Generality
The tracheostomy is the surgical operation through which a passageway is created at the level of the neck for the air destined for the lungs. This allows those who undergo this surgery to breathe again and / or correctly.
The tracheostomy procedure does not require special preparation and is relatively easy to perform. Complications, in fact, are rare and mostly reserved for emergency cases.
The results are generally satisfactory, however, the conditions that required the tracheostomy must also be considered when evaluating the benefits.
What is a tracheostomy?
The tracheostomy is the surgical procedure used to create an "opening (or stoma) in the neck, at the level of the trachea. This operation is performed by joining the edges of a" skin incision, made on the neck, to the tracheal tube, which is also perforated.
Once the two openings are connected, a small tube is inserted, called a tracheostomy tube, which allows air to be conveyed into the lungs and to breathe.
Tracheostomy is usually a long-term remedy.
TRACHEOSTOMY AND TRACHEOTOMY
It should be noted that tracheostomy and tracheostomy, although performed to allow breathing and having common procedural aspects, are not the same thing.
Tracheotomy, in fact, involves the creation of a "(always) temporary opening on the trachea, made with a simple neck incision. Therefore, unlike tracheostomy, no modification of the tracheal tract is expected, so much so that, if it is not maintained voluntarily permitting the opening (by means of a cannula), this closes spontaneously in a short time.
TRACHEOSTOMY AND ASSISTED VENTILATION
When you do
A tracheostomy is usually performed when an individual can no longer breathe properly due to a health disorder or airway obstruction.
There are three main situations that require tracheostomy:
- In case of respiratory failure
- In case of blockage of the upper airways
- In case of accumulation of fluid within the lower airways and in the lungs
RESPIRATORY INSUFFICIENCY
Respiratory failure is a condition in which an individual has difficulty breathing or does not breathe at all.
Cases of respiratory failure, which require tracheostomy, are caused by the following circumstances:
- Stroke or severe brain trauma, which causes the patient to be in a state of coma or unconsciousness.
- Paralysis, due to severe trauma of the spinal cord, at the level of the neck.
- Deep damage to the lungs, caused by pneumonia or cystic fibrosis.
- Degenerative diseases of the nervous system, such as those affecting motor neurons (for example, ALS or amyotrophic lateral sclerosis) or multiple sclerosis.
BLOCKING OF UPPER AIRWAYS
The upper airways can become blocked for several reasons. The tracheostomy becomes essential when the obstruction is permanent.
Permanent obstructions are caused by trauma, severe infections and severe allergic reactions, which constrict the throat; or from a tumor of the mouth, larynx or thyroid gland.
The tracheostomy tube, in these situations, serves to bypass an obstacle that is upstream.
ACCUMULATION OF FLUID IN THE AIRWAYS
In the lower airways or lungs, fluid can accumulate, which, in addition to reducing an individual's breathing capacity, can trigger an infection.
Through the tracheostomy, breathing is restored and the airways that have accumulated fluid are cleared.
Liquid collection can occur for the following reasons:
- After a severe lung infection (pneumonia)
- After trauma to the lower airways and lungs. The liquid, in this case, is mostly blood.
- After a neuromuscular disorder (for example, SMA or spinal muscular atrophy), which prevents the patient from moving the chest muscles and coughing. The cough serves to expel nasal secretions, which, accumulating, are a breeding ground for bacteria.
WHEN IS THE TRACHEOSTOMY PERMANENT AND WHEN IS IT NOT?
The tracheostomy is usually practiced as a permanent remedy, in all those situations (serious or not serious) in which a recovery of normal respiratory capacities is not expected. However, if the respiratory disorders are treatable, it can be a temporary solution, but of a moderate duration, applied while waiting for the patient to recover.
MECHANICAL VENTILATION: WHEN TO APPLY IT?
Sometimes, the tracheostomy is not sufficient to ensure the patient's breathing. In fact, cases of severe respiratory insufficiency, or particular neurodegenerative diseases affecting the chest muscles, require assisted ventilation. This is performed by means of a transportable (or non-fixed) instrument, which is connected to the tracheostomy tube and infuses, through of it, oxygen to the lungs.
Preparation
The tracheostomy provides, with some exceptions, general anesthesia; therefore, on the day of the operation, it is necessary to have fasted for several hours (generally, from the previous evening).
In addition, it is good to equip yourself with everything you might need during hospitalization (which is several days) and, according to medical advice, stop taking certain drugs (for example, anticoagulants), as these could cause the onset complications.
PREOPERATIVE CHECK-UP
Like any surgical operation, tracheostomy also requires a preoperative check-up, which serves to assess the patient's health and whether he is able to withstand the operation.
Procedure
The tracheostomy can be performed either as a scheduled intervention or as an emergency solution.
When it is scheduled, there is time to prepare the operation in the smallest details and to resort to general anesthesia; when, on the other hand, it is an emergency remedy, the time available is short, the anesthesia is local and it is necessary to act quickly, if you want to save the patient's life.
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