Tracheostomy is a surgical technique that relies on an incision in the front of the neck, more specifically the trachea. It serves to allow airflow to the lungs.
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What is a tracheostomy?
As we have said, tracheotomy is a surgical procedure that consists of making a cut in the front part of the necktag. At this point, it is necessary to point out that there is a very evident terminological discrepancy regarding the concept in the different languages. En español, tracheotomy or tracheostomy are used interchangeably, as they refer to an incision in the neck and subsequent intubation. On the other hand, in Spanish, tracheotomy is an incision in the trachea that is made to obtain tissue samples or treat local injuries, but it is closed after the procedure.
If we want to refer to posterior intubation, in Spanish the most correct thing is to speak of tracheostomy. While tracheostomy is used to detect cancers and other conditions that affect the tracheal area by obtaining tissue samples, tracheostomy indicates the creation of a tracheostomy (a surgically created hole to communicate the trachea with the skin) and the formation of a new air intake.
For informative purposes (and because surely your reason for searching is tracheostomy), we will treat both terms interchangeably. In any case, keep in mind that, if a tracheotomy is indicated in a medical procedure,it consists of an incision with subsequent closure, always within the operating roomtag. Bearing this in mind, it can be noted that the general procedure is performed for 4 different reasons:
- Because an emergency upper airway access area is required.
- To allow air flow during prolonged mechanical ventilation processes (respirators for more than two weeks).
- To bypass a mechanical obstruction in any part of the upper airways.
- Due to an inability to expectorate tracheobronchial secretions.
Types of tracheostomy
As we have already mentioned, in this procedure an incision is made in the neck, a hole is created that puts the trachea in direct contact with the skin with a continuity of mucosa(tracheostoma) and, subsequently, a tracheostomy tube is inserted with an appropriate size cuff. The latter is adjustable, so that there is no space between the walls of the trachea and the tube. Thus, infectious events and other derived pathologies are avoided.
In addition, it should be noted that tracheostomy can be divided into two large blocks: emergency or elective. Although the outcome is more or less similar, it is very important for medical professionals (and the patient) to take into account the premeditation of the event. An emergency tracheotomy is performed directly because the patient cannot breathe and is at risk of dying, while an elective tracheostomy is considered in preoperative scenarios or prior to cancer treatment.
Depending on the type of procedure to be performed, there are also two variants. However,both require similar anesthesia, analgesia, positioning, and sterilizationtag. We tell you its particularities in the following lines.
1. Open Surgery Tracheostomy
After the appropriate preparations, a horizontal or vertical incision (about three centimeters) is made between the sternal notch and the thyroid cartilagetag. Once the epidermal barrier and the platysma muscle have been overcome, the hyoid muscles must be separated to reach the trachea. Adjacent blood vessels can bleed a lot during the procedure, so cauterizing them with electrical devices is recommended.
Once hemostatic equilibrium has been reached and the trachea is uncovered, a vertical or transverse cut is made at the desired level and the previously described tracheostomy tube is inserted. Using the sleeve of the contraption, it is necessary to modulate the size and layout of the tube, so that the distance between the skin and the tube is minimal. This allows proper ventilation and prevents involuntary aspirations and infections in the upper respiratory tract.
2. Percutaneous tracheostomy
It is a variant that has gained strength in recent years, since it is a much less invasive process thanOpen surgery. In this case, a flexible wire pathway is inserted between the cricoid cartilage and the first tracheal cartilage (or between the first and second tracheal cartilage), through a needle that connects to the trachea through a cut 1 to 2 centimeters wide. diameter.
The main difference with open surgery tracheostomy is that, in this case, the opening created is gradually dilated through the established wire guide. The diameter of the hole can be modulated, hence it can be calculated very accurately so that the breathing cannula enters perfectly.
When is a tracheostomy necessary?
As we have said, tracheostomy conceived as a procedure for opening and immediately closing the trachea is used, above all, to obtain biopsies of tumor masses in the tracheal areatag. It is also necessary to remove foreign bodies that have become stuck and treat local injuries. Again, it can be raised urgently or in advance.
On the other hand, tracheostomy (what we have been describing so far) is performed as an emergency, basically, when the patient cannot breathe and an air inlet route is needed immediately before considering any other type of approach. Epiglottitis (inflammation of the epiglottis), laryngeal edema, laryngeal stenosis, severe congenital malformations, head injuries, vocal cord paralysis and other critical events may require an emergency tracheostomy.
Beyond borderline events, a tracheostomy may also Be considered for patients with upper airway cancersor those who will require continued assisted ventilation. In this case, the approach is carried out more calmly, the person can become familiar with what is going to happen and a series of keys and prior guidelines will be given. As it is not such a hasty procedure, the chances of something going wrong are much lower.
In addition, it should be noted that the tracheostomy (opening) can be closed in many ways when the patient is breathing well again or, failing that, allow it to be present at all times, always cleaning and changing the tracheostomy tube to avoid infections.
Summary
As you have seen, tracheotomy is a surgical operation that, in extreme situations, can mean the difference between life and death. It is estimated that a human being can remain alive for 2 to 3 minutes without taking a full breath, so in the most severe cases, a few seconds and medical efficacy can save lives.
If you have questions about any of these medical approaches, we recommend that you consult all relevant information with a health professional. We have presented the general steps of a tracheostomy and a tracheostomy, but a patient with an inserted cannula must take into account a series of daily care and routines that only a doctor can indicate.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.