Tracheostomy

I saw a patient with a tracheostomy in an Acute Stroke Unit during my placement. She is very exhausted with the trachy inserted. She couldn't talk, she coughs a lot with a lot of sputum inside her throat.

This lady had a stroke which causes respiratory failure, the inserted trachy is required to provide a path of low resistance for air exchange as a result of this emergency accident.

WHAT IS TRACHEOSTOMY?

A tracheostomy is a surgical procedure where the surgeon creates an opening in the neck at the front of the windpipe (trachea).

A tube is inserted into the opening and connected to an oxygen supply to assist with breathing.

Fluid that has built up in the throat and windpipe can also be removed through the opening.

In fact, besides stroke patients who have respiratory failure, there are many patients who also need a tracheostomy.

WHY A TRACHEOSTOMY IS NECESSARY

A tracheostomy is usually performed:

· to deliver oxygen to the lungs when a person is unable to breathe normally – the loss of normal lung function is called respiratory failure

· to bypass an airway that has become blocked

· to remove fluid that has built up in the upper airway, particularly in the throat and windpipe (trachea)

RESPIRATORY FAILURE

There are many conditions that can lead to respiratory failure and the need for a tracheostomy. Examples are:

· being unconscious or in a coma as a result of a severe head injury, drug overdose or accidental poisoning

· brain damage caused by a stroke or a severe head injury

· paralysis (an inability to move one or more muscles) after a serious neck or spinal injury

· a condition that causes extensive damage to the lungs, such as pneumonia or cystic fibrosis (where the lungs become clogged up with mucus)

· a condition that causes progressive damage to the nervous system, such as motor neurone disease or Guillain-Barré syndrome (both conditions can lead to paralysis and breathing difficulties)

BLOCKAGE

The airways can become blocked due to:

· accidentally swallowing something that gets stuck in the windpipe, such as a piece of bone

· an injury, infection, burns or a severe allergic reaction (anaphylaxis) that causes the throat to become swollen and narrowed

· a cancerous tumour that blocks one or more airways – this can sometimes happen with mouth cancer, laryngeal canceror thyroid gland cancer

In addition, some children are born with birth defects that cause one or more of their airways to be abnormally narrow.

FLUID

There are several factors that can cause fluid to build up inside the airways and lungs, resulting in breathing difficulties. There is also a danger that the fluid could become infected.

In some circumstances, it may be necessary to carry out a tracheostomy so the fluid can be sucked out through the tracheostomy tube. This may be necessary when the person:

· is unable to cough properly due to chronic pain, muscle weakness or paralysis

· has a serious lung infection, such as pneumonia, that has caused their lungs to become clogged with fluid

· has an injury that has resulted in their airways or lungs becoming filled with blood