Tracheostomy

A tracheostomy is a surgical procedure done to the trachea. It helps to open the trachea or windpipe to facilitate breathing. After creating a hole, a tube is placed in the hole to help breathing. This procedure is done when the airway is blocked due to any obstruction. This delivers oxygen directly to the lungs by bypassing the airway tract and reducing the stress on vital organs. 

Anatomy:

A tracheostomy is done on the trachea which is an important part of the respiratory system. It is also called a windpipe and ultimately opens into the lungs. Air from the nose travels through the trachea to reach the lungs for exchange. Any pressure or trauma to the trachea prevents air from reaching the lungs. This causes immense stress on the vital organs due to the lack of oxygen. In such conditions, a tracheostomy is done to open the windpipe to facilitate breathing. 

Indications:

Tracheostomy helps in breathing. It is indicated in

• Individuals who are on ventilators for a prolonged period 
• Vocal cord paralysis that obstructs the windpipe
• Throat cancers that narrow or obstruct the windpipe
• Neurological conditions that cause difficulty in coughing up secretions 
• Conditions where secretions have to be constantly cleared from the throat
• In surgical preparations where breathing has to be supported 
• Trauma to the head and neck area where there is difficulty in breathing 
• Emergency conditions that need supportive breathing 

Advantages:

• Saves the life of an individual in emergencies 
• It provides oxygen to the lungs 
• Mechanical ventilation can be slowly reduced

Before the procedure:

Before septoplasty, an individual should understand the importance and necessity of the procedure by discussing it with the healthcare provider (HCP). All the medications taken by the individual should be informed to the HCP along with the history of previous diseases, infections, surgeries, and allergies. Based on the medications taken, some medicines are advised to stop depending on the health condition and risk vs. benefits. 

These include over-the-counter medications, blood thinners, and opioid painkillers. Medicines will be prescribed before undergoing the surgery. Certain routine blood and urine investigations are carried out to rule out any infections or other conditions not known to the individual. In certain emergencies like the scene of the accident, it isn't easy to do a tracheostomy. In such situations, a procedure called cricothyrotomy is done where a cut is given below the Adam’s apple to facilitate breathing. This is later converted to tracheostomy. 

During the procedure:

The tracheostomy is done under general anesthesia. Sometimes local anesthesia may be given when there is a fear of a compromised airway. Based on the cause for which the tracheostomy is intended, it is of two types. They are:

• Surgical tracheostomy uses a small cut at the lower front part of the neck. The trachea is reached by moving the surrounding muscles, vessels, and nerves. A small hole is made in the trachea called the tracheotomy to allow a thin hollow tube to be passed through the hole. 
• The percutaneous technique is a minimally invasive tracheostomy procedure. A small cut is made near the lower front part of the neck. Later, a special lens is sent through the mouth to visualize the inner structures. Using a needle a small hole is made in the trachea following the guidance shown by the lens. A tube is inserted in the hole to expand the hole and facilitate breathing. 

The tube has a face plate that connects it to the neck strap and prevents it from slipping out of the hole or can be secured by sutures. 

After the procedure:

The individual will be monitored till the vitals stabilize. Medications will be given to reduce pain and ward off infection. An HCP trained in the tracheostomy procedure will give instructions on the after-care of the tube. 

Instructions:

• One has to clean the tracheostomy tube to reduce infections and complications
• Tracheostomy makes it difficult to speak as exhaled air does not go through the voice box. One can communicate by writing on paper, using sign language, or with training from a speech therapist. Special devices can also be used to facilitate speech. 
• Tracheostomy also makes swallowing difficult. An individual can have a feeding tube or the nutrients can be given directly through an intravenous line. 
• The air exhaled through the tracheostomy tube is dry as it does not pass through the moist structures of the nose and throat. A saline nebulizer can be used to moisten the air. Room humidifiers can also be of great help. 
• One should use a suction machine to clear the secretions of the throat or airway.  

Side effects:

Pain, Bleeding, and infections at the site of placement are some of the side effects associated with the procedure. 

Risks and complications:

Certain short-term risks or complications associated with the procedure include permanent damage to the thyroid gland in the neck, the surrounding nerves, or to the trachea. The tracheostomy tube may be placed in the wrong direction or into the wrong pipe or displacement of the tube. Air entrapment or blood collection under the layers of skin can cause breathing difficulties or in the chest leading to pain and collapse of the lungs. 

Long-term complications include tube obstruction due to prolonged usage of the tracheostomy tube. Scarring and narrowing of the trachea can occur. Abnormal connection between the trachea and the food pipe increases the risk of fluid entry into the lungs leading to life-threatening conditions. An abnormal opening between the trachea and the surrounding artery can cause life-threatening bleeding. Infection can develop around the tube affecting the trachea, and lungs leading to pneumonia. 

Conclusion:

Tracheostomy is the surgical insertion of a tube in the trachea. It is done to facilitate breathing in emergencies or when normal airway breathing is compromised. It saves the life of an individual and improves their quality of life.