Tracheostomy - series

Normal anatomy

The trachea, or windpipe, carries air from the larynx to the bronchi and lungs.

Normal anatomy

Indications

The indications for tracheostomy include:

  • prolonged intubation during the course of a critical illness
  • subglottic stenosis from prior trauma
  • obstruction from obesity for sleep apnea
  • congenital (inherited) abnormality of the larynx or trachea
  • severe neck or mouth injuries
  • inhalation of corrosive material smoke or steam
  • presence of a large foreign body that occludes the airway
  • paralysis of the muscles that affect swallowing causing a danger of aspiration
  • long term unconsciousness or coma
Indications

Incision

General anesthesia is used and the patient is deep asleep and pain-free. The neck is cleaned and draped. Incisions are made to expose the tough cartilage rings that make up the outer wall of the trachea.

Incision

Procedure

The surgeon then cuts two of these rings and inserts a tracheostomy tube.

Procedure

Aftercare

Most patients require 1 to 3 days to adapt to breathing through a tracheostomy tube. Communication will require adjustment. Initially, it may be impossible for the patient to talk or make sounds. After training and practice, most patients can learn to talk with a trach tube. Patients or parents learn how to take care of the tracheostomy during the hospital stay. Home-care service may also be available. Normal lifestyles are encouraged and most activities can be resumed. When outside a loose covering for the tracheostomy stoma (hole) (a scarf or other protection) is recommended. Other safety precautions regarding exposure to water, aerosols, powder or food particles must be adhered to.

After treatment of the underlying problem that necessitated the tracheostomy tube initially, the tube is easily removed, and the hole heals quickly, with only a small scar.

Aftercare

Revision

Last reviewed 1/1/2013 by Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

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