Tracheostomy is a surgical procedure in which an opening is created directly into the trachea

through the neck. This opening, known as a tracheostoma, allows for the insertion of a
tracheostomy tube, which facilitates breathing when the upper airways are blocked or impaired.
Here’s an in-depth look at tracheostomy, including its indications, types, procedure, care,
complications, and advantages.
Indications
Tracheostomy is performed for various medical reasons, often categorized into emergent, urgent,
and elective indications:
Emergent Indications
 Upper Airway Obstruction: Caused by trauma, foreign bodies, tumors, or severe
infections (e.g., Ludwig's angina, epiglottitis).
 Severe Facial Trauma: Compromising the airway.
 Burns: Resulting in upper airway edema and obstruction.
Urgent and Elective Indications
 Prolonged Mechanical Ventilation: For patients requiring extended ventilatory support,
such as those with chronic respiratory failure or severe neurological conditions.
 Obstructive Sleep Apnea: Severe cases unresponsive to other treatments.
 Chronic Lung Diseases: Conditions like COPD or cystic fibrosis where secretion
management and airway support are necessary.
 Neuromuscular Diseases: Conditions like ALS or spinal cord injuries leading to
respiratory insufficiency.
 Facilitating Airway Clearance: In patients with ineffective cough and secretion
management.
 Congenital Anomalies: Such as tracheomalacia or laryngeal stenosis.
Types of Tracheostomy
There are different types of tracheostomy procedures based on the timing and approach:
1. Surgical Tracheostomy
 Method: An incision is made in the neck and the trachea, usually in an operating room
under general anesthesia.
 Preferred for: Patients with anatomical variations or when more controlled conditions
are necessary.
2. Percutaneous Dilatational Tracheostomy (PDT)
 Method: Performed at the bedside using a needle, guidewire, and dilators to create the
tracheal opening.
 Preferred for: Critically ill patients where a quicker, less invasive procedure is
advantageous.
3. Mini Tracheostomy
 Method: A smaller, temporary opening is created for airway suctioning rather than
prolonged ventilation.
 Preferred for: Patients needing short-term secretion clearance.
Procedure
The procedure for tracheostomy involves several key steps, typically carried out under sterile
conditions:
1. Preparation: Patient positioning, skin antisepsis, and local or general anesthesia.
2. Incision: A horizontal or vertical incision is made in the lower neck, just above the
sternal notch.
3. Tracheal Access: The thyroid isthmus is divided or retracted, and a tracheal ring (usually
the second or third) is incised.
4. Stoma Creation: The tracheostomy tube is inserted through the incision into the trachea.
5. Securing the Tube: The tube is secured with sutures or ties, and the cuff is inflated if
present.
6. Post-Procedure Care: The stoma is dressed, and ventilation support is connected if
needed.
Postoperative Care
Proper care is essential to ensure the tracheostomy remains functional and to prevent
complications:
 Cleaning: Regular cleaning of the stoma and inner cannula.
 Humidification: To prevent drying of the tracheal mucosa.
 Suctioning: To remove secretions and prevent blockages.
 Monitoring: Regular assessment of tube positioning, patency, and signs of infection.

Complications
Complications can be immediate, early, or late:
Immediate Complications
 Bleeding: From the incision site or tracheal vessels.
 Pneumothorax: Air trapped in the pleural space.
 Misplacement: Incorrect positioning of the tube.
Early Complications
 Infection: At the stoma site or within the trachea.
 Subcutaneous Emphysema: Air leakage into subcutaneous tissues.
 Tube Obstruction: Due to mucus plugs or blood clots.
Late Complications
 Tracheal Stenosis: Narrowing of the trachea.
 Tracheomalacia: Weakening of the tracheal walls.
 Tracheoesophageal Fistula: Abnormal connection between the trachea and esophagus.
Advantages of Tracheostomy
 Improved Airway Management: Easier to maintain a clear airway.
 Facilitates Long-term Ventilation: More comfortable for patients needing prolonged
mechanical support.
 Enhanced Communication: Allows patients to speak with a speaking valve or when the
tube is capped.
  Improved Oral Hygiene: Easier to maintain oral and airway cleanliness.
 Reduced Work of Breathing: Direct access to the trachea reduces the resistance
compared to endotracheal tubes.
Conclusion
Tracheostomy is a critical procedure with significant benefits for patients requiring long-term
airway management or experiencing upper airway obstruction. Effective management, including
meticulous postoperative care and monitoring for complications, is essential to ensure the
procedure's success and improve patient outcomes.