Tracheostomy
A tracheostomy is a surgical procedure that involves creating an opening in the trachea, or windpipe, through the throat. This intervention is primarily performed to alleviate upper airway obstructions, facilitate mechanical ventilation, and enhance patient comfort. While it is rare to perform a tracheostomy in emergency situations, certain medical conditions or acute emergencies may necessitate this procedure. During the operation, local anesthesia is applied, and an incision is made in the neck to access the trachea, allowing for the insertion of a tracheostomy tube. Post-surgery, proper care is crucial, including humidifying air and monitoring for complications such as infection or displacement of the tube.
Though often dramatized in media, a tracheostomy is a nuanced procedure that requires specialized skills. While advances in medical technology, such as laryngoscopes, have made tracheostomies less common, they remain an important option for patients with specific medical needs, particularly those requiring prolonged ventilation or in cases of neck trauma.
Tracheostomy
Anatomy or system affected: Neck, respiratory system, throat
Definition: The creation of a hole in the trachea, thus providing an alternative source for getting air into the lungs.
Indications and Procedures
A tracheostomy is the surgical creation of an opening into the trachea through the throat. It is done to relieve upper airway obstruction, decrease the effort of breathing, provide access for mechanical ventilation, and improve patient comfort. It is uncommonly used in an emergency except in the field; the preferred method of establishing an airway is to pass a tube through the trachea via the mouth.
Local anesthesia is used to deaden the skin of the front of the neck. A horizontal incision is made over the space between the second and third tracheal rings. If the thyroid gland is encountered, it is divided. Bleeding must be carefully controlled throughout the procedure. The trachea is entered through an incision that will divide the second and third rings of cartilage. In an adult, a small portion of the third ring may be removed. A previously tested tracheostomy tube with a cuff is inserted within the interior of the trachea. The wound is loosely closed, and a gauze dressing is applied. An X-ray is taken after the procedure to ensure that the tube has been correctly placed and that there is no free air in the mediastinum or thorax.
Uses and Complications
Once a tracheostomy has been performed, ambient air in a patient’s room must be humidified and warmed. If any secretions develop, the tracheostomy site must be suctioned in a sterile manner. If shortness of breath is observed, the tracheostomy site should be examined for a mucus plug. The tracheostomy tube should be removed, and the opening closed at the earliest possible time that is consistent with the condition of the patient.
Some potential problems are associated with a tracheostomy. The most common is bacterial contamination of the lungs or adjacent tissues. Air may enter the space between the lungs and the tissue that lines the cavity containing the lungs, a condition known as pneumothorax. The tube may also become displaced. Attempting to replace the tube blindly can result in obstruction.
Perspective and Prospects
Although dramatic when portrayed on television programs, a tracheostomy is a delicate surgical procedure that requires skill and training. With the invention of modern laryngoscopes, tracheostomies are uncommon, being used primarily in cases of fracture of the anterior neck or when a patient has spent an extended period of time on a ventilator.
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