The trachea, or windpipe, carries air from the larynx to the bronchi and lungs.
The indications for tracheostomy include:
prolonged intubation during the course of a critical illness
subglottic stenosis from prior trauma
obstruction from obesity for sleep apnea
congenital (inherited) abnormality of the larynx or trachea
severe neck or mouth injuries
inhalation of corrosive material smoke or steam
presence of a large foreign body that occludes the airway
paralysis of the muscles that affect swallowing causing a danger of aspiration
long term unconsciousness or coma
General anesthesia is used and the patient is deep asleep and pain-free. The neck is cleaned and draped. Incisions are made to expose the tough cartilage rings that make up the outer wall of the trachea.
The surgeon then cuts two of these rings and inserts a tracheostomy tube.
Most patients require 1 to 3 days to adapt to breathing through a tracheostomy tube. Communication will require adjustment. Initially, it may be impossible for the patient to talk or make sounds. After training and practice, most patients can learn to talk with a trach tube. Patients or parents learn how to take care of the tracheostomy during the hospital stay. Home-care service may also be available. Normal lifestyles are encouraged and most activities can be resumed. When outside a loose covering for the tracheostomy stoma (hole) (a scarf or other protection) is recommended. Other safety precautions regarding exposure to water, aerosols, powder or food particles must be adhered to.
After treatment of the underlying problem that necessitated the tracheostomy tube initially, the tube is easily removed, and the hole heals quickly, with only a small scar.
Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.