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Tracheostomy

With a tracheostomy, respiratory support is provided through the connection of air from ventilator to a tracheomstomy cannula. A tracheostomy cannula is a plastic tube which passes through a hole in the throat and enters into the trachea. Ventilation provided by this techinique is called invasive mechanical ventilation therapy, as opposed to non-invasive therapy, e.g., mask therapy.

Illustration of how tracheostomy works

Indications

Why do some people need a tracheostomy (invasive treatment) and when should it be performed?

  1. When mechanical respiratory support is needed almost around the clock:

    Some types of respiratory failure increase the need for respiratory support. When ventilatory support is critical, mask therapy could be less safe ande even more cumbersome than invasive treatment. Choices depend on individual preferences. To some patients 24/7 nonivasive treatment is preferable, but others may prefer a tracheostomy even when ventilatory support is required for more than 16 hours during a 24-hour period. Advantages and disadvantages need to be discussed with each patient.

  2. With weakening of the upper airway muscles:

    The upper airway muscles of some patientse may be weakened, causing problems with swallowing and keeping the airways open or free/ protected from aspiration. Mucus and residual food could enter into the trachea and lungs with the subsequent risk of breathing problems and pneumonia. Weakened upper airway muscles can also lead to airway collapse, especially when sleeping. If these problems cannot be solved in any other way and mask therapy is difficult, a tracheostomy could be a potential solution.

  3. Problems with mucus clearance:

    Some experience an increased problem with mucus in the airways, This could be caused by reduced ability to cough effectively, problems with swallowing or more proneness to mucus production due to a lung disease. If these problems cannot be solved in any other way and mask therapy is difficult, a tracheostomy could be a potential solution.

  4. When mask therapy is inefficient:

    If a user has persistent hypoventilation despite optimal mask therapy, a tracheostomy could provide improved ventilation.

Advantages of a tracheostomy

  • Can be life-saving.
  • Can give a better quality of life than mask therapy in some cases.
  • No face mask is required.
  • Less problems with leakage.
  • Direct entry of air to the trachea and lungs:
    • Mucus can be removed more easily.
    • Safe and easy to ventilate patient.

Disadvantages of a tracheostomy

  • Increased risk of infection, haemorrhaging and scar tissue.
  • Natural humidification, heating and filtering of air is lost.
  • Invasive surgery is required.
  • One has to live with a ‘hole in the throat’.
  • The ability to swallow and speak may deteriorate.
  • The ability to taste and smell can change.
  • Caregivers require more training.
  • More technical equipment is needed.

About training and preparedness at work

An assistant’s story: Cassandra

Readiness at the job – text version

So then I asked Øyvind and the other assistants “What do I do if the power goes off? You know that the respirators run on electricity. That you have some back-up knowledge, so that if something happens you know that you’ve done what you should and that you had the knowledge necessary for that particular situation. If something critical happens, at least you know that you’ve done your part, that you’ve done your best. And are not left with a bad feeling of “I should have done this”, “I should have known that”. So our training has been very broad but also good, you feel secure. Most respirators have a back-up battery, and if not, we can get the respirator from the charged chair to the bed or in any case move them. If none of the respirators work we have to put a bag next to and squeeze. We have done this in training. We have both squeezed as often it needs to be squeezed per minute and tried to squeeze on their breathing hole. We have two bags so it’s one for each and then we must call so they can come with an emergency generator from the hospital. If something happens, putting their life in risk, we must be able to intervene. And I haven’t been formally trained in any way, but still I feel that I can be alone at work and feel safe that I can do what’s necessary. And that the boys feel secure with me that’s also extremely important. It’s absolutely necessary that we have such a safety net for me to feel secure, because there are things, f.ex. if they get anxious. Maybe they don’t want to talk to me about those things, maybe they don’t want to tell their inner thoughts to the assistants the must see every day. It’s very nice to be able to help them call someone so that they can talk to a priest, or a good friend or whoever they wish. Or if the power goes off and you now that they will bring a generator so we don’t have to keep pumping for 7 hours until the power comes back. That there is someone who can help you, I’m not a doctor, I can’t do medical interventions So it’s very nice that someone can do it that they are easily available.