2. Tracheotomy
Greek origin: ‘tom’- ‘to cut’ the trachea
Surgical opening of the trachea
Tracheostomy
Greek origin: ‘stom’- ‘mouth’
Creation of a stoma between trachea and
cervical skin
3. 1st known reference- rig veda dated 2000 BC.
Ebers papyrus (dated 1550 BC)- Egyptian medical
papyrus mentions tracheotomy
Alexander the Great
Antyllus (2 AD), Greek surgeon-
performed tracheostomies in oral
surgeries
Tracheotomy well documented in
Indian and Arabian literature in
middle ages.
4. Tracheostomy gained popularity in 1800s
Two methods:
High- by dividing cricoid
Low- trachea entered directly
Significant problems associated with high
method
Till the end of 19th century tracheostomy
considered hazardous
Chevalier Jackson in 1923 established principles
of tracheostomy
7. Removal of secretions and protection of
tracheobronchial tree from aspiration
Neurological diseases- GBS, MS, Bulbar palsy
Coma- head injury, poisoning, tumour
In such situations- laryngeal/pharyngeal
incompetence
Cuffed tube useful
8. Respiratory failure
Tracheostomy- dead space, effort of
breathing, alveolar ventilation
Ease of removal of secretions
Pulmonary diseases- exacerbation of chronic
bronchitis, emphysema, severe pneumonia
Neurological diseases- MS, Motor neuron
disease
Severe chest injury- flail chest
9. Prolonged ventilation
T-tube more secure than ET tube; easier to wean
off vent
>3wks of intubation
length of ventilation and hospital stay
As a part of another procedure
Temporary tracheostomy in head and neck
surgeries
10. TEMPORARY/PERMANENT:
Temporary tracheostomy- elective or emergency
Permanent tracheostomy-as part of operation
involving removal of larynx
HIGH/MID/LOW:
High- above isthmus via 1st tracheal ring
Mid- through 2nd-3rd tracheal ring, preferred
Low- below level of isthmus
11. Informed consent
Coagulation profile adequate, platelet count
>50000/cumm
Neck examination- to anticipate difficulties in
procedure as in enlarged thyroid, limited neck
extension.
T-tube arranged, checked and prepared
26. Procedure for opening airway through
cricothyroid membrane
Minitracheostomy kits commercially available
27. Anatomy of paediatric upper airway different from
adults
Age of child critical when deciding appropriate size
of tube
Standard of paediatric intensive care facilities have
improved in last 2 decades
Reduced rate of tracheostomy in paediatric
population
Speech development may be impaired in long term
tracheostomies
29. Prolonged intubation
Indicated for patients requiring long term PPV
such as- PT neonate, CNS disease, severe burns
Long term intubation leads to complications and
difficult decannulation
>3 weeks of intubation
Pulmonary toilet
For intractable aspiration- decreases dead space
and eases work of pulmonary toilet
30. Structures lie higher up
Soft and compressible
airway
Structures from superior
mediastinum pulled up
during extension of neck
Small tracheal lumen
Trachea, a developing
structure
Funnel shaped larynx with
narrowest part being
subglottis
31.
32. Suction
Regular suctioning
Frequency depends on
individual basis
Indications
Appropriate size of
Suction catheter
Method
33. Humidification
Upper respiratory tract
bypassed, conditioning of
inspired gas lost
Different preferences in diffirent
set ups
Types: -cold water humidifiers
-hot water humidifiers
-heat and moisture
exchangers
-stoma protector
Nebulization
34. Tracheostomy tube change
1st tube change- 5-7 days
Frequency of tube change- no standard interval
‘if you can hear a tube, you should change it’
Bougies or guidewires
42. Considered when original condition requiring
tracheostomy has improved
Approached in a step-wise manner
In paediatric group endoscopic assessment prior
to decannulation essential
Fenestrated tube> occlusion cap> occlusion cap
for 12 hrs > 24 hrs>decannulation