A tracheostomy is a surgical procedure to create an opening in the trachea, the tube that connects the larynx to the lungs. This opening allows a tube (cannula) to be inserted to facilitate breathing, especially when the upper airway is obstructed or when the patient has significant difficulty breathing.
- Patients with upper airway obstruction.
- Patients who have undergone major neck or throat surgery and have difficulty breathing.
- Patients in a persistent vegetative state.
- People with certain neuromuscular diseases that affect the respiratory muscles.
- Bleeding.
- Infection.
- Pneumothorax.
- Cannula obstruction.
- Granulomas.
- Tracheal stenosis.
- Speech difficulties.
- Between 15 and 45 minutes.
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Tracheostomy: In which cases?
Tracheostomy is a surgical procedure that may be considered in a variety of clinical settings.
People who are likely to undergo a tracheostomy have:
- Chronic airway diseases such as chronic obstructive pulmonary disease (COPD),cystic fibrosis, or vocal cord paralysis.
- Upper airway obstructions due to tumors, infections, severe facial or neck trauma, or neuromuscular disorders of the respiratory muscles.
- Severe chronic respiratory insufficiency requiring prolonged mechanical ventilation.
- Prevention of pulmonary complications during certain surgical procedures or in high-risk patients.
This procedure facilitates breathing, improves quality of life and in some cases prolongs survival.
Symptoms that may lead to a tracheostomy
Tracheostomy may be a treatment option when respiratory symptoms become significantly and chronically worse.
These symptoms may include
- Difficulty breathing (dyspnea).
- Persistent cough.
- Wheezing.
- Feeling of suffocation.
- Retraction of the intercostal muscles.
- Cyanosis, characterized by a bluish discoloration of the lips and fingernails, may occur with hypoxia, when the body is deprived of oxygen.
Complications of a tracheostomy
Immediate complications after a tracheostomy may include:
- Bleeding.
- Infections.
- Pneumothorax (collapse of part of the lung).
- Recurrent nerve damage (affecting voice).
- Blockage of the tube.
In the long term, other problems may occur:
- Tracheal stenosis (narrowing of the windpipe).
- Granuloma formation (abnormal scar tissue).
- Fistulas (abnormal connections).
- Swallowing difficulties.
- Psychological problems related to tube dependence and voice changes.
Common side effects include:
- Loss of voice.
- Dry mucous membranes.
- Difficulty coughing.
- Increased risk of aspiration.
Strict care, such as regular cannula cleaning, respiratory physiotherapy and humidification, can significantly reduce these risks. Regular doctor visits are essential for optimal care.
Preparing for the operation
Before a tracheostomy is performed, a full medical examination will be carried out to assess the patient's general state of health and identify any contraindications to the procedure.
This includes :
- Blood analysis.
- Imaging tests (chest X-ray, CT scan, MRI).
- Respiratory function tests.
Preparatory measures are put in place, such as pre-operative fasting and skin preparation in the neck area.
Operating phase
A tracheal operation is usually performed under general anesthesia. The surgeon begins by making a small incision in the neck, just above the Adam's apple.
The tissues are then gently pulled apart to reach the windpipe. Once the trachea is exposed, a small opening is made and a cannula, a plastic or metal tube, is inserted into the opening.
This cannula allows air to flow directly out of the lungs. Finally, the incision is closed with stitches.
Postoperative phase
During the first few days after a tracheostomy, the patient is closely monitored for possible complications.
The length of the post-tracheostomy hospital stay varies depending on the complexity of the case and the development of complications. Once discharged from the hospital, the patient must continue to follow medical recommendations and care for the cannula. In some cases, the tube may be permanently removed once the upper airway has returned to normal function.
Recovery from a tracheostomy requires time and patience.
Respiratory rehabilitation is essential to learn how to use the tube and improve lung function. Postoperative care includes regular cannula cleaning, respiratory monitoring, and respiratory physiotherapy. Respiratory physiotherapy helps the patient regain good respiratory function and cough up secretions.
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