TRACHEOSTOMY

1. Tracheostomy
Pratik Manek

2. Introduction
• Artificial airway
• Tracheostomy tube – opening created on anterior aspect of trachea –
neck incision

3. Indications
• Usually elective
• Major Indications –
Prevent laryngeal and upper airway damage due to prolonged intubation
Allow easy access to the lower airway for managing secretions
Stable airway for prolonged mechanical ventilation

4. Techniques
• Open surgical (OS)
• Percutaneous Dilatational Tracheostomy (PDT)
• OSPDT

6. Open surgical

13. Concerns

14. Tracheostomy tube selection

15. Cuffed vs Uncuffed
• Children – usually uncuffed tube used unless
Need for high pressure ventilation
High risk of aspiration

16. OS vs PDT
• Open Surgical technique usually used in children
• PDT usually in adults and children >13-15 years

17. Timing of Tracheotomy
• Early tracheostomy (<7 days) post cardiac surgery has improved
outcomes as compared to late tracheostomy(>7 days)
Puentes et al. Anaesthesiology Intensive Therapy 2016,vol.48,89-94
Atrial Fibrillation (AF)
Kidney Dysfunction
Kidney failure
Reduced ICU stay and Hospital stay
• No difference in mortality and infection rate

18. Care
• Tube Care – Suction, Position, Inner Tube,
• Skin Care and Hygiene
• Infection and C/S

19. Complications
• Intra-Operative
Hemorrhage
Pneumo-thorax/Pneumo-mediastinum
Esophageal Injury
Recurrent Laryngeal Nerve injury
Loss of Airway
Creation of false passage
Cardiac arrest and death

20. Complications
• Early post-operative (<7 days, i.e tract maturation)
Hemorrhage
Dysphagia and aspiration
Wound infection
Tube obstruction (blood clot/mucus plug)
Accidental decannulation
Tube displacement into false passage
Subcutaneous Emphysema

21. Complications
• Late post-oprative (>7 days)
Stomal and tracheal granulation
Supra-stomal collapse
Tracheal stenosis
Tracheomalacia
Tracheo-Esophageal Fistula
Tracheo-Innominate Fistula
Tracheo-Cutaneous Fistula

22. Decannulation
• Protocol
Determine the correction of the precipitating cause
If necessary a formal airway assessment – vocal cord insufficiency, stomal
granulation, supra-stomal collapse, distal tracheal granulation or
tracheomalacia
Closure of the stoma to be done by secondary intention
Cuffed to uncuffed
Gradual down sizing upto 3-0 tube
Capping intermittently during daytime and then continuously
O2 saturation monitoring
De-cannulation and stoma occlusion

23. Discharge on Tracheostomy
• The first tracheostomy changed after 1 week – tract maturation
• Preparations while changing the tube
• Before discharge we should ensure
Sensitized to routine tracheostomy care
Learn to identify important problems – need of suctioning, mucus plugging
and respiratory difficulty
Should be able to change tracheostomy tube if urgent need arises
Should have at home – spare tubes, suction catheter with machine, sterile
saline bottles with syringes
Local hygiene and skin care

24. Thank You