Tracheostomy

A tracheostomy is a type of artificial airway consisting of a small, plastic tube that’s inserted through a surgically created opening, or stoma, in the anterior neck, known as a tracheotomy.

Typically, a tracheostomy is placed when a patient can’t keep their own airway open. It can be placed urgently when intubation by other means isn’t possible, or as a planned procedure, if the patient requires long-term airway assistance.

Now, patients with a tracheostomy typically have a short tube that protrudes from the anterior of their neck, which is usually stabilized with a flange and ties that encircle the neck. Many tracheostomy tubes have an outer cannula, which keeps the airway patent, and an inner cannula, which can be disposable or non-disposable and is removed for cleaning.

The tube may or may not be connected to a mechanical ventilator or another source of oxygen; and depending on the type of tracheostomy tube your patient has, they may or may not be able to talk.

Okay, so tracheostomy tubes come in various sizes and configurations. First, tubes can be cuffed, meaning there is a balloon that can be inflated to provide a leak-proof connection; or uncuffed, where there is no balloon.

Cuffed tubes are usually used short-term because they occlude the upper trachea and pharynx, and the pressure exerted can compress tracheal capillaries, limit blood flow, and predispose the patient to tracheal necrosis. On the other hand, uncuffed tubes are used for patients with long-term tracheostomies to decrease the risk to surrounding tissues.

It’s also important to note that tracheostomy tubes can be fenestrated or non-fenestrated. A fenestrated tube has a hole on its dorsal surface, which helps promote spontaneous breathing.

When patients have a cuffed, fenestrated tracheostomy tube, the cuff can be deflated and inner cannula removed. This allows air to pass from their lungs through the opening in the tube, enabling them to breathe spontaneously and speak.