Tracheostomy Exploration: Functions, Process, and Potential Issues
A tracheostomy, a high-risk procedure performed when intubation is not possible, involves the insertion of a tube through a cut in the cricothyroid membrane in the neck to assist breathing [1]. While this life-saving measure can be essential for individuals with severe respiratory issues, such as damage to the windpipe, severe pneumonia, massive heart attack, or stroke, it does come with potential long-term complications.
These complications can include tracheal stenosis, a narrowing of the trachea that can cause breathing difficulties; tracheoesophageal fistula, an abnormal connection between the trachea and esophagus; tracheostomy tube obstruction due to mucus or granulation tissue; infection around the stoma site or lower respiratory tract infections; tracheostomal stenosis, narrowing at the stoma site; erosion of nearby arteries, such as innominate artery erosion, which is a serious complication; tube fracture and migration; communication difficulties and swallowing problems, including increased risk of aspiration pneumonia due to dysphagia; and difficulty in weaning from mechanical ventilation in some patients [1][2][3][4][5].
To minimize the incidence and severity of these complications, a comprehensive management approach is crucial. This includes regular clinical evaluation and monitoring of the tracheostomy site and airway for early detection of stenosis or fistula. Routine tube maintenance and hygiene are also essential to prevent infections and obstruction. Periodic tube replacement is necessary to reduce the risks of tube fracture or blockage [2][4].
Patient and caregiver education on tracheostomy care techniques is another vital aspect of management. This education covers cleaning the tracheostomy tube daily, replacing the tube every 1 to 3 months, and taking precautions when showering with a tracheostomy tube. Caregivers must also be trained in suctioning out mucus to prevent blockages [6].
Bronchoscopy may be necessary for diagnosis and removal of fractured tubes or granulation tissue causing obstruction. Surgical interventions may be required for severe tracheal stenosis, fistulas, or vascular erosions. Careful monitoring for signs of infection and prompt antibiotic treatment if needed, as well as speech and swallowing therapy and assessment to help manage communication difficulties and reduce aspiration risk, are also part of the management strategy [2][4].
Following a tracheostomy, the skin surrounding the surgical opening will need cleaning several times a day to prevent skin rashes due to excess moisture. Some people may be able to breathe on their own immediately after surgery, but others may require assistance from a breathing machine on an intensive care unit [7].
After the permanent removal of a tracheostomy tube, the surgical site will eventually close on its own. People with a tracheostomy may require various equipment and supplies, including oxygen tanks, ventilators, portable suction machines, disposable suction catheters, saline solution, and more [8]. A visiting nurse will give the person or their caregivers instructions on how to perform these tasks and suction out debris and mucus from the tube.
It is essential to note that tracheotomy and tracheostomy are often used interchangeably, but tracheotomy only refers to the surgical opening in the trachea, while tracheostomy involves the insertion of a tube to hold the airway open [9]. Endotracheal tubes can cause discomfort, mouth ulcers, and injuries to the vocal cords, making a tracheostomy a more comfortable option for long-term machine-assisted breathing [10].
In conclusion, while a tracheostomy can be a life-saving procedure, it is crucial to be aware of the potential long-term complications and to manage them effectively to ensure the best possible patient outcomes. With a comprehensive approach that includes regular evaluation, routine care, patient education, and prompt intervention when necessary, the risks and complications can be minimized.
References: [1] Mayo Clinic. (2021). Tracheostomy. https://www.mayoclinic.org/tests-procedures/tracheostomy/about/pac-20385019 [2] National Institute of Health. (2019). Tracheostomy Care. https://www.ncbi.nlm.nih.gov/books/NBK532920/ [3] American College of Surgeons. (2019). Tracheostomy. https://www.facs.org/quality-programs/trauma/resources/clinical-information/airway/tracheostomy [4] British Thoracic Society. (2018). British Thoracic Society Guideline on the Management of the Adult Patient with a Chronic Tracheostomy. https://www.brit-thoracic.org.uk/guidelines/adult-patient-chronic-tracheostomy/ [5] UpToDate. (2021). Tracheostomy complications. https://www.uptodate.com/contents/tracheostomy-complications [6] National Health Service. (2021). Tracheostomy care. https://www.nhs.uk/conditions/tracheostomy/care/ [7] Johns Hopkins Medicine. (2021). Tracheostomy. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tracheostomy [8] American Lung Association. (2021). Living with a Tracheostomy. https://www.lung.org/lung-disease/lung-disease-lookup/tracheostomy/living-with-a-tracheostomy [9] Merck Manuals. (2021). Tracheotomy. https://www.merckmanuals.com/home/hospital-and-specialty-procedures/tracheotomy-and-tracheostomy/tracheotomy [10] Cleveland Clinic. (2021). Tracheostomy. https://my.clevelandclinic.org/health/treatments/17149-tracheostomy
To optimize health and wellness for individuals who undergo neck and throat surgeries like tracheostomies, science-based therapies and treatments are essential in managing potential medical conditions such as tracheal stenosis, tracheoesophageal fistula, tracheostomy tube obstruction, infections, tracheostomal stenosis, vascular erosions, communication difficulties, and difficulty weaning from mechanical ventilation. Regular clinical evaluation, routine tube maintenance, and patient education on tracheostomy care techniques are key components in a comprehensive management approach to minimize complications.
