
INDICATIONS AND CONTRAINDICATIONS OF TRACHEOSTOMY
Definition: Tracheostomy is making an opening on the anterior wall of the trachea for establishing an airway.
Functions of Tracheostomy:
- Reduces the dead space by 40%.
- In patients with severe respiratory depression, it allows Intermittent Positive Pressure Ventilation (IPPR).
- For tracheobronchial toilet.
- Prevents aspiration as portex tracheostomy tube has a cuff.
- Creates a bypass to relieve upper respiratory tract obstruction.
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A. Intrinsic:
I. Laryngeal causes:
a) Congenital.
b) Laryngeal stenosis.
c) Laryngeal web.
d) Laryngeal hemangioma.
e) Laryngeal carcinoma- Certain cases who undergo total laryngectomy, during operation tracheostomy done to ventilate patient via tracheostomy tube and also post-operative permanent tracheostomy done to regain airway and voice rehabilitation done by artificial voice prosthesis.
II. Traumatic:
a) Cut throat injury.
b) Laryngeal oedema due to toxic fumes.
c) Strangulation.
III. Inflammatory:
a) Acute epiglottitis.
b) Acute laryngotracheobronchitis.
c) Diphtheria.
d) Tuberculosis.
Extralaryngeal:
- Congenital – Choanal atresia.
- Trauma – Burns, chest trauma.
- Inflammatory:
a) Ludwig’s angina.
b) Cellulitis.
- Neoplastic:
a) Bronchogenic carcinoma.
b) Malignancy of thyroid.
c) Lymphoma.
d) Hemangiomas.
C. Neural:
- Poliomyelitis.
- Guillain-Barre Syndrome.
- Tetanus.
- Spinal cord lesions.
- Myasthenia gravis.
- Abductor cord palsy.
D. Central:
- Head injury.
- Muscle relaxant poisoning.
- Cerebrovascular accidents.
- Coma.
E. Miscellaneous:
- Prior to tongue, larynx and mandible surgery. Rarely prior to bronchoscopy.
- Tracheobronchial toilet.
- Foreign body larynx.
- Laryngomalacia.
- In patients with obstructive carcinoma of the larynx, once tracheostomy is done there are increased chances of stromal recurrence.
- Bleeding disorders: They can give troublesome bleeding from the tracheostomy site.
- If a foreign body is lodged below the level of the tracheostomy site, it would not help in relieving the stridor unless emergency bronchoscopy is done.
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