Tracheotomy

The tracheostomy ( from Ancient Greek τραχύς trachys, rough ' and τομή tome, cut ') [Note 1] - colloquially tracheotomy - a surgical procedure in which created by the neck soft tissues, access to the windpipe ( tracheostomy ). Indications for tracheostomy may be, for example, the need for long-term ventilation after accidents or surgery, neurological disorders with disturbances of swallowing reflex, radiation treatment to the head or neck or laryngeal paralysis. Also, patients after complete removal of the larynx wear a tracheostomy.

Is colloquially also erroneously a life-saving measure in emergency medicine, coniotomy understood as tracheotomy, although there the trachea is not affected. This is carried out at an obstruction of the upper respiratory tract as a last resort to prevent the patient from suffocation.

Surgical methods

Percutaneous puncture and dilation

Here, the air tube is punctured by a hollow needle from the outside, a guide wire is advanced. Endoscopically, the correct position of the wire is controlled in the trachea and then expanded over the guide wire with Plastikdilatatoren access until a cannula breathing tube fits. This simple process is often used in intensive care units at the ventilated patient when a mechanical ventilation is to be expected over time, but the view is that not a permanent cannula breathing tube must be worn.

Surgical tracheotomy

In this method, in the operating room a cluttered surgical access to the trachea is created, often severed portions of the thyroid and blood vessels are hereby prohibited. Subsequently, the trachea was opened and the tracheal tube is inserted from the outside through the neck of the soft tissues.

The resulting tracheostomy is larger and more stable than in the percutaneous Punktionstracheotomie and also allows the routine change of the tracheostomy tube. However, the tracheostomy is not durable or stable: If no tube used for a long time, it shrinks and closes usually. A needle exchange is sometimes not possible even a few minutes after removal of the cannula. If it is expected that for a long time an artificial breathing opening must be worn, one is created " plastic tracheostomy ". Here, a portion of the trachea is windows like wings unfolded and firmly sewn into the neck skin. The result is a stable breathing channel without wound surface. The patient can move the needle safely themselves. Such a plastic tracheostomy must, if it is no longer needed, are usually closed by reoperation.

Tracheostomy in laryngectomy

After a complete removal of the larynx ( laryngectomy ) the bottom separated from the larynx trachea is permanently moved outward and sewn into the neck skin. Medical correctly called this intervention tracheostomy. Since the larynx is removed, the procedure can not be undone. Laryngectomy people have no vocal cords and have to learn "substitute language" a: during laryngeal surgery a voice prosthesis between the trachea and esophagus is used.

Advantages of tracheotomy

  • For long-term ventilation, the risk of damage to vocal cords and trachea is minimized.
  • By switching off the upper respiratory tract and the resulting thereby reducing the " Atemtotraumes " breathing for the patient will be easier and thus facilitates weaning from the ventilator or at all possible.
  • The oral care and hygiene are much easier.
  • The patient no longer has the sense to permanently have a foreign body in the mouth.
  • Compared to the intubation, the patient requires considerably less or no sedation.
  • The tracheostomy patient can speak using a speech cannula or a speech essay. This is not possible for the intubated patient.
  • An oral feeding is possible.

Disadvantages of tracheotomy

After tracheotomy the air no longer flows through the upper respiratory tract, but directly into the trachea and lungs.

  • The breathing air is not humidified in the nose and no longer reaches the olfactory nerves, that is tracheostomised people can no longer smell and taste, therefore, only limited.
  • The air no longer flows when exhaling through the larynx. Therefore tracheostomised people can form only one vote, if they wear a special speaking cannula, or swallow air and belch to speak (see above)
  • The cleaning function of the upper respiratory tract is eliminated.
  • Increased secretion by irritation of the trachea ( foreign body irritation through the cannula ).

All the drawbacks mentioned here are applicable also for the normal orotracheal intubation. So you can not Tracheotomy versus intubation help in balancing.

Breathing cannulas

After a tracheotomy, the patient breathing cannulas ( tracheostomy ) are used which keep open the tracheostoma and if necessary allow by an inflatable " block " or " cuff " is a ventilation and prevent throat secretions down can get into the lungs. Special forms of breathing cannulas allow also through openings in the cannula tube and speaking valves phonation. Cannulas are made ​​of plastic ( polyvinyl chloride, PVC) or metal (silver or nickel silver). The advantage of the metal cannula is that with the same outer diameter, they have a larger internal diameter and clog less rapidly with secretion. Inner cannulas allow for cleaning without having to change the entire same cannula. The picture shows a PVC cannula of size 8 (88 mm length and 11 mm outer diameter) with block sleeve and inner cannula. The guide rod ( obturator) is used to facilitate insertion.

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