- What Is
What facts should I know about a tracheostomy?
- Tracheostomy is a surgical procedure used to create an opening in the neck for direct access to the trachea (the breathing tube).
- Tracheostomy is performed because of airway obstruction, problems with secretions, and inefficient oxygen delivery.
- Tracheostomy can have complications.
- A tracheostomy requires follow-up care.
What is a tracheostomy?
A tracheostomy is a surgically created opening in the neck leading directly to the trachea (the breathing tube). It is maintained open with a hollow tube called a tracheostomy tube.
What are the reasons for a tracheostomy procedure?
A tracheostomy is usually done for one of several reasons:
- to bypass an obstructed upper airway (an object obstructing the upper airway will prevent oxygen from the mouth to reach the lungs);
- to clean and remove secretions from the airway;
- prolonged mechanical ventilation (breathing machine); and
- to more easily, and usually more safely, deliver oxygen to the lungs.
What are the risks and complications of a tracheostomy procedure?
It is important to understand that a tracheostomy, as with all surgeries, involves potential complications and possible injury from both known and unforeseen causes. Because individuals vary in their tissue circulation and healing processes, as well as anesthetic reactions, ultimately there can be no guarantee made as to the results or potential complications.
Tracheostomies are usually performed during emergency situations or on very ill patients. This patient population is, therefore, at higher risk for a complication during and after the procedure
The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is listed here for information only in order to provide a greater awareness and knowledge concerning the tracheostomy procedure.
- Airway obstruction and aspiration of secretions (rare).
- Bleeding. In very rare situations, the need for blood products or a blood transfusion.
- Damage to the larynx (voice box) or airway with resultant permanent change in voice (rare).
- Need for further and more aggressive surgery
- Air trapping in the surrounding tissues or chest. In rare situations, a chest tube may be required
- Scarring of the airway or erosion of the tube into the surrounding structures (rare).
- Need for a permanent tracheostomy. This is most likely the result of the disease process which made the tracheostomy necessary, and not from the actual procedure itself.
- Impaired swallowing and vocal function
- Scarring of the neck
Many of the types of patients who undergo a tracheostomy are seriously ill and have multiple organ-system problems. The doctors will decide on the ideal timing for the tracheostomy based on the patient's status and underlying medical conditions.
What happens during a tracheostomy procedure?
In most situations, the surgery is performed in the intensive care unit or in the operating room. In either location, the patient is continuously monitored by pulse oximeter (oxygen saturation) and cardiac rhythm (EKG). The anesthesiologists usually use a mixture of an intravenous medication and a local anesthetic in order to make the procedure comfortable for the patient.
The surgeon makes an incision low in the neck. The trachea is identified in the middle and an opening is created to allow for the new breathing passage (tracheostomy tube) to be inserted below the voice box (larynx). Newer techniques utilizing special instruments have made it possible to perform this procedure via a percutaneous approach (a less invasive approach using a piercing method rather than an open surgical incision).
What is the recovery care like after a tracheostomy?
The surgeons will monitor the healing for several days after the tracheostomy. Usually, the initial tube that was placed at the time of surgery will be changed to a new tube sometime between 10 and 14 days following surgery, depending on the specific circumstances. Subsequent tube changes are usually managed by the treating physician or nursing staff.
Speech will be difficult until the time comes for a special tube to be placed which may allow talking by allowing the flow of air up to the vocal cords. Any time a patient requires mechanical ventilation, air is prevented from leaking around the tube by a balloon. Therefore, while the patient is on a mechanical ventilator, he/she will be unable to talk. Once the doctors are able to decrease the-size of the tube, speaking may be possible. At the appropriate time, instructions will be given. Oral feeding may also be difficult until a smaller tube is placed.
If the tracheostomy tube will be necessary for a long period of time, the patient and family will be instructed on home care. This will include suctioning of the trachea, and changing and cleaning the tube. When the time comes you will be provided with ample information, instruction, and practice. Often, home healthcare will be provided, or the patient will be transferred to an intermediate health care facility.
In some cases (especially when performed during an emergency or prolonged intubation) the tracheostomy will not be a permanent situation. If the patient can tolerate breathing without the tracheostomy tube the surgical site can be closed, leaving a scar at the outside of the neck.
Health Solutions From Our Sponsors
Hyzy, Robert C., MD. "Overview of tracheostomy." UptoDate.com. Updated Aug. 8, 2016.
