Tracheostomy is a surgical procedure that creates an opening in the trachea to bypass upper respiratory obstructions. It can be performed as an emergency or electively. Indications for tracheostomy include upper airway obstruction from various causes, protection of the tracheobronchial tree for patients with conditions affecting secretions, assistance with ventilation for patients requiring prolonged intubation or mechanical respiration, and respiratory failure to reduce dead space. The procedure involves making an incision through the neck to access the trachea and insert a tube. Post-operative care focuses on humidification, suctioning, monitoring for bleeding, feeding, antibiotics, and tube care. Complications can include hemorrhage, surgical emphysema,

1. TRACHEOSTOMY Dr. Fadl A. Fadl, FRCSI, FICS, DLO

2. It is a life saving procedure by creating a surgical opening into the trachea bypassing an upper respiratory obstruction. It can be done as an emergency or electively. (stomy = stoma = opening). DEFINITION

3. Trachea & larynx

5. A) Upper airway obstruction : 1- Congenital : laryngeal web, laryngeal stenosis, haemangioma, laryngomalacia… 2- Trauma : ETT injuries, cut throat, gun shot, steam inhalation, corrosives, DXT, flail chest… 3- Infection: Ac. Epiglottitis, L.T.B. , Diphtheria, Ludwick’s angina. 4- Malignant Tumours: Ca tongue Base, ca larynx & upper trachea, ca thyroid. 5- Preoperative procedture of laryngeal or oral surgery. 6- Bilat. Vocal Cord paralysis: - post- thyroidectomy, bulber palsy. 7- Hair-dye Poisoning: angioneurotic oedema. INDICATIONS

6. B) Protection of tracheobronchial tree : (Reduction of secretions): 1- Myathenia Gravis, Polyneuritis. 2- Brainstem Stroke. 3- Multiple rib fractures. INDICATIONS

7. C) Respiratory Failure (Reduction of dead space ): 1- Chronic obstructive airway disease. 2- Severe bronchial asthma. 3- Gillian Barry syndrome. 4- Abnormal thoracic cage (thoracic kyphosis). INDICATIONS

8. D) Assisted ventilation (Prolonged intubation) 1- Prolonged coma for any cause 2- Extensive faciomaxillary surgery. 3- Any condition needing IPPR , artificial or mechanical respiration. INDICATIONS

9. Types of tracheostomy : - High - Mid - Low

10. Procedure : - - G.A. , local , no anaethesia. - Position of the patient: supine, neck extended. - Incision : emergency: Transverse, longitudinal:elective. - Layers: skin , superficial cervical fascia , platysma, strap muscles, pretracheal fascia, thyroid isthmus , stoma in 2 nd , 3 rd & 4 th rings. Insert tube :metal or portex. - Close wound & dressing.

11. Post-operative Care : - Position: semi-sitting. - Humidification. - Suctioning . - Observe breathing & bleeding. - Feeding. - Antibiotics & analgesics. - Tube care. - Decannulation.

12. Complications: - Hemorrhage. - Surgical emphysema . - Pneumothorax. - Respiratory obstruction (tube slipping or obstruction). - Injuries to blood vessels, nerves, esophagus…etc. - Wound infection: perichondritis, stenosis, septicaemia. - Difficult extubation . - Tracheo-esophageal fistula. - Speech problems.