Indications and complications of tracheostomy

Tracheostomy:is an emergency life saving surgical procedure where in an opening is created in the anterior wall of the trachea between the second and third tracheal rings.

Indications:

"The main indication of tracheostomy is that when the surgeon thinks about it" (Mosher).

1. In upper air way obstruction (obstruction above the level of larynx). Trachesotomy is indicated in all cases of upper airway obstruction irrespective of the cause as an emergency life saving procedure. It is also indicated in impending upper airway obstruction as in the case of angioneurotic oedema of larynx.

2. For assisted ventilation: In comatose patients who do not have the required respiratory drive airway can be secured by performing a tracheostomy and the patient can be connected to a ventilator for assisted ventilation.

3. For bronchial toileting: Chronically ill patients who do not have sufficient energy to cough out the bronchial secretions may have to undergo tracheostomy with the primary aim of sucking out the bronchial secretions through the tracheostome.

4. In cases of prolonged intubation: tracheostomy will have to be performed to prevent subglottic stenosis.

Disadvantages of tracheostomy:

1. It is a surgical procedure and hence has morbidity and mortality rates associated with surgical procedures.

2. The tracheostomy tube will have to be cleaned periodically.

3. During early phases periodical suction must be applied hence hospital support is a must.

4. The patient may not be able to use the voice. Some tracheostomy tube like the Fuller's metal tube may have a speaking valve which could help the patient to speak, the patient must get used to plugging the hole while speaking.

5. Decannulation is a complicated procedure.

Complications of tracheostomy:

1. Injury to thyroid isthumus causing troublesome bleeding

2. Too lateral dissection may cause extensive bleeding and possible injury to recurrent laryngeal nerve.

3. Injury to the apex of the lung (right)

4. Sudden apnoea when the trachea is opened, due to loss of hypoxic respiratory drive. This can be prevented by slow opening of the trachea, or by subjecting the patient to inhage carbogen a mixture of carbondioxide and oxygen.

5. Subcutaneous emphysema if pretracheal fascia is not dissected properly, or too small a tube is introduced into the tracheostome.

6. Injury to great vessels. This can occur in children.