Top Tracheostomy Related Articles
ALS (Amyotrophic Lateral Sclerosis) Symptoms, Causes, Life ExpectancyAmyotrophic lateral sclerosis (ALS, Lou Gehrig's disease) is a neurological disease that progresses rapidly. The disease attacks the nerve cells responsible for the control of voluntary muscles. Early symptoms include cramping, twitching, or stiffness of the muscles; slurred nasal speech; difficulty swallowing or chewing, and muscle weakness in an arm or leg. Currently, the cause of ALS is not known. ALS is a fatal disease. No cure has been found for ALS, however, the drug riluzole (Rilutek) is FDA approved, and this drug reduces the damage to motor neurons by decreasing the release of glutamate.
ARDS (Acute Respiratory Distress Syndrome)
Acute respiratory distress syndrome (ARDS) is a lung condition in which trauma to the lungs leads to inflammation of the lungs, accumulation of fluid in the alveolar air sacs, low blood oxygen, and respiratory distress. ARDS can be life-threatening. Signs and symptoms of are shortness of breath and low levels of oxygen in the blood, which can cause your organs to fail.
Causes of ARDS include:
- Aspiration into the lungs
- Severe blow to the chest
- Severe injury with shock
- Drug overdose
- Inflamed pancreas
- Other lung conditions and infections
- Near drowning
There have been genetic factors linked to ARDS. Treatment for includes supplemental oxygen, and/or medication. According to some studies, survival rates for ARDS depend upon the cause associated with it, but can vary from 48% to 68%.
Harman, EM, MD. "Acute Respiratory Distress Syndrome Clinical Presentation." Medscape. Updated: Aug 11, 2016.
Harman, EM, MD. "Acute Respiratory Distress Syndrome." Medscape. Updated: Aug 11, 2016.
PubMed Health. "ARDS." Updated: Jun 11, 2014.
Reynolds, HN. et al. Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base. Crit Care. 1998; 2(1): 29–34. Published online 1998 Mar 12. doi: 10.1186/cc121
Chest X-RayChest X-Ray is a type of X-Ray commonly used to detect abnormalities in the lungs. A chest X-ray can also detect some abnormalities in the heart, aorta, and the bones of the thoracic area. A chest X-ray can be used to define abnormalities of the lungs such as excessive fluid (fluid overload or pulmonary edema), fluid around the lung (pleural effusion), pneumonia, bronchitis, asthma, cysts, and cancers. Normal chest X-ray shows normal size and shape of the chest wall and the main structures in the chest
Children's HealthChildren's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health, and community health.
What Is Endotracheal Intubation?Doctors perform endotracheal intubation when a patient cannot breathe on their own, whether it is due to surgery, disease, or an emergency. Endotracheal intubation is the safest way of providing breathing support to COVID-19 coronavirus disease patients who have severe lung symptoms.
Lung AnatomyThe lungs are primarily responsible for the exchange of oxygen and carbon dioxide between the air we breathe and the blood. Eliminating carbon dioxide from the blood is important, because as it builds up in the blood, headaches, drowsiness, coma, and eventually death may occur. The air we breathe in (inhalation) is warmed, humidified, and cleaned by the nose and the lungs.
Malignant HyperthermiaMalignant hyperthermia is a severe reaction to certain drugs that are often used during invasive procedures or surgery. Certain mutations in genes increase the risk of a person having malignant hyperthermia. Without prompt treatment, the complications of malignant hyperthermia can be life-threatening.
MPS I (Mucopolysaccharidosis Type I, Hurler Syndrome)MPS I (also referred to as mucopolysaccharidosis type I or Hurler syndrome) is a genetic, inherited condition that involves chromosome number 4. Symptoms of MPS I include thick lips, eye problems, chronic nasal discharge, enlarged spleen or other abdominal organs, joint stiffness, coarsening of facial features. There is no cure for MPS I, but signs and symptoms may be managed with enzyme replacement therapy and surgery to improve symptoms.
Sleep ApneaSleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
What Are the Most Common Surgical Airway Techniques?Surgical airway management involves the creation of an airway using surgical techniques. The four distinct but related most common surgical airway techniques include open cricothyroidotomy, needle cricothyroidotomy with jet oxygenation, percutaneous cricothyroidotomy using the Seldinger technique, and surgical tracheostomy (an incision in the windpipe made to relieve an obstruction to breathing).
When Should a Tracheostomy Tube Be Changed?A tracheostomy is an opening that surgeons make through the front of the neck and into the windpipe (trachea). The tracheostomy tube is placed into the opening to keep it open for breathing when the usual route for breathing is somehow blocked or reduced. When health problems require long-term use of a machine (ventilator) to help breathe, a tracheostomy is often needed. In rare cases, an emergency tracheostomy is performed when the airway is suddenly blocked, such as after a severe injury to the face or neck.
Why Would A Child Need A Tracheostomy?A tracheostomy, a procedure to cut a hole in the throat to clear an airway to the lungs, is used to insert a tube into the trachea to provide assisted ventilation to children who are unable to breathe, or have difficulty breathing on their own.