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TRACHEOSTOMY (a life saving procedure)

TRACHEOSTOMY (a life saving procedure). Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine. Introduction.

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TRACHEOSTOMY (a life saving procedure)

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  1. TRACHEOSTOMY(a life saving procedure) Dr. Abdussalam M jahan ENT depart, Misurata university, faculty of medicine

  2. Introduction • Tracheostomy:is a surgical opening in the anterior aspect of the neck leading directly to the trachea. It is maintained open with tube called a Tracheostomy tube.

  3. Relevant Surgical Anatomy 1 - Vocal cords 2 – Thyroid cartilage 3 - Cricoid cartilage 4 - Tracheal cartilages 5 - Balloon cuff

  4. Indications: 1-upper airway obstruction, as mass or trauma, where intubation may be impossible. 2- Assist respiration over prolonged periods. 3-prolonged intubation with endotracheal tube: (more than 7-10 days) to reduce the possibility of subglottic stenosis.

  5. 4- assist cleaning of lower respiratory tract secretions 5-Facial fracturesthat may lead to upper airway obstruction (eg, comminuted fractures of the midface and mandible) 6-Major operations on the head and neck.

  6. 7- Reduce aspiration • 8-Severe obstructive sleep apnea. (if other options failed).

  7. Contraindications • No absolute contraindications exist to tracheostomy • RELATIVE • Laryngeal carcinoma it may lead to increased incidence of stomal recurrence (adiffuse infiltrate of neoplastic tissue at the junction of the amputated trachea and skin )

  8. Types of Tracheostomy Tubes Metal TT

  9. Procedure • Transverse Incision • Incision 1 cm below the cricoid or halfway between the cricoid and the sternal notch.

  10. Procedure cont’d • Blunt dissection of subcut tissue • Transversely retracted as shown

  11. Procedure cont’d • Strap muscles are divided longitudinally at midline

  12. Procedure cont’d • Thyroid ismuth is divided at midline by 2 hemostatic forcepses and cut edge secured by 2/0 vicryl

  13. Procedure cont’d • After exposing of trachea, inverted U opening is made in trachea below 2nd ring

  14. Procedure cont’d • By the Negus forceps the trachea dilated and tracheostomy tube inserted in the inverted U incision.

  15. Procedure cont’d • Fixation of the tube.

  16. Post-Op Management • Repeat X-Ray soft tissue neck • Strong Analgesia • Antibiotics • IV fluid until able to tolerate orally

  17. Complications of Tracheostomy • Complications 5-40% • Mortality <2% • Complications are more frequent in emergency situations, severely ill patients

  18. Immediate complications: • Apnea due to blood clot obstructing the tube, wrong insertion or displacement of the tube. • Bleeding. • Pneumothorax or pneumomediastinum: These can result from direct injury to the pleura or the cupola of the lung (especially in children). • Injury to adjacent structures: paratracheal structures vulnerable to injury are RLN, the great vessels, and the esophagus.

  19. Early complications: • Early bleeding: This is usually the result of increased blood pressure as the patient recovery from anesthesia and begins to cough. Although this may necessitate a return to the operating room, bleeding may be controlled with local packing, cautery, control blood pressure. • Plugging with mucus.

  20. Tracheitis: present in all patients with fresh tracheostomies. humidification, minimization of the fraction of inspired oxygen (FIO2) (because high oxygen levels exacerbate drying), and irrigation are essential. • Cellulitis. • Displacement of the tube.

  21. Subcutaneous emphysema: This results from a tight closure of tissue around the tube, tight packing material around the tube, or false passage of the tube into pretracheal tissues. • Atelectasis: An overly long tube can mimic a unilateral mainstem intubation, causing atelectasis or collapse of the opposite lung.

  22. Late complications: • Bleeding: Bleeding more than 48 hours after the procedure is most commonly (50%) caused by tracheo-innominate erosion (fistula). • Stenosis (subglottic stenosis) • Tracheoesophageal fistula: usually caused by friction between a posteriorly displaced tracheostomy tube or overinflated cuff and a rigid nasogastric tube. It manifests as aspiration and subsequent chemical pneumonia.

  23. Tracheo-cutaneous fistula. • Scarring: Both vertical and horizontal incisions heal with small but visible scars. Clinico-Pathology Seminar: Dept. of ORL, UITH.

  24. The Endwww.zahrawi.ly

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