Tracheostomy

Introduction

Tracheostomy is a surgical procedure in which an opening is created into the trachea from the outside, commonly to bypass an upper respiratory obstruction.
It may also be done to provide easier access for care of the chest in some seriously ill patients.
In addition, it is equally done for respiratory support and artificial ventilation in patients with respiratory insufficiency or paralysis.
Most cases are done to by-pass upper airway obstruction under any of these conditions:

  • Acute infections of the larynx
  • Trauma
  • Foreign body aspiration
  • Acute laryngeal oedema
  • Vocal cord paralysis
  • Tumours

Some cases are done as part of, or to facilitate major head and neck surgery.
An appropriate-sized tracheostomy tube,
portex or metal, is inserted to maintain the opening.

  1. Symptoms and clinical features of tracheostomy
  2. Acute presentation with clinical features of airway obstruction, stridor and incipient asphyxia following trauma
  3. Acute inflammatory conditions of the larynx, which would require the operation as an emergency
  4. Progressive lesions: may require less urgent intervention in anticipation of likely obstruction
  5. Cases with medical indications requiring respiratory support are usually done on a more elective basis

Complications of tracheostomy

  1. Haemorrhage
  2. Infection: wound and chest
  3. Damage to nerves and large vessels in the neck

Treatment for tracheostomy

Treatment objectives

  • To secure the airway

Non-drug treatment

  • Postoperative care of tracheostomy preferably in an intensive care unit, with suction, humidification, stoma care as appropriate

Drug treatment

  • Broad spectrum antibiotic cover