Array ( [0] => {{Short description|Temporary surgical incision to create an airway into the trachea}} [1] => {{For|a similar procedure|Cricothyrotomy}} [2] => {{Use dmy dates|date=September 2020}} [3] => {{Infobox medical intervention [4] => | Name = Tracheotomy [5] => | Image = Traqueostomia.png [6] => | Caption = Completed '''tracheotomy''':
[7] => 1 – [[Vocal folds]]
[8] => 2 – [[Thyroid cartilage]]
[9] => 3 – [[Cricoid cartilage]]
[10] => 4 – [[Tracheal rings]]
[11] => 5 – Balloon cuff [12] => | ICD10 = 0B110F4 [13] => | ICD9 = {{ICD9proc|31.1}} [14] => | MeshID = D014140 [15] => | MedlinePlus = 002955 [16] => | OtherCodes = [17] => }} [18] => [19] => '''Tracheotomy''' ({{IPAc-en|ˌ|t|r|eɪ|k|i|ˈ|ɒ|t|ə|m|i}}, {{small|UK also}} {{IPAc-en|ˌ|t|r|æ|k|i|-}}), or '''tracheostomy''', is a [[surgical airway management]] procedure which consists of making an incision (cut) on the [[anterior]] aspect (front) of the neck and opening a direct airway through an incision in the [[Vertebrate trachea|trachea]] (windpipe). The resulting [[Stoma (medicine)|stoma]] (hole) can serve independently as an [[airway]] or as a site for a [[tracheal tube]] or '''tracheostomy tube'''{{cite web|last1=Molnar|first1=Heather|title=Types of Tracheostomy Tubes|date=11 April 2023 |url=http://www.hopkinsmedicine.org/tracheostomy/about/types.html|language=en}} to be inserted; this tube allows a person to breathe without the use of the nose or mouth. [20] => [21] => ==Etymology and terminology== [22] => [[File:Tracheostomy NIH.jpg|frame|Figure A shows a side view of the neck and the correct placement of a tracheostomy tube in the trachea, or windpipe. Figure B shows an external view of a patient who has a tracheostomy.|alt=]] [23] => The [[etymology]] of the word ''tracheotomy'' comes from two [[Greek language|Greek]] words: the [[root (linguistics)|root]] ''tom-'' (from [[Ancient Greek|Greek]] τομή ''tomḗ'') meaning "to cut", and the word ''trachea'' (from Greek τραχεία ''tracheía'').{{cite web|author=Romaine F. Johnson |date=6 March 2003 |url=http://www.bcm.edu/oto/grand/03_06_03.htm |title=Adult Tracheostomy |publisher=Department of Otolaryngology–Head and Neck Surgery, [[Baylor College of Medicine]] |location=Houston, Texas |archive-url=https://web.archive.org/web/20080517073046/http://www.bcm.edu/oto/grand/03_06_03.htm |archive-date=17 May 2008 }} The word ''tracheostomy'', including the root ''stom-'' (from Greek στόμα ''stóma'') meaning "mouth", refers to the making of a semi-permanent or permanent opening and to the opening itself. Some sources offer different definitions of the above terms. Part of the ambiguity is due to the uncertainty of the intended permanence of the [[Stoma (medicine)|stoma]] (hole) at the time it is created.{{cite web|author1=Jonathan P Lindman |author2=Charles E Morgan |date=7 June 2010|url=http://emedicine.medscape.com/article/865068-overview|title=Tracheostomy|publisher=WebMD}} [24] => [25] => ==Indications== [26] => There are four main reasons why someone would receive a tracheotomy: [27] => [28] => # Emergency airway access [29] => # Airway access for prolonged mechanical ventilation [30] => # Functional or mechanical upper airway obstruction [31] => # Decreased/incompetent clearance of tracheobronchial secretions [32] => [33] => In the acute (short term) setting, indications for tracheotomy include such conditions as severe [[facial trauma]], tumors of the head and neck (e.g., [[Head and neck cancer|cancers]], [[branchial cleft cyst]]s), and acute [[angioedema]] and [[inflammation]] of the head and neck. In the context of failed [[tracheal intubation]], either tracheotomy or [[cricothyrotomy]] may be performed.{{citation needed|date=January 2022}} [34] => [35] => [[File:VIP Bird2.jpg|thumb|left|Tracheotomy tubes and [[endotracheal tube]]s are often attached to [[Medical ventilator|ventilator]]s to assist in breathing.]] [36] => In the chronic (long-term) setting, indications for tracheotomy include the need for long-term mechanical ventilation and [[Pulmonary toilet|tracheal toilet]] (e.g., [[coma]]tose patients, extensive surgery involving the head and neck). Tracheotomy may result in a significant reduction in the administration of [[sedative]]s and [[Antihypotensive agent|vasopressors]], as well as the duration of stay in the [[intensive care unit]] (ICU).{{cite thesis|last1=Eberhardt|first1=Lars Karl|title=Dilatational Tracheostomy on an Intensive Care Unit|date=2008|url=http://vts.uni-ulm.de/doc.asp?id=6821|publisher=Universität Ulm|type=Dissertation}} [37] => [38] => In extreme cases, the procedure may be indicated as a treatment for severe [[obstructive sleep apnea]] (OSA) seen in patients intolerant of [[continuous positive airway pressure]] (CPAP) therapy. The reason tracheostomy works well for OSA is because it is the ''only'' surgical procedure that completely bypasses the upper airway. This procedure was commonly performed for obstructive sleep apnea until the 1980s, when other procedures such as the [[uvulopalatopharyngoplasty]], [[genioglossus advancement]], and [[maxillomandibular advancement]] surgeries were described as alternative surgical modalities for OSA. [39] => [40] => If prolonged ventilation is required, tracheostomy is usually considered. The timing of this procedure is dependent on the clinical situation and an individual's preference. An international multicenter study in 2000 determined that the median time between starting mechanical ventilation and receiving a tracheostomy was 11 days.{{cite journal | vauthors = Esteban A, Anzueto A, Alía I, Gordo F, Apezteguía C, Pálizas F, Cide D, Goldwaser R, Soto L, Bugedo G, Rodrigo C, Pimentel J, Raimondi G, Tobin MJ | title = How is mechanical ventilation employed in the intensive care unit? An international utilization review | journal = American Journal of Respiratory and Critical Care Medicine | volume = 161 | issue = 5 | pages = 1450–8 | date = May 2000 | pmid = 10806138 | doi = 10.1164/ajrccm.161.5.9902018 }} Although the definition varies depending on hospital and provider, early tracheostomy can be considered to be less than 10 days (2 to 14 days) and late tracheostomy to be 10 days or more. [41] => [42] => ==Alternatives== [43] => [[Iron lung|Biphasic cuirass ventilation]] is a form of non-invasive mechanical ventilation that can — in a small subset of cases — allow people to avoid a tracheostomy.{{cite journal|last=Linton|first=DM|title=Cuirass ventilation: a review and update|journal=Critical Care and Resuscitation|volume=7|issue=1|pages=22–8|year=2005|doi=10.1016/S1441-2772(23)01566-1 |pmid=16548815|doi-access=free}} [44] => [45] => ==Components== [46] => [[Image:Tracheostomy tube.jpg|thumb|An outer cannula (top item) with inflatable cuff (top right), an inner cannula (center item) and an obturator (bottom item)]] [47] => A tracheostomy tube may be single or dual lumen, and also cuffed or uncuffed. A dual lumen tracheostomy tube consists of an outer cannula or main shaft, an inner cannula, and an obturator. The obturator is used when inserting the tracheostomy tube to guide the placement of the outer cannula and is removed once the outer cannula is in place. The outer cannula remains in place but, because of the buildup of secretions, there is an inner cannula that may be removed for cleaning after use or it may be replaced. Single-lumen tracheostomy tubes do not have a removable inner cannula, suitable for narrower airways. Cuffed tracheostomy tubes have inflatable balloons at the end of the tube to secure them in place. A tracheostomy tube may be fenestrated with one or several holes to let air through the [[larynx]], allowing speech.Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 1382–1383, 1404. [48] => [49] => Special tracheostomy tube valves (such as the Passy-Muir valve{{cite journal|vauthors= Passy V, Baydur A, Prentice W, Darnell-Neal R|title=Passy-Muir tracheostomy speaking valve on ventilator-dependent patients|journal=The Laryngoscope|volume=103|issue= 6|pages=653–8|year=1993|pmid=8502098|doi=10.1288/00005537-199306000-00013|s2cid=22397705}}) have been created to assist people in their speech. The patient can inhale through the unidirectional tube. Upon expiration, pressure causes the valve to close, redirecting air around the tube, past the vocal folds, producing sound.{{cite journal|vauthors=Cullen JH|title=An evaluation of tracheostomy in pulmonary emphysema|journal=Annals of Internal Medicine|volume=58|issue=6|pages=953–60|year=1963|pmid=14024192|doi=10.7326/0003-4819-58-6-953}} [50] => [51] => ==Surgical procedure== [52] => ===Open surgical tracheotomy (OST)=== [53] => The typical procedure done is the open surgical tracheotomy (OST) and is usually done in a sterile operating room. The optimal patient position involves a cushion under the shoulders to extend the neck. Commonly a transverse (horizontal) incision is made two fingerbreadths above the [[suprasternal notch]]. Alternatively, a vertical incision can be made in the midline of the neck from the thyroid cartilage to just above the suprasternal notch. Skin, subcutaneous tissue, and strap muscles (a specific group of neck muscles) are retracted aside to expose the thyroid isthmus, which can be cut or retracted upwards. After proper identification of the cricoid cartilage and placement of a tracheal hook to steady the trachea and pull it forward, the trachea is cut open, either through the space between cartilage rings or vertically across multiple rings (cruciate incision). Occasionally a section of a tracheal cartilage ring may be removed to make insertion of the tube easier. Once the incision is made, a properly sized tube is inserted. The tube is connected to a ventilator and adequate ventilation and oxygenation is confirmed. The tracheotomy apparatus is then attached to the neck with tracheotomy ties, skin sutures, or both.{{Cite book|title=CURRENT Diagnosis & Treatment in Otolaryngology—Head & Neck Surgery, 3e|last=Lalwani|first=Anil K.|publisher=McGraw-Hill|year=2012|isbn=978-0-07-162439-8|location=New York, NY|pages=Yu KY. Chapter 38. Airway Management & Tracheotomy}}{{Cite book|title=Zollinger's Atlas of Surgical Operations, 10th edition|last1=Ellison|first1=E. Christopher|last2=Zollinger, Jr|first2=Robert M.|publisher=McGraw-Hill|year=2016|isbn=978-0-07-179755-9|location=New York, NY|pages=Chapter 120- Tracheotomy, Chapter 121- Tracheotomy, Percutaneous Dilational}} [54] => [55] => ===Percutaneous dilatational tracheotomy (PDT)=== [56] => The first widely accepted percutaneous tracheotomy technique was described by Pat Ciaglia, a New York surgeon, in 1985.{{cite journal | vauthors = Ciaglia P, Firsching R, Syniec C | title = Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report | journal = Chest | volume = 87 | issue = 6 | pages = 715–9 | date = June 1985 | pmid = 3996056 | doi = 10.1378/chest.87.6.715 | s2cid = 27125996 }} The next widely used technique was developed in 1989 by [[Bill Griggs]], an Australian intensive care specialist.{{cite journal | vauthors = Griggs WM, Worthley LI, Gilligan JE, Thomas PD, Myburg JA | title = A simple percutaneous tracheostomy technique | journal = Surgery, Gynecology & Obstetrics | volume = 170 | issue = 6 | pages = 543–5 | date = June 1990 | pmid = 2343371 }} In 1995, Fantoni developed a translaryngeal approach of percutaneous tracheostomy.{{Cite web|url=http://www.translaryngealtracheostomyfantoni.it/|title=Translaryngeal Tracheostomy- TLT Fantoni method|website=www.translaryngealtracheostomyfantoni.it|access-date=2018-12-21|archive-date=11 September 2017|archive-url=https://web.archive.org/web/20170911163221/http://translaryngealtracheostomyfantoni.it/}} The Griggs and Ciaglia Blue Rhino techniques are the two main techniques in current use. A number of comparison studies have been undertaken between these two techniques with no clear differences emerging{{cite journal|vauthors=Ambesh SP, Pandey CK, Srivastava S, Agarwal A, Singh DK|date=December 2002|title=Percutaneous tracheostomy with single dilatation technique: a prospective, randomized comparison of Ciaglia blue rhino versus Griggs' guidewire dilating forceps|journal=Anesthesia and Analgesia|volume=95|issue=6|pages=1739–45, table of contents|doi=10.1097/00000539-200212000-00050|pmid=12456450|s2cid=22222451|doi-access=free}} An advantage of PDT over OST is the ability to perform the procedure at the patient's bedside. This significantly decreases costs and time/people-power needed for an operating room (OR) procedure. Contraindications for percutaneous tracheostomy include infection at the site of tracheostomy, uncontrolled bleeding disorder, unstable cardiopulmonary status, patient unable to stay still, abnormal anatomy of the tracheolaryngeal structures. [57] => [58] => ==Risks and complications== [59] => As with most other surgical procedures, some cases are more difficult than others. Surgery on children is more difficult because of their smaller size. Difficulties such as a short neck and bigger thyroid glands make the trachea hard to open.{{cite journal | vauthors = Rosen H | title = On enactment | journal = Journal of the American Psychoanalytic Association | volume = 40 | issue = 4 | pages = 1228–9 | date = January 1897 | pmid = 1430766| pmc = 1430766 | doi = 10.1097/00000441-189701000-00008 }} There are other difficulties with patients with irregular necks, the obese, and those with a large [[goitre]]. [60] => [61] => The many possible complications include [[hemorrhage]], loss of airway, [[subcutaneous emphysema]], wound infections, stomal cellulites, fracture of tracheal rings, poor placement of the tracheostomy tube, and [[bronchospasm]]. [62] => [63] => Early complications include infection, hemorrhage, [[pneumomediastinum]], [[pneumothorax]], [[tracheoesophageal fistula]], recurrent laryngeal nerve injury, and tube displacement. Delayed complications include [[Tracheoinnominate fistula|tracheal-innominate artery fistula]], [[tracheal stenosis]], delayed tracheoesophageal fistula, and tracheocutaneous fistula. [64] => [65] => A 2013 systematic review (published cases from 1985 to April 2013) studied the complications and risk factors of percutaneous dilatational tracheostomy (PDT), identifying major causes of fatality to be [[hemorrhage]] (38.0%), airway complications (29.6%), tracheal perforation (15.5%), and [[pneumothorax]] (5.6%){{cite journal | vauthors = Simon M, Metschke M, Braune SA, Püschel K, Kluge S | title = Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors | journal = Critical Care | volume = 17 | issue = 5 | pages = R258 | date = October 2013 | pmid = 24168826 | pmc = 4056379 | doi = 10.1186/cc13085 | doi-access = free }} A similar systematic review in 2017 (cases from 1990 to 2015) studying fatality in both open surgical tracheotomy (OST) and PDT identified similar rates of mortality and causes of death between the two techniques. [66] => [67] => [[Hemorrhage]] is rare, but the most likely cause of fatality after a tracheostomy. It usually occurs due to a [[Tracheoinnominate fistula|tracheoarterial fistula]], an abnormal connection between the trachea and nearby blood vessels, and most commonly manifests between 3 days to 6 weeks after the procedure is done. Fistulas can result from incorrectly positioned equipment, high cuff pressures causing pressure sores or mucosal damage, a low surgical trachea site, repetitive neck movement, radiotherapy, or prolonged intubation.{{cite journal | vauthors = Grant CA, Dempsey G, Harrison J, Jones T | title = Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review | journal = British Journal of Anaesthesia | volume = 96 | issue = 1 | pages = 127–31 | date = January 2006 | pmid = 16299043 | doi = 10.1093/bja/aei282 | doi-access = free }} [68] => [69] => A potential risk factor identified in a 2013 systematic review of the percutaneous technique was the lack of [[Bronchoscopy|bronchoscopic]] guidance. Use of the bronchoscope, an instrument inserted through a patient's mouth for internal visualization of the airway, can help with proper placement of instruments and better visualization of anatomical structures. However, this can also be dependent on the skills and familiarity of the surgeon with both the procedure and the patient's anatomy. [70] => [71] => There are a multitude of potential complications related to the airway. The main causes of mortality during PDT include dislodgment of the tube, loss of airway during procedure and misplacement of the tube. One of the more urgent complications include displacement or dislodgment of the tracheotomy tube, either spontaneously or during a tube change. Although uncommon (< 1/1000 tracheostomy tube days), the associated fatality is high due to the loss of airway.{{Cite journal|title=Tracheostomy tube displacement: An update on emergency airway management|last=Rajendram|journal=Indian Journal of Respiratory Care|volume=6|issue=2|pages=800–806|doi=10.4103/ijrc.ijrc_12_17|year=2017|doi-access=free}} Due to the seriousness of such a situation, individuals with a tracheotomy tube should consult with their healthcare providers to have a specific, written, emergency intubation and tracheostomy recannulation (reinsertion) plan prepared in advance. [72] => [73] => [[Laