traccheostomy

2. Definition
It is an operation in which an
opening is made in cervical part
of trachea to bye pass the upper
respiratory tract

4. Acute emergencies for short duration
Endotracheal intubation
Later shift to Tracheostomy

5. Intubation
Drawbacks
Non
invasive
No need of
equipped
OT
Rapid
procedure
Tube may be blocked
pressure necrosis if kept
for longer period 48hrs

6. Types of tracheostomy
• Based on:
• Duration
Circumstances
Site

7. Types of tracheostomy
Based on:
• Circumstances
• Duration
• Site
Emergency
Elective
Temporary
Permanent
High
Mid
Low

8. Temporary tracheostomy
Can be elective or emergency
Elective : as a part of planned procedure as in major
head &neck surgery or for prolonged respiratory
support for ventilated patients
Emergency : severe trauma to head &neck, acute
upper airwayobstruction

9. Permanent tracheostomy
Elective procedure
In operations involving removal of larynx-
laryngectomy, laryngopharyngectomy, diversion
procedures for aspiration problems
Trachea is permanently disconnected from the
pharynx &proximal end of trachea sutured to the skin

11. Effects ??
Laryngeal bypass- unable tocough &phonate
Reduction in respiratory dead space
Redundantarea between larynx &tracheal opening
where mucous tends to accumulate
Filtration &humifification effect of nasal mucosalost
Increased risk forinfection
Tracheostomy tube acts as FB producing local
inflammation &abrasions

12. Indications
Upper Airway
Obstruction
As a part of
another
procedure
Removal of
retained
secretions
Prolonged
ventilation

13. 1 .Upper airway obstruction
A Intrinsic
Congenital - web, laryngeal stenosis, tracheo esophageal fistula,
Traumatic - Fumes, corrosives, Sharp object FB, Instrumentation
Infective - Ac laryngitis, Ac epiglottitis,diphtheria
Chr granulomatous lesions
Neurological- B/L abd vc palsy, myasthenia gravis ,Tetanus,
poliomyelitis
Neoplastic -Benign-Papilloma, chondroma
Malignant- Ca Larynx&laryngopharynx
Miscellaneous - FB,Angioneurotic edema

14. B Extrinsic
• Traumatic - Cut throat, Crush injuries of Larynx,
Strangulation
• Infective - Ludwig’angina, RPAbscess, PPAbscess
• Neurological - Rec Laryngeal N Palsy, caesophagus,
ca thyroid, metastaticmediastinal LN,
thyroidectomy
• Malignant - Pressure due to Ca Thyroid& other
neck tumors

15. Removal of retained secretions
CCF
Infection
Pulmonary oedema
Bulbar palsy
Here secretions can be aspirated with minimal
upset to the patient & reduction in respiratory
dead space makes it easier for patient to breathe.

16. Prolonged ventilation
• Unconscious pt- Coma( Head Injuries, CVA, encephalitis)
• Depressed Resp Center- Bulbar palsy,barbiturate
poisoning
• Lesion of ant horn cells &Nerves - Polyneuritis,
Poliomyelitis, Myasthenia gravis
• Myoneural lesions - Tetanus
• Chest Injuries - Flail chest, multiple # ribs
• Lung Pathology-Fibrosis, collapse, Emphysema
Asits more secure than nasotracheal / orotracheal tube
& reduced dead space facilitatesweaning

17. As a part of another procedure
Prior to major H&N surgery
Laryngofissure , Laryngectomy,
hemiglossectomy, mandibulectomy
RPAbscess, maxillofacial operations
It prevents aspiration of blood & helps easy
administration of anaestheticdrugs
Contraindications- NIL

18. Types of Tracheostomy tubes
Metallic
Chevalier Jackson
Fuller’s bivalve
size 8 to 44 with ↑of 2
Portex
Cuffed -size 5.5-10(↑0.5)
Non Cuffed -size 3 -10(↑0.5)

19. Salpekar’s double cuffed
Durhams tube
Adjustable shield for short neck
Redcliff tube - right angled for short neck

20. Features of tracheostomy
tube

21. TracheostomyProcedure
Anaesthesia Local / General
Position Supine with
extended neck& fixed head
Incision
Vertical in emergency
Transverse in electivesurgery

25. Post operative Care
Frequent suctioning
Humidification
Deflation of tube every 4 hrs for 15
mins for first 24 hrs
Never remove outer tube in first 48
hrs
Change of dressing Ambulation and physiotherapy
Supportive treatment

26. Sequelae of Tracheostomy
Inability to speak
Can not swim
Inability to lift heavy wt and heavy work
Difficulty in micturition , defecation and
parturition
Anosmia

27. Tracheostomy complications
A Immediate
Hemorrhage
Injury to thyroid isthmus, ant Jugularvein,
Innominate art, Inf Thyroid art, Carotid
vessels
Injury to
Oesophagus, Dome ofPleura,
RLN, Cricoid cartilage
Apnoea d/t release of CO2
Vasovagal attack
Aspiration andLung collapse

28. B Intermediate
Extubation /tube obstruction
Subcutaneous emphysema - tracheal opening islarge
Mediastenal emphysema - Pretracheal fascia is not incised
Tracheo esophageal fistula /tracheoarterialfistula
pressure necrosis
Infection- Perichondritis ,Tracheo bronchitis
Dysphagia -  glottic pressure

29. C Late
• Tracheo malacia
• Laryngeal stenosis
• Tracheal stenosis
• Tracheo cutaneous fistula
• Difficult decannulation-
psychological dependence,
persistant pathology
Granuloma formation

30. Thank
you