Tracheostomy is performed for patients who needs ventilator for an extended period usually for more than one or two weeks. Surgical tracheostomy creates a hole on the lower neck and into your trachea or windpipe. This performed in an operating room under general anesthesia. A horizontal incision is made through the skin a the lower part of the neck. The muscle over the trachea are separated and the thyroid glad is moved superiorly away from the trachea. Then we make an incision on the windpipe and place the tracheostomy tube. A tracheostomy tube is temporarily stitched to the neck and a strap is placed around the neck to secure the tube.
Tracheostomy is a safe procedure with very few risks. The short term risks of the operation are bleeding, infection, injury to the trachea, subcutaneous emphysema or air trapped underneath the skin, and pneumothorax or air between the chest wall and the lung. Rare injury to the recurrent laryngeal nerve which controls the vocal cord that helps you to speak. Long term risks are the narrowing of the trachea, granulation tissue forming in the trachea, obstruction or displacement of the tracheostomy tube. Even rarer cases are development of a fistula between the airway and the esophagus or the blood vessel.
After the tracheostomy placement, the endotracheal tube is removed and the sedation can be significantly reduced. You will spend several days in the hospital as your body heals. A nurse will teach you how to clean and change your tracheostomy tube. Once you are weened off of the ventilator, you will work with a speech therapist to learn how to speak and to eat. You will use a special device and techniques to learn how to speak.
Long Term Outcome
Most of the time, a tracheostomy is a temporary tube. It is used as alternative breathing route until other medical issues are resolved. The tube is usually downsized and eventually removed. The hole will eventually shut on its own.