1. Tracheostomy

2. Indication Airway obstruction Ventilation support Pulmonary toilet
Elimination of dead space
Airway protection

3. Function of a tracheostomy
1.Decreasing dead space in tracheobronchial tree
2.Reduction of resistance to airflow – effective alveolar ventilation
3.Protection against aspiration
4.Enables swallowing without reflex apnea
5.Access to the trachea for cleaning
6.Decreasing the power of the cough

4. Techniques
Preoperative management
Preparation
Position
Anesthesia

5. Operation technique
The skin of anterior neck and chest is prepared and the neck draped
The cricoid cartilage should be located by palpation
Horizontal or vertical incision is made approximately 1 FB below the cricoid cartilage in adult and 1 CM. above sternum in children
The midline is identified and the strap muscles are separated and retracted laterally
The thyroid can usually be reflected superiorly to allow access to the trachea
Bleeding is contrlled before opening the airway
Tracheal incision : inverted U shape for adult (2nd -3rd)
Stay suture of 2-0 silk inserted on either side of the incision provides traction force
Tracheostomy tube is inserted under directed visualization
Ties should be applied around the neck , tight enough to admit a finger and no more

6. Choice of tube Age Size of trachea and tracheostomy tube
Type of tube : metal , plastic
Cuff or no cuff

7. Complications of tracheostomy
1.Operative complication
Hemorrhage
Pneumothorax and pneumomediastinum
Subcutaneous emphysema
Failure to obtain an airway
Accidental decannulation , improper position of tube
Tracheoesophageal fistula
Pulmonary edema
Recurrent laryngeal nerve paralysis
High tracheostomy

8. 2. Delayed complications
hemorrhage (innominate artery erosion)
Tracheoesophageal fistula (following decannulation)
laryngotracheal lesion
aspiration
Tracheocutaneous fistula
Displacement or obstruction of a tube and cuff
Atelectasis and pulmonary infection
Cosmesis

9. Postoperative care CXR : tube and complication Humidification
Pulmonary toilet : suction , clean inner tube 1-2 hr.
Prevention of infection
Maintenance of airway ; hr.
Decannulation