Tracheotomy Tubes and Airway Options

When your doctor suggests a Tracheotomy, there are some special things that you should know. An opening into the trachea or airway, the Tracheotomy or Tracheostomy as some doctors say, may actually be beneficial in managing a difficult long-term problem. In fact, for some patients, it can be lifesaving.

Usually recommended when a long-term illness or emergency breathing problem cause the need for support with plastic breathing tubes, the Trach tube can be a better tool for management of the breathing passages. The endotracheal tube often seen in television shows and commonly used in surgery and in the Intensive Care setting, is a helpful tool that allows doctors and nurses to blow air in and out of the lungs. In most cases this is easier than the old Iron Lung machines used in the days of Polio epidemics. The endotracheal tube is placed into the trachea through the voicebox. Since it passes out the mouth, it is somewhat uncomfortable for the patient. In Intensive Care settings, the need for breathing machine support may be longer than a few hours as in surgery, and may, in some cases last for weeks. If a tube is to be left for more than a few days, it may be wisest to consider a tracheotomy placement.

The tracheotomy tube is usually placed through an operative incision in the neck and also through a hole created in the windpipe. There are many types of tubes that can be useful and they come in many sizes. The proper initial fitting of a tracheotomy tube allows removal of the tube in the mouth and throat without interrupting the support given by the breathing machine.

In most cases, the procedure is done under brief local and general anesthesia in the operating theatre of a hospital. Only in rare circumstances is the procedure performed at the bedside or in an emergency setting.

After a few days, the neck skin and muscles around the Trach tube should heal and the initial tube may be exchanged for another type of tube. There are tubes with balloon cuffs to hold pressure, and there are tubes with special channels for assisting with speech. With the special speech tubes, the patient can still breathe through the speaking tracheotomy tube, but can exhale air past the tube through the voicebox to make sounds and speak.

There are a few times when a tracheotomy is unwise, but in most cases, when the doctor suggests a Trach, it is best to push ahead for improved airway support, and for patient comfort. In most tracheotomy cases, the tube is ultimately removed after the patient has recovered and is able to breathe without support again. In some cases, the problem may be with the voicebox or with the trachea below the voicebox. In these special cases, the tube may need to remain in place for an extended period. Many types of tracheotomy tubes have inside and outside tubes to allow for removal of secretions and plugs by briefly removing the inside tube for cleaning prior to replacement. In some cases, special T-tubes may be used to keep the trachea from collapsing. Other types of tracheotomy tubes only pass through the skin and muscles and have little tabs to hold them in place just inside the front wall of the windpipe without having a tube passing down into the airway.

As with all operations, the procedure has the risk of possible problems associated with it. The opposing problem is that the endotracheal tubes may also cause complications if left in for an extended time. In this situation, the tracheotomy tube may actually be less risky than leaving the other tubes in place. This is why they are often recommended in long term Intensive Care settings. Tracheotomy in children is also a significant problem and requires very careful attention to special care and preventive cleaning.

Some patients leave the hospital while continuing to wear a tracheotomy. In paralyzed patients who have brain or spinal cord injuries like SUPERMAN, Christopher Reeve, the tracheotomy may be a permanent tool to provide an open breathing passage without taking out the voicebox in a style used for cancer patients.
Ask the nurse if you have questions about the benefits of tracheotomy. She will help you find answers and share your concerns with the doctors.
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