Tracheostomy is an operation that involves opening the trachea to facilitate the passage of air into the lungs. What are its indications? The results ? What risks?
What is the definition of a tracheotomy?
The tracheotomy is a surgical intervention which consists of performing an opening at the base of the neck to insert a prosthesis, usually plastic, in the trachea. The introduction of this small cannula allows to ensure the freedom of the upper airways, in particular during pathologies which create an obstacle at the level of the upper airways (glottic plane in particular). In other words, the tracheotomy is a medical device that allows freedom and access to the lower airways. She may be permanente or temporary.
What are the indications for a tracheotomy?
“The purpose of tracheotomy is to bypass the upper airways to allow air to pass into the lungs without passing through the nose or mouth.“, explains Dr. Maxens Decavèle. Its main indications are:
► The desire to circumvent an obstacle that would be located above the vocal cords. “The most well-known obstacles are the ENT cancers (vocal cords, glottic plane, pharynx, mouth, tongue, all aerodigestive pathologies that would be located above the glottic plane. Sometimes these pathologies compromise breathing and are responsible for acute upper respiratory failure (obstructive respiratory failure). Tracheotomy will restore breathing by bypassing this obstacle“, develops the resuscitator.
► Allow access to the lower airways in a very practical way and to suction patients whose capacity to mobilize bronchial, pulmonary and distal secretions is drastically reduced. “This is particularly the case in the neuromuscular diseases in which the force of the cough is weaker. Tracheotomy helps manage patients’ broncho-pulmonary secretions”details the specialist.
► Within the intensive care unit, tracheostomy is performed in the context of complicated ventilatory weaning, that is to say duringan artificial ventilator separation failure. “We speak of complicated or prolonged ventilatory weaning after 7 days of trying to separate from the ventilator“, specifies Dr. Maxens Decavèle.
There are two types of tracheotomies:
► Surgical tracheostomy: the procedure lasts a few minutes and takes place under general anesthesia. The surgeon (usually ENT or maxillofacial) makes an incision in the skin and trachea at the base of the neck, then inserts a small cannula.
► Percutaneous tracheostomy: tracheotomy can also be performed percutaneously under general anesthesia by intensive care physicians.
What are the risks of a tracheostomy?
Several complications can occur in the context of a surgical or percutaneous tracheotomy:
► A hemorrhagic riskcaused by vascular lesions;
► A fracture of the tracheal rings because the trachea is a very cartilaginous organ;
► Irritation of the tracheal mucosa related to having a long-term foreign body in the trachea. “Sometimes these irritations can lead to aberrant scarring reactions called granulomas. These can progress to strictures: the tissue shrinks, so much so that it can be difficult to remove the tracheostomy since all the airways then become even more narrowed“, indicates the specialist.
► Lung infections linked to the fact that the tracheostomy favors the stagnation of saliva above.
Can we talk after a tracheotomy?
“A tracheostomy does not prevent talking. On the contrary, it allows intensive care patients attached to the artificial ventilator by an intubation tube to regain speech. Nevertheless, it is necessary to deflate the tracheostomy rod and to position either a voice valve or a plug at the end of the cannula. Patients may also start smelling odors again, swallowing“, develops Dr. Maxens Decavèle. The use of a tracheostomy also allows a very marked improvement in the comfort of patients with failed ventilation or in a situation of prolonged ventilation weaning, without the effect on the duration of artificial ventilation being significantly reduced.
There are different models more or less suitable for everyday life. Most of the time, the tracheostomy is temporaryit aims to improve comfort and facilitate the respiratory weaning process in intensive care. Tracheotomy may be considered permanently in case of ventilatory insufficiency requiring long-term ventilatory assistance: diaphragmatic insufficiency, high tetraplegia, myopathies or other neuromuscular diseases affecting the ventilation function. Regular follow-up is essential, theoretically the tracheotomy must be changed every 30 days (medical device)”continues the specialist.
What is the difference between a tracheostomy and a tracheostomy?
Tracheotomy consists of performing an incision in the trachea and inserting a cannula therein to bypass the upper airway. This device can be removed. Conversely, tracheostomy designates a definitive connection of the trachea to the skin.
Thanks to Dr Maxens DECAVELE, resuscitator at the Pitié-Salpêtrière hospital