.  A tracheostomy is the opening or stoma made by the incision in the neck.

What is a Tracheostomy:  A tracheostomy is a small hole or stoma in the neck or windpipe that a person can breathe through.  It's usually temporary, yet in some cases it can be permanent.

What is a tracheostomy tube:  This is a small, hollow tube inserted into a stoma created by a tracheotomy.

Who performs the operation of tracheotomy and tracheostomy insertion? The procedure of tracheotomy is usually performed in a sterile environment such as in an operating room by a surgeon, however an emergency trach can be inserted just about anywhere by any trained professional.  Any hollow tube can be used as a tracheostomy in emergency procedures.  An incision is made through the crichoid cartilage between the 2nd and 4th tracheal rings.

What are the indications for tracheostomies? There are a variety of indications:
  • To reduce resistance to breathing: Anything that may cause the upper airway to become obstructed increases airway resistance, making it hard to inhale or exhale.  Diseases that may obstruct the upper airway include epiglotitis, cancer, foreign object, paralysis of vocal cords, and trauma. By making the airway shorter resistance is reduced.  By creating a shorter airway and thereby reducing resistance, the procedure may be beneficial to patients with end stage emphysema, chronic bronchitis, severe pneumonia or chest injury
  • Long term ventilation is required.  This makes it easier to manage the airway and is more convenient to the patient than having an ETT in the throat.  It's also improves infection control and facilitates weaning from a ventilator
  • Respiratory muscle paralysis. Various neuromuscular disorders such as polio myelitis, amyotrophic lateral sclerosis,  stroke, muscular dystrophy may inhibit the ability to breathe and closed head injury. 
  • Enhance secretion clearance:  Some diseases, such as chronic bronchitis, cystic fibrosis and pneumonia may cause thick secretions that are difficult to expectorate.  A tracheotomy creates an easy access route for expectorating and suctioning the airway.  It may also enhance a cough, making it easier to clear the airway
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