What is a tracheostomy?

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.

Bibliography

Kertoy, Marilyn. Children with Tracheostomies: Resource Guide. Albany, N.Y.: Singular/Thomson Learning, 2002.

Kittredge, Mary. The Respiratory System. Edited by Dale C. Garell. Philadelphia: Chelsea House, 2000.

Levitzky, Michael G. Pulmonary Physiology. 7th ed. New York: McGraw-Hill Medical, 2007.

Mason, Robert J., et al., eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia: Saunders/Elsevier, 2010.

Myers, Eugene N., and Jonas T. Johnson, eds. Tracheotomy: Airway Management, Communication, and Swallowing. 2d ed. San Diego, Calif.: Plural, 2008.

Parker, Steve. The Lungs and Breathing. Rev. ed. New York: Franklin Watts, 1991.

"Speech for People With Tracheostomies or Ventilators." American Speech-Language-Hearing Association, June 26, 2013.

"Tracheostomy." Mayo Clinic, June 26, 2013.

"What Is a Tracheostomy?" National Heart, Lung, and Blood Institute, March 19, 2012.