|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
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.