Tracheostomy | Need and Risks - ICU And Critical Care | Apex Hospitals

What is Tracheostomy?

A tracheostomy, also known as a tracheostomy, is a surgical procedure in which an opening is created through the front of the neck into the trachea (windpipe) to facilitate breathing. Surgeons insert a tracheostomy tube (trach tube) into this opening to provide an airway and assist in clearing lung secretions. Unlike normal breathing through the nose and mouth, a person with a tracheostomy breathes directly through the tracheostomy tube.

Depending on the patient's condition, this procedure can be temporary or permanent. A tracheostomy is typically performed when the regular breathing route is obstructed or when long-term mechanical ventilation is required. In rare emergencies, such as after a severe facial or neck injury that blocks the airway, an emergency tracheotomy may be performed to restore breathing.

Once the tracheostomy is no longer necessary, the opening can usually heal on its own or is surgically closed. In some cases, however, the tracheostomy may become a permanent fixture for the patient’s breathing needs.

Who might need a tracheostomy?

A tracheostomy may be needed for individuals with difficulty breathing due to various medical conditions or emergencies. Some common reasons include:

1. Airway obstruction: Conditions that block or narrow the airway, such as tumours, swelling, or severe trauma to the face, neck, or throat.

2. Long-term ventilation: People who require prolonged use of a ventilator to assist with breathing, often due to chronic lung disease, spinal cord injury, or neuromuscular disorders.

3. Severe lung infections: Patients with serious respiratory diseases, such as pneumonia, may need a tracheostomy if they struggle to breathe.

4. Neurological conditions: Diseases like stroke, ALS (Amyotrophic Lateral Sclerosis), or severe head injury can impair the ability to breathe, requiring a tracheostomy for support.

5. Trauma or injury: Sudden injuries to the airway, such as from accidents, burns, or gunshot wounds, may require an emergency tracheostomy to establish a clear breathing passage.

6. Congenital abnormalities: Some individuals are born with conditions obstructing normal airflow, making a tracheostomy necessary.

In emergency or planned procedures, a tracheostomy ensures that patients can breathe effectively, especially when other ventilation or airway management methods are insufficient.

Risks of Tracheostomy

Any medical procedure involving breaking the skin carries inherent risks, such as infection and excessive bleeding. There's also a rare possibility of an allergic reaction to anaesthesia. If you’ve experienced an allergic reaction to anaesthesia before, it’s essential to inform your doctor.

Specific risks related to a tracheostomy include:

• Blocked or dislodged tube: This can lead to breathing difficulties if the airway obstructs.
• Air may get trapped in tissues around the tracheostomy site.
• The area around the tracheostomy opening (stoma) can deteriorate over time.
• A mix of connective tissue and blood vessels may form in the airway, potentially causing complications.
• Scar tissue may develop, which could narrow the airway
• Infection of the trachea is a potential risk.
• The thyroid gland may be injured during the procedure.
• There’s a risk of developing lung infections like pneumonia.
• Air may leak into the space around the lungs, causing them to collapse.

Specific individuals, such as babies, smokers, and older adults, are at a higher risk of complications from a tracheostomy. However, these risks can be managed with proper care and monitoring.

What to expect during tracheostomy?

A tracheostomy is typically performed under general anaesthesia, which ensures that you're asleep during the procedure and do not feel any pain. However, it may be done in emergencies using local anaesthesia, in which you're awake, but the area around your neck is numbed.

During the procedure, the surgeon cuts the skin at the front of your neck, carefully creating a small opening in your windpipe (trachea). A tracheostomy tube is inserted through this opening, allowing you to breathe directly through the tube instead of your nose and mouth.

The tracheostomy tube is secured with tape or ties around your neck to keep the airway open and ensure proper breathing.

What happens after tracheostomy?

After your tracheostomy procedure, you’ll likely spend several days in the hospital to heal and learn essential skills for managing your tracheostomy. Here’s what to expect:

• Caring for the tracheostomy tube: Our Nurses will guide you through cleaning and changing the tube to prevent infections and reduce complications. You will continue this care at home as long as the tracheostomy is in place.
• Speaking: A tracheostomy typically prevents speech because air exits through the tracheostomy opening instead of passing through the voice box.
• Eating: Swallowing may be difficult during the initial healing phase. Nutrition is often provided through an IV line, feeding tube, or tube inserted directly into the stomach.
• Coping with dry air: The air you breathe will bypass your nose and throat, making it much drier and causing irritation, coughing, and excess mucus. To manage this, saline may be added to the tracheostomy tube, or a saline nebulizer treatment can be used to loosen secretions.
• Managing other effects: You may need a suction machine to remove secretions from your airway. Our healthcare team will show you how to manage this and other impact, ensuring you feel confident in your care routine.

These steps will help you manage and adjust to life with a tracheostomy, ensuring you stay as healthy and comfortable as possible.

Speak to our team about Tracheostomy.

Speak to our expert team at Apex Hospitals about tracheostomy care and management. Whether you have questions about the procedure, recovery, or long-term care, we’re here to provide the support and guidance you need. Reach out to us today for expert advice and personalized care plans.