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Tracheostomy

Definition

A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. This tube is called a tracheostomy tube or trach tube.

Description

General anesthesia is used, unless the situation is critical. In that case, local anesthesia is injected into the area to reduce the discomfort caused by the procedure.

The neck is cleaned and draped. Surgical cuts are made to expose the tough cartilage rings that make up the outer wall of the trachea. The surgeon then creates an opening into the trachea and inserts a tracheostomy tube.

Why the Procedure Is Performed

A tracheostomy may be done if you have:

• A large object blocking the airway
• An inability to breathe on your own
• An inherited abnormality of the larynx or trachea
• Breathed in harmful material such as smoke, steam, or other toxic gases that swell and block the airway
• Cancer of the neck, which can affect breathing by pressing on the airway
• Paralysis of the muscles that affect swallowing
• Severe neck or mouth injuries
• Surgery around the voicebox (larynx) that prevents normal breathing and swallowing

Risks

The risks for any anesthesia are:

• Problems breathing
• Reactions to medications, including heart attack and stroke

The risks for any surgery are:

• Bleeding
• Infection
• Nerve injury, including paralysis

Other risks include:

• Damage to the thyroid gland
• Erosion of the trachea (rare)
• Puncture of the lung and lung collapse
• Scar tissue in the trachea that causes pain or trouble breathing

After the Procedure

If the tracheostomy is temporary, the tube will eventually be removed. Healing will occur quickly, leaving a minimal scar. Sometimes, a surgical procedure may be needed to close the site (stoma).

Occasionally a stricture, or tightening of the trachea may develop, which may affect breathing.

If the tracheostomy tube is permanent, the hole remains open.

Outlook (Prognosis)

Most patients need 1 to 3 days to adapt to breathing through a tracheostomy tube. It will take some time to learn how to communicate with others. At first, it may be impossible for the patient to talk or make sounds.

After training and practice, most patients can learn to talk with a tracheostomy tube. Patients or family members learn how to take care of the tracheostomy during the hospital stay. Home-care service may also be available.

You should be able to go back to your normal lifestyle. When you are outside, you can wear a loose covering (a scarf or other protection) over the tracheostomy stoma (hole). Use safety precautions when you are exposed to water, aerosols, powder, or food particles.

References

Goldenberg D, Bhatti N. Management of the impaired airway in the adult. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005:chap 106.

Neacy KA. Tracheostomy care. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 7.