Tracheostomy is a procedure performed in emergency situations or in patients with severe illness. The main purpose of this procedure is to maintain the airway. But in addition to the benefits, this procedure also has the risk of complications, during or after the tracheostomy is performed.
Tracheostomy is also known as stoma. Health problems that require this procedure are generally associated with the respiratory tract. With the aim of making patients able to breathe well. This procedure is usually performed in medical emergencies or in certain diseases that cause airway obstruction or respiratory failure. This condition is a serious condition that can be life threatening if it is not treated immediately, therefore a tracheostomy is performed to keep the breathing process running properly to support the continuity of life.
Tracheostomy is the operation of opening or making a hole made in the windpipe or trachea, through an incision in the skin in the front of the neck, with the help of general anesthesia , to be used as direct access to the breathing tube. In emergency cases, general anesthesia is often not done so the doctor will provide local anesthesia in the neck area to be surgically removed. After the anesthesia works, the doctor will begin to dissect the neck area under the Adam’s apple and the surgery is carried out to the part of the trachea cartilage ring. After opening, the breathing tube will be installed in the hole.
The breathing tube is then inserted into a hole made in the throat, just below the vocal cords. Then the air will enter through the tube, towards the lungs. Patients will then breathe through this tube, not through the nose or mouth. If needed, the breathing tube can be connected to an oxygen tube or ventilator machine. This hole can be temporary or permanent. This surgery must be performed by a specialist doctor.
Conditions that Require Tracheostomy
Some health conditions that require a tracheostomy procedure include:
- Congenital or congenital respiratory tract disorders
- Injuries in the respiratory tract due to inhalation of corrosive materials
- Chronic obstructive pulmonary disease (COPD)
- Diaphragmatic dysfunction
- Severe infection
- Laryngeal / laryngectomy wounds
- Wounds on the chest wall
- Burns or major surgery on the face
- Conditions that require prolonged breathing or ventilator assistance such as paralysis.
- Blockage of the respiratory tract by foreign objects or tumors.
- Sleep apnea , due to obstruction of the airway.
- Anaphylactic shock
- Muscle paralysis used to swallow
- Severe mouth or neck injury
- Vocal cord paralysis
- Neck cancer
Apart from facilitating breathing, a tracheostomy is also carried out for the following reasons:
- Make alternative breathing grooves that surround or through a blocked path so that oxygen can still reach the lungs
- To make it easier to clean the respiratory tract and also as a drainage fluid that comes from the lungs.
- As a liaison between the respiratory organs and a long-term mechanical breathing (ventilator) machine.
Although leaving a small scar when the tube is removed (in the tracheostomy temporarily), patients who go through this procedure can not be separated from the risk of complications of the tracheostomy to watch out for, namely:
- Damage to the thyroid gland in the neck
- The presence of scar tissue in the trachea
- Leak or failure of lung function
- Air is trapped in the surrounding tissue or in the chest cavity.
- Impaired swallowing and vocal function.
There are also some risks of complications that are less common, but still need to be watched out for, such as damage to the larynx (vocal cord box) or airway, and lead to permanent sound changes and injury or erosion of the tissue around the breathing tube.
The doctor will usually adjust the tracheostomy procedure to the patient’s condition and continue to monitor the oximeter and ECG results as long as the procedure is carried out. This procedure is indeed uncomfortable for patients. In some cases after a tube is attached to the trachea, the patient is often difficult or even unable to speak or swallow, although indications of the tracheostomy action aim to prevent fatal complications continue. In addition to surgical procedures for conventional tracheostomy, there is now a technique to install a breathing tube through the fat tissue in the neck that is less invasive. However, the act of tracheostomy through fatty tissue (percutaneous) is a high risk for complications in obese people, disorders of the neck and throat structure, children and thyroid enlargement.
After attaching a breathing tube to a hole made in the trachea, patients generally need three days before getting used to the breathing tube in their neck. For long-term users, the doctor will tell you how to treat and clean the breathing tube and do not forget to regularly check the condition according to the doctor’s advice.