- Indications for tracheotomy
- How does a tracheotomy work?
- Complications after tracheotomy
- Permanent tracheotomy
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Tracheotomy is a procedure for cutting open the trachea. It is often done urgently to save lives. In what other situations is a tracheotomy performed? After cutting the trachea, is it possible to resume normal breathing?
Tracheotomyis one of those procedures - apart from resuscitation and defibrillation - which are presented very gracefully in front of the camera. Probably each of us has seen how it is performed in a movie, and even in a TV series ( although there we more often deal with a conicotomy, a procedure similar, but much more invasive). The sight of a suffocating man who, thanks to a quick intervention, regains his breath in an instant, is really impressive. Especially if a pen is hurriedly prepared for this purpose … Saving a life is one of the reasons why a tracheotomy (emergency tracheotomy) is performed, but we also have others (non-emergency tracheotomy) where there is time to perform the surgery calmly.
Indications for tracheotomy
Tracheotomy is performed when replacement breathing is necessary:
- laryngeal edema, shortness of breath
- burns of the upper respiratory tract
- serious skull injuries
- lumen constriction trauma
- neoplastic tumor of the larynx
- other obstacles in the larynx, foreign body
- excessively residual bronchial secretion
- necessity of chronic artificial ventilation
- prolonged intubation
- before performing a partial or total laryngectomy (excision of the larynx)
How does a tracheotomy work?
Tracheotomy is a surgical procedure that involves opening the front wall of the trachea and inserting a tube into it to guide this way of breathing.
Tracheotomy is one of the oldest surgical procedures. It was carried out in antiquity, reportedly for the first time by Asclepiades, a physician living at the turn of the 2nd and 1st centuries BCE
This way, air is supplied to the lungs bypassing the nose, throat and larynx. To perform a tracheotomy, the skin below the cricoid larynx must first be dissected vertically or horizontally. Then the superficial muscles of the neck are cut as wellthe subglass muscles and it goes to the thyroid gland. It can be moved (upper or lower tracheotomy) or cut (middle tracheotomy) to expose the tracheal cartilages. With the help of a scalpel, a window (called a tracheostomy) is cut out, usually in the second or third cartilage, through which a tracheotomy tube is inserted.
Complications after tracheotomy
Unfortunately, although people's lives are often saved by tracheotomy, you have to realize that this is a procedure that can have very serious consequences. After a tracheotomy, numerous complications can occur. We divide them according to the moment of occurrence into:
- immediate - pneumothorax or pneumothorax, tracheo-esophageal fistula, damage to major vessels, bleeding
- early - extension of the tube, obstruction with secretion, respiratory arrest, pulmonary edema
- late - fistula bleeding, narrowing of the trachea, tracheo-esophageal fistula, traco-cutaneous fistula and cosmetic defect
The side effects after tracheotomy also include problems with swallowing, the formation of granulomas, narrowing of the trachea through a scar, necrosis of a fragment of the trachea, various infections.
Permanent tracheotomy
After the surgical intervention that required a tracheotomy, when the patient is able to breathe independently, the tube can be removed. In cases where normal breathing is not possible for a long time, it should be replaced approx. 10-14 days after the operation. The initially quite thick tube makes it impossible to speak, but replacing it with a thinner one brings improvement. Similarly with nutrition - oral intake will be a problem until the tube is reduced in size.
If the tracheotomy tube must remain in the trachea longer or permanently (e.g. in the case of excision of the larynx or part of it), both the patient and his relatives will be trained in the handling of the tube and skin care in the area tracheostomy. It should also be remembered that from now on the patient is more susceptible to infections, because breathing bypasses the nose and throat and the air immediately enters the lungs without, for example, having a chance to warm up. Another obstacle to overcome is speech - you have to learn how to produce sound in a completely different way, using the reflection mechanism.
About the author
Marta Uler A journalist specializing in he alth, beauty and psychology. She is also a diet therapist by education. Her interests are medicine, herbal medicine, yoga, vegetarian cuisine and cats. I am a mother of two boys - a 10-year-old and a 6-month-old.
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