Tracheostomy and Trachea Intubation

Zeng Quan

Department of Otolaryngology
The First Affiliated Hospital
Chongqing Medical University
 ”What is“Tracheostomy

• Tracheostomy is an operative
procedure that creates a surgical
airway in the cervical trachea .
 Anatomical Relations of Trachea

• Major blood vessels

(carotis, innominate a.,
jugular veins)
• Thyroid gland
• Esophagus
• Larynx
• Nerves (Rec.Laryngeal)
• Cervical spine
 Tracheostomy
Relative anatomy
 Tracheostomy Indications

•Respiratory obstruction
•Retained secretions
•Respiratory insufficiency
Tracheostomy Indications
Respiratory obstruction

•Infections
•Foreign body larynx
•Trauma
•Congenital anomalies
•Tumors
•Bilateral vocal cord paralysis
 Tracheotomy Indications
Retained secretions

•Inability to cough
•Painful cough
•Aspiration of pharyngeal
secretions
 Tracheostomy Indications
Respiratory insufficiency

•Chronic lung conditions

•Conditions listed above
 Types of Tracheostomy

•Emergency tracheostomy
•Elective tracheostomy
•Permanent tracheostomy
Emergency tracheostomy
Elective tracheostomy
Permanent tracheostomy
 Surgical techniques

•Open procedure
Position
Anaesthesia
 Complications
immediate
• Apnea
• Bleeding
• Pneumothorax or pneumomediastinum
• Injury to recurrent laryngeal nerves
• Injury to oesophagus
• Aspiration of blood
 Complications
early
• Early bleeding:
This is usually the result of increased blood pressure
as the patient emerges from anesthesia and begins to
cough.
• Blocking of tube
• Tracheitis
• Tube displacement
• Subcutaneous emphysema
• Local wound infection and granulations
 Complications
late
• Bleeding
• Stenosis
• Tracheoesophageal fistula
• Tracheocutaneous fistula
• Scarring
• Failure to decannulate
 Tracheostomy care

• Suctioning • Not aggressive and not too much

deep
• Skin care • To prevent irritation and
secondary inflammation due to
discharge
• Inner tube
• Once or more daily remove and
care
clean.
Tracheotomy care
•
 Tracheostomy care

• Humidification • “Artificial nose”

• Tube position • To prevent decubitus of

trachea

• Not to cover with blanket!

 TYPES OF TRACHEOSTOMY
TUBES

• CUFLESS TUBES

• CUFFED TUBES
Eating with tracheostomy
 Decanulation
?when
• Resolution of pathology that necessitated
the tracheostomy (upper airway obstruction,
pneumonia)
• Normal protective laryngeal mechanisms
(no aspirations during normal swallowing,
good coughing)
• No planed further interventions
(radiotherapy, H&N operations)
• No mechanical ventilation
 Trachea Intubation

.This is the most rapid method

Larynx is visualised with a larynoscope and

.endotracheal tube inserted

.This helps to avoid a hurried tracheostomy

Cricothyrotomy

This is a procedure
for opening the
airway through the
cricothyroid
.membrane
Thank you