Tracheotomy

At my word Tracheotomy Many people have bad images before their eyes: Accidents, emergency doctors fighting for the victim's life and finally saving him by opening his windpipe. This may sound dramatic, but according to the medical definition, it is not a tracheal incision, but a cricothyrotomy.

What is a tracheotomy?

A Tracheotomy or Tracheotomy is used in medicine when a person cannot or should not use their upper airways for a long time.

This can be a temporary and provisional procedure, such as percutaneous puncture and dilatation tracheotomy, or a permanent measure, for example if the larynx has to be removed.

The puncture tracheotomy is also used in intensive care units as an alternative to intubation, i.e. ventilation with a tube that is inserted through the mouth or nose.

Function, effect & goals

If patients fall into a coma after an accident or have to be placed in an artificial coma, artificial respiration may also be necessary. If this is necessary for a long time, then the puncture tracheotomy offers several advantages.

The trachea is punctured with a hollow needle in order to insert a breathing cannula later. The surgical tracheotomy, in which parts of the thyroid gland are also cut off, is more complex. This measure is designed for a longer period of time, which also means that the tracheostomy tube has to be changed over and over again. This kind of Tracheotomy is placed when, for example, the upper airways are blocked. The causes for this can be very different and range from an insect bite to infectious diseases to tumor formation. Parkinson's disease can also weaken the breathing muscles so much that a tracheotomy is necessary.

In most cases, this type of tracheal incision is still reversible. It depends on how long it takes for the person to get well again. After successful therapy, the windpipe is closed again and the patient can speak normally again. This is no longer possible with a tracheotomy caused by a larynx removal. The vocal cords are completely absent and have to be replaced with prostheses. The procedure is then no longer called a tracheostomy but a tracheostomy. This intervention is irreversible. The patient has to learn to speak again.

Tracheotomy offers several advantages over intubation. The tube that goes through the mouth can damage the vocal cords and windpipe. This risk is eliminated when cutting the trachea. Above all, however, the patient can eat normally or brush his teeth, which is absolutely impossible with a tube in the mouth and throat. Less pain medication also has to be used. With a special essay it is even possible for the patient to speak.

Another important point is to shorten the so-called dead space, i.e. the area between the entry of air into the body and the reaching of the lungs. With a tracheal incision, this distance is roughly halved. In reality, this means that the effort required to breathe is no longer as high. So the patient breathes more easily. This plays a role if the patient was previously connected to a ventilator and has to get used to breathing again.

Risks & dangers

With all the advantages, there are also some disadvantages to be aware of. Because all breathing no longer runs through the head, the necessary moistening of the nose is also missing. This has the unpleasant side effect that the ability to smell is no longer there. The smell, however, is very much related to the taste.

That is, people with a tracheotomy will not be able to smell. They can still taste good, but that is only possible to a very limited extent. The air that flows through the throat is also extremely important for something else: for speaking.

After all, it is the air that makes the vocal cords vibrate. If a person breathes through an incision in the trachea, no more air can get past the vocal cords. The problem can be solved with a so-called speaking cannula.