Tracheostomy is the name both of a surgically created opening between the trachea (or windpipe) and the skin, and of the surgery to create it.
Tracheostomies can be necessary for several different reasons:
- the patient may have an upper airway obstruction that makes it impossible to pass an endotracheal tube into his lungs
- the patient may have been intubated for a long period, and will have to stay that way for awhile
- the patient may have had surgery (laryngectomy, for example) that obliterates the connection between the trachea and the oropharynx
When patients receive tracheostomies because of respiratory conditions, they are generally on the ventilator. The ventilator connects to a small plastic tube with an inflatable balloon cuff close to the end. This tube is inserted into the tracheostomy, and the balloon is inflated just enough to stop air from escaping around it. The ventilator can then deliver a set volume of air at a set rate, replacing the patient's natural breathing (or supplementing it).
After the patient recovers and is taken off the ventilator, they can still breathe through the tracheostomy. If their natural airway is intact and useable, the stoma may be capped off, allowing air to pass through the nose and mouth, and allowing the person to speak.
Tracheostomies are not necessarily permanent; once the patient recovers, and their airway is healed, the tracheostomy may be allowed to close. In some cases this is not possible, and the patient has a permanent hole, or stoma, in the little dip at the top of his sternum, at the base of his neck.
Tracheostomy (the surgery) differs from tracheotomy in that tracheotomy is generally an emergency procedure, used when there is no other way to establish an airway, and not intended to be long-term, and tends to be a cricothyroidotomy. The terms may, however, be used interchangeably.