Tracheostomy is a surgical procedure that consists of opening the anterior wall of the trachea, creating communication with the external environment and opening the airway.
Tracheostomy is used, essentially, in situations where there is obstruction of the upper airway, accumulation of tracheal secretion, weakness of the respiratory musculature or to provide a stable airway in people with prolonged tracheal intubation.
Classification of Tracheostomies
Tracheostomy, as it is didactically classified according to the objective it proposes, namely regarding its purpose, the appropriate time to perform it and the length of stay.
As for the purpose , they can be classified in:
- Preventive: Complement other surgical or endoscopic procedures that may cause airway obstruction or breathing difficulties;
- Curative: Situations where it ensures the maintenance of the airway, as in laryngeal obstructions due to neoplasms, laryngotracheal strictures or infectious processes that cause glottis edema;
- Palliative: Used in terminally ill patients, with no possibility of treatment, with the aim of promoting respiratory comfort.
As for the adequate time to be performed, the tracheostomy can be:
- Urgent: When the patient needs rapid surgical intervention, due to respiratory failure, as in asphyxiation by a glottal foreign body;
- Elective: Performed on patients with controlled airways, already intubated.
Regarding the length of stay, the tracheostomy can be:
- Temporary: Those that in a short time are closed;
- Definitive: They become the route of permanent ventilation, as with total laryngectomized patients.
Indications for Tracheostomy
The primary purpose of tracheostomy is to serve as an artificial and safe alternative for the passage of air. The indications for performing the tracheostomy are:
- Allow mechanical ventilation in prolonged orotracheal intubations;
- How to maneuver to clear an airway obstruction;
- Allow lung hygiene, including individuals with laryngotracheal aspiration;
- Allow ventilation in patients with respiratory muscle weakness by decreasing dead space.
The most eminent indication for tracheostomy is airway obstruction , where several situations must be considered:
- Inflammatory processes of the upper airway (diphtheria, infectious epiglottitis, anaphylactic shock, burns of the cervicofacial region);
- Large tumors involving the pharynx, larynx, trachea and esophagus, which obstruct airflow;
- Craniomaxillofacial injuries;
- Laryngotracheal injuries (with airway edema or cervical emphysema);
- Congenital anomalies with obstruction of the larynx or trachea (hemangiomas, lymphangiomas, laryngomalacea, genetic syndromes);
- Extrinsic compressions of cervical tumors or vascular lesions (goiters, abscesses, hematomas, benign cervical tumors);
- Bilateral paralysis of vocal folds;
- Laryngotracheal strictures;
- Laryngeal foreign bodies;
- Ingestion and aspiration of caustic or acidic chemical agents.