Tracheostomy-A-Lifesaving-Surgical-Procedure.pptx

INDICATIONS AND COMPLICATIONS OF TRACHESOTOMY

1. Tracheostomy: A Lifesaving Surgical Procedure Tracheostomy is a critical surgical procedure that creates an opening through the neck into the trachea. This opening, also known as a tracheostomy or trach, provides an alternative airway for breathing when the usual route is somehow obstructed or impaired. With a rich history dating back to ancient times, tracheostomy has evolved into a vital medical intervention used in various clinical scenarios. This presentation will explore the indications, types, procedure, and considerations surrounding tracheostomy. by DR Manu S Babu ASST PROF ENT DR DY PATIL MEDICAL COLLEGE HOSPITAL, PIMPRI PUNE

2. Historical Perspective of Tracheostomy 1 Period of Legend (2000 BC - 1546 AD) Tracheostomy's origins trace back to ancient civilizations, shrouded in myth and legend. 2 Period of Fear (1546 - 1833) The procedure was performed by few brave surgeons, often risking their reputation. 3 Period of Dramatization (1833 - 1932) Tracheostomy was primarily performed in cases of acutely obstructed airways. 4 Period of Enthusiasm (1932 - 1965) The procedure gained popularity, with the mantra "Do tracheostomy if you think so." 5 Period of Rationalization (1965 onwards) Modern era focusing on the merits of tracheostomy versus intubation.

3. Indications for Tracheostomy: Upper Airway Obstruction 1 Congenital Causes Laryngeal web, cyst, and choanal atresia are some congenital conditions that may necessitate a tracheostomy. 2 Infection and Inflammation Conditions like epiglottitis, croup, deep neck space abscess, and edema due to irritation, irradiation, or allergy can obstruct the airway. 3 Trauma and Neoplasms External or endoscopic trauma to the airway, as well as laryngo-tracheal or pharyngeal neoplasms, may require tracheostomy. 4 Other Causes Foreign body in the airway and bilateral abductor palsy of the larynx are additional indications for the procedure.

4. Indications for Tracheostomy: Respiratory Insufficiency Chronic Respiratory Conditions Chronic bronchitis, bronchiectasis, and atelectasis can lead to respiratory insufficiency requiring tracheostomy. Retained Airway Secretions Inability to cough out sputum due to coma, respiratory muscle palsy or spasm, or laryngectomy may necessitate the procedure. Excessive Secretions Conditions like pulmonary edema that cause excessive secretions may require tracheostomy for effective management.

5. Tracheostomy for Anesthesia Administration Laryngo-pharyngeal Growths Tracheostomy may be necessary for anesthesia administration in patients with growths in the larynx or pharynx. Maxillofacial Trauma In cases of severe facial injuries, tracheostomy can provide a secure airway for anesthesia. Trismus and Ludwig's Angina These conditions can make traditional intubation difficult, necessitating tracheostomy for anesthesia delivery. Prolonged Ventilation For patients requiring positive pressure ventilation for more than 72 hours, tracheostomy may be preferred over endotracheal intubation.

6. Types of Tracheostomy Timing Tracheostomies can be classified as emergency or elective procedures, depending on the urgency of the situation. Duration They can be temporary or permanent, based on the patient's condition and long-term prognosis. Purpose Tracheostomies may be therapeutic or prophylactic, addressing current issues or preventing future complications. Location Based on the placement, tracheostomies can be high, mid, or low, each with its own considerations and risks.

7. Commonly Used Tracheostomy Tubes: Jackson's Metallic Tube Composition Made of German silver, known for its durability and resistance to corrosion. Components Consists of an obturator, inner tube, and outer tube. The inner tube is longer for easy removal and cleaning. Functionality The outer tube maintains patency, while the pilot ensures smooth insertion. A lock mechanism secures the inner tube.

8. Commonly Used Tracheostomy Tubes: Fuller's Bivalved Metallic Tube 1 Unique Design The outer tube is bivalved, with two blades that can be pressed together for smooth insertion. 2 Inner Tube Features The inner tube is longer and includes a vent for phonation, allowing patients to speak by closing the main tube opening. 3 Decannulation Advantage The vent in the inner tube also aids in the process of decannulation, making it easier to remove the tube when necessary.

9. Modern Tracheostomy Tubes: Portex Cuffed and Uncuffed Tubes Feature Portex Cuffed Tube Portex Uncuffed Tube Material Siliconized PVC Siliconized PVC Cuff Low-pressure, high-volume No cuff Main Use Prevent aspiration, ventilation Radiation therapy, children Thermolabile Yes Yes

10. Specialized Tracheostomy Tubes Fenestrated Tube Features an opening in the outer cannula to facilitate speech and weaning from the tracheostomy. Adjustable Flange Tube Used in patients with obese or edematous necks, allowing for customized fit and depth. Salpekar Double Cuff Tube Designed to prevent ischemic necrosis of the tracheal cartilage by alternating cuff inflation.

11. Steps of Tracheostomy Procedure 1 Positioning and Preparation Patient is placed supine with neck extended. Area is prepped and draped. 2 Incision and Exposure A horizontal incision is made, and strap muscles are exposed and retracted. 3 Tracheal Access Thyroid isthmus is divided if necessary. Trachea is confirmed and a window is created. 4 Tube Insertion and Securing Tracheostomy tube is inserted, position confirmed, and tube is secured with sutures and tapes.

12. Complications and Post-Operative Care Complications Immediate: Hemorrhage, air embolism, cardiac arrest Intermediate: Tube displacement, subcutaneous emphysema Late: Tracheal stenosis, fistula formation Post-Operative Care Regular suctioning and humidification Wound care and dressing changes Monitoring for complications Gradual weaning and decannulation when appropriate THANK YOU