Tracheostomy is a procedure to restore the airway.

1. Tracheostomy
Dr Shrikant Phatak
Consultant & Head of ENT
Choithram Hospital Indore

2. Tracheostomy
• Tracheostomy
is an operative
procedure that
creates a
surgical airway
in the cervical
trachea .

3. Tracheostomy
Relative anatomy

4. Indications
To bypass obstruction
1 Tumors (of oropharynx, larynx, upper trachea)
2 Infections (epiglottitis, severe tracheobronchitis)
3 Bilateral Vocal Cord Paralysis
4 Trauma (laryngeal, maxillofacial fractures)
5 Edema (tongue, laryngopharynx)

5. Indications
To bypass obstruction
Subglottic Polyp Carcinoma Larynx

6. Tracheotomy Indications
Prolonged intubation
• To reduce anatomic dead space ( weaning )
• To improve the patient`s quality of life
easier toilet, ability to speak and eat
• Neuromuscular diseases paralyzing or weakening chest
muscles and diaphragm.

7. Prolonged intubation and assisted
ventilation

8. Prophylactic before Surgery
Supraglottic Malignancy Retro Pharyngeal Abscess

9. Tracheostomy Indications
miscellaneous
• Congenital abnormalities (tracheomalacia,
subglottic stenosis, craniofacial abnormalities
• OSAS
• Prophylaxis ( H & N surgery)
• Cervical spinal cord injuries with respiratory
muscles paralysis

10. Care of tube
• Dressing
• Humidification
• Suction
• Cleaning of inner tube
• Cuff deflation

11. Care of tube Dressing

12. Humidification
Always keep moist gauze over tube opening to
prevent drying of secretions & crusting.

13. suctioning
• Should be done hourly / sos
for first day.
• Then 2 hrly for next 24 hrs
and onwards .
• Suctioning should be done
with 2.5 % NaHCO3 and not
7.5 %

14. Check The Patency of The Tube

15. TRACHEOSTOMY TUBE CARE: monitoring cuff
pressure
• Tracheostomy tube cuff
pressure 20 to 25 mm Hg.
• Low cuff pressures < 18
mm microaspiration of
secretions .
• High cuff pressures above
35 mm mucosal ischemia
tracheal stenosis.

16. Oral feeding after tracheostomy
• Tube prevents normal upward movement of
the larynx during swallowing and hinders
Glottic closure.
• Between 20% and 70% of patients with a
chronic tracheostomy experience at least one
episode of aspiration every 48 hours

17. Cuffed tube : Indications
• when an air-tight seal is required around the tube to prevent
blood and other secretions from running down the sides of
the tracheostomy tube into the lungs.
• when the patient is unable to breathe on their own and
requires artificial respiration.
• Disadvantages of Cuffed Tubes
• Pressure necrosis, fistula or stenosis in the trachea.
The patient cannot speak when the cuff is inflated as no air
can go past the vocal cords – this has a massive psychological
impact on the patient.

18. Un-cuffed Tubes
• Maintains airway once
aspiration risk has passed
• Increase airflow to the
larynx
• Which patients:
– Long term
tracheostomy pts
– Patients who do not
require a seal
– Paediatrics

19. Fenestrated Tube
• Cuffed or un-cuffed
• These are used for weaning
• Enables phonation
• (speaking)
• The fenestrated tube can be
used as such if the patient is
tolerating the cuff down

20. Inner Cannula
• Allows maintenance
of tube patency
• Allows fenestrated
tubes to be used
earlier

21. Metallic tubes:Chevalior Jackson

22. Fuller’s tracheostomy tube

23. Calculating the Size of tube
For metallic tube:
Age/3 + 3.5 < 6 years of age
Age/4 +4.5 > 6 years of age
Portex tube:
(Portex X 4 ) + 2 = size of metallic tube

24. Complications of Tracheostomy
 Immediate
 Apnea
 Hemorrhage
 Pneumothorax and
pneumomediastinum
 Tube Obstruction
 Tube Displacement
 Surgical emphysema
Late
 Tracheomalacia
 Stenosis
 Difficult decanulation
 Broken tube
 Tracheoesophageal fistula

25. Complications
Large stoma causes Surgical
Emphysema X-Ray Surgical emphysema

26. • Before Decanulation one should ensure
• Suprastomal air column
• Appropriate vocal cord function
• Good respiratory reserve
Decannulation

27. Decannulation Protocol
• Downsize tube.
• Get x –ray soft tissue neck
• Assess patient’s voice
• Gradually increase corking
• Corked 24-48 hours before
decannulation
• Occlusive dressing for
stoma

28. Normal Suprastomal air column

29. Difficult decannulation

30. Suprastomal Air column
• Suprastomal narrowing Suprastomal narrowing

31. Suprastomal Air column
Suprastomal Stenosis Grade 3 Subglottic Stenosis

32. Suprastomal Air column
Suprastomal block Grade 4 Subglottic stenosis

33. Broken Tracheostomy

34. Broken Tracheostomy

35. Broken metallic tube

36. Broken metallic tube

37. Disclaimer
• The information contained in the presentation is based on the personal
experience and cases collected at Choithram Hospital Indore over the last
20 years.
• It is intended for the use of Medical students ENT post graduates.
• The views expressed are purely on personal opinion. viewers can make
their own opinion. For any confusion please contact sole author.
• Everybody is allowed to copy or download the material best suited to him.
I am not responsible for any controversies arising out of the presentation.
• For any suggestions or corrections you may please contact
phatak_shrikant@yahoo.in

38. Tracheostomy
• Thank you