TRACHEOSTOMY_COMPLETE GUIDE

Posted by e-Medical PPT
Tracheostomy is one of the oldest surgical procedures.
A tracheotomy was portrayed on Egyptian tablets dated back to 3600 BC.
Asclepiades of Persia is credited as the first person to perform a tracheotomy in 100 BC.
The first successful tracheostomy was performed by Brasovala in the 15th century.

Tracheostomy History and indications
1932 prevent pulmonary infection in neurologically impair patients secondary to infections (poliomyelitis).
1943 remove bronchial secretions in cases of myasthenia gravis and tetanus.
1951 reduce the volume of dead space, use in COPD and severe penumonia.
1950 positive pressure through tracheostomy for patients with poliomyelitis.
1955 obstruction secondary to infection: diphteria, Ludwig’s angina.
1961 Obstructions secondary to tumour, infectious disease and trauma.

The Lindholm Scale of Laryngotracheal Damage
Grade I erythema and edema without ulceration Grade II superficial ulceration of the mucosa <1/3 airway circumference Grade III continuous deep ulceration <1/3 airway circumference or superficial ulceration >1/3 airway circumference Grade IV deep ulceration with exposed cartilage.

TRACHEOSTOMY VS TRANSLARYNGEAL INTUBATION
Increased patient mobility
More secure airway
Increased comfort
Improved airway suctioning
Early transfer of ventilator-dependent patients from the intensive care unit (ICU)
Less direct endolaryngeal injury
Enhanced oral nutrition
Enhanced phonation and communication
Decreased airway resistance for promoting weaning from mechanical ventilation
Decreased risk for nosocomial pneumonia in patient subgroups

TRACHEOSTOMY TUBE CARE
Securing tracheostomy around patient’s neck.

Tube changes:
Indications: soiled, cuff rupture.
Complications: insertion into a false passage bleeding, and patient discomfort.
Avoid within 1st week.
First tube change by surgeon.
Difficult cases (obese, short and thick neck), be prepared for endotracheal intubation.

Tracheostomy tube cuff pressures in a range of 20 to 25 mm Hg.
Overly low cuff pressures < 18 mm Hg, may cause the cuff to develop longitudinal folds, promote microaspiration of secretions collected above the cuff, and increase the risk for nosocomial pneumonia.
Excessively high cuff pressures above 25 to 35 mm Hg exceed capillary perfusion pressure and can result in compression of mucosal capillaries, which promotes mucosal ischemia and tracheal stenosis.
Cuff pressure should be measured with calibrated devices and recorded at least once every nursing shift and after every manipulation of the tracheostomy tube.

Chest Xray:
Cuff has a width greater than the caliber of the trachea, which suggests the presence of a hyperinflated cuff and tracheal overdistention

Humidification of the inspired gas is a standard of care for tracheostomized patients...

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