Specialist ENT trachea

Tracheostomy

What is Tracheostomy?

Tracheostomy is making an opening on the anterior wall of the trachea (the wind pipe) for establishing an airway.

What are the 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.

What are the indications of tracheostomy?

A. Intrinsic:

I. Laryngeal causes

  • Congenital
  • Laryngeal stenosis
  • Laryngeal web
  • Laryngeal haemangioma

II. Traumatic

  • Cut throat injury
  • Laryngeal oedema due to toxic fumes
  • Strangulation

III. Inflammatory

  • Acute epiglottitis
  • Acute laryngotracheo bronchitis
  • Diphtheria
  • Tuberculosis
B. Extrinsic: Extralaryngeal
  1. Congenital – Choanal atresia
  2. Trauma – Burns, chest trauma
  3. Inflammatory
    1. Ludwig’s angina
    2. Cellulitis
  4. Neoplastic
    1. Bronchogenic carcinoma
    2. Malignancy of thyroid
    3. Lymphoma
    4. Haemangiomas

C. Neural:

  • Poliomyelitis
  • Guillain-Barre Syndrome
  • Tetanus
  • Spinal cord lesions
  • Myaesthenia gravis
  • Abductor cord palsy

D. Central:

  • Head injury
  • Muscle relaxant poisoning
  • Cerebrovascular accidents
  • Coma

E. Miscellaneous:

  • Prior to tongue, larynx and mandible surgery. Rarely bronchoscopy
  • Tracheobronchial toilet
  • Foreign body larynx
  • Rarely , laryngomalacia

What are the contraindications of a tracheostomy?

As tracheostomy is a life saving procedure, there are no absolute contraindications to tracheostomy.

However some relative contraindications are:

  • 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.

It must be understood that the above should not be considered in cases of an emergency.

“The time to do a tracheostomy is the first time you think of it”