Tracheotomy

Image:Tracheotomy neck profile.png

A tracheotomy or tracheostomy is a surgicalprocedure performed on the neck to open a direct airway through an incision in the trachea(the windpipe). (Technically, the former term, with the Greek root tom- meaning "to cut," refers to the procedure of cutting into the trachea, whereas the latter term, with the root stom- meaning "mouth," refers to the procedure of making a semipermanent or permanent opening. Tracheostomy can also refer to the result of the procedure, i.e. the opening itself.)

Indications for a tracheotomy

The indications for tracheotomy are:

• Acute setting - maxillofacialinjuries, large tumors of the head and neck, congenital tumors, e.g. branchial cyst, acute inflammation of head and neck, and
• Chronic / elective setting - when there is need for long term mechanical ventilationand tracheal toilet, e.g. comatosepatients, surgery to the head and neck.

In emergent settings, in the context of failed endotracheal intubation or where intubation is contraindicated, cricothyrodotomyor mini-tracheostomymay be performed in preference to a tracheostomy.

How a tracheotomy is performed

1. Curvilinear skin incision along relaxed skin tension lines(RSTL) between sternal notch and cricoid cartilage
2. Midline vertical incision dividing strap muscles
3. Division of thyroidisthmus between ligatures
4. Elevation of cricoidwith cricoid hook
5. Placement of tracheal incision. An inferior based flap or Bjork flap(through second and third tracheal rings) is commonly used. The flap is then sutured to the inferior skin margin. Alternatives include a vertical tracheal incision (pediatric) or excision of an ellipse of anterior tracheal wall.
6. Insert tracheostomy tube (with concomitant withdrawal of endotracheal tube), inflate cuff, secure with tape around neck or stay sutures.
7. Connect ventilator tubing

It is also possible to make a simple horizontal incision between tracheal rings (typically 2nd and 3rd) for the incision. Bjork flaps may produce more intratracheal granulation tissue at the site of the incisions, making it less favorable to some surgeons.

Complications

1. Immediate - pneumothoraxor pneumomediastinum, tracheoesophageal fistula, injury to great vessels or recurrent laryngealnerves, bleeding, e.g. from divided thyroid isthmus
2. Early - secretions and mucus plugging, dislodged tube, respiratory arrest and post obstructive pulmonary edema(when tracheostomy is performed in a patient with longstanding upper airway obstruction, and is dependant on hypoxia drivefor respiration)
3. Late - bleeding from tracheoinnominate fistula(can be torrential), tracheal stenosis(from ischemiainduced by a cuffed tracheostomy tube)

See also

• intubation
• mechanical ventilation

External links

• Aaron's tracheostomy page(Caring for a tracheostomy)de:Tracheotomie

es:Traqueotomía fr:Trachéotomie it:Tracheotomia nl:Tracheotomie no:Trakeotomi sv:Trakeotomi pl:Tracheotomia zh:?????

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Tracheotomy Wikipedia article Tracheotomy.