TRACHEOSTOMY

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TRACHEOSTOMY
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• Tracheostomy is making an opening in the anterior
  wall of trachea and converting it into a stoma on
  the skin surface

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FUNCTIONS

1. Relieve airway obstruction
2. Protects airway
3. Improves alveolar ventilation
4. Removal of tracheobronchial secretions
5. Intermittent Positive Pressure Ventilation

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INDICATIONS

• Upper airway obstruction
• Potential upper airway obstruction
• Protection of lower airway
• Artificial respiration

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I. Upper Airway Obstruction

• Infections
• Foreign body larynx
• Neoplasms
• Trauma
• Laryngeal edema
• Bilateral abductor palsy
• Congenital anomalies

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II. Potential Upper Airway Obstruction

• Surgeries in
• Oral cavity
• Pharynx
• Larynx
• Neck

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III. Protection of Lower Airway

• Against aspiration
• From retained secretions
• Inability to cough
• Painful cough

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IV. Positive pressure ventilation
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Types

• Selection of methods depends
• on degree of urgency in
• establishing airway
• Emergency tracheostomy
• Elective tracheostomy
• Permanent tracheostomy

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Anatomy
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Pre-op preparation

• Inspection and palpation of neck
• Direct / Indirect laryngoscopy
• X-ray Lateral view neck
• Assessment of pulmonary functions
• Hb, CT, BT

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Operative

• Position- supine with pillow under shoulders
• Anaesthesia- GA, LA or no anaesthesia
• Intubation if possible

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Emergency tracheostomy

• Incision- vertical midline incision from inferior
  border of thyroid cartilage to suprasternal
  notch.
• Retract skin and dissect midline structures
• Further vertical incision straight to trachea
• Rotate knife handle through 90 degrees
• Insert a tube into trachea
• Ensure hemostasis
• Suction clearance

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Elective tracheostomy

• Incision transverse incision 5 cm long 2 finger
  breadth above sternal notch
• Dissection of structures
• Division of thyroid isthmus
• Incision on trachea
• Introduction of tube
• Packing

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Post-op care

• Constant supervision
• Suction
• Humidification
• Prevention of crusting
• and tracheitis
• Care of tracheostomy tube

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Tracheostomy tubes

• Made of silver or plastic
• Cuffed tubes
• Prevents aspiration
• Can give PPV

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Physiological changes after tracheostomy

• Anatomical dead space decreases by 50
• Work of breathing decreases
• Alveolar ventilation decreases
• Loss of heat and moisture exchange
• Desiccation of tracheal epithelium
• Increased mucus production

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Complications

• INTRA-OPERATIVE
• Haemorrhage
• Injury to paratracheal structures
• Damage to trachea
• Pneumothorax

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• EARLY POST-OP
• Apnoea
• Haemorrhage
• Accidental extubation
• Swallowing dysfunctions

-Subcutaneous emphysema
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• LATE POST-OP
• Difficult decannulation
• Tracheo-oesophagial fistula
• Tracheo-cutaneous fistula
• Tracheal stenosis
• Granulations

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Decannulation

• Removal of tracheostomy tube
• First tracheostomy tube plugged off for 24 hrs
• Only if no problem decannulation done.

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Sydney examines her trach tube just after
decannulation
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Minitracheostomy

• Cricothyroidotomy
• Mainly used for removal of secretions
• Jet flow ventillator for ventillation
• Airway management in laryngial malignancy

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Percutaneous tracheostomy

• A minimally invasive method
• Complications less
• False passage

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Speech with tracheostomy

• Closing the stoma
• Use of special valves
• Fenestrated tubes
• Artificial larynx

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• Thank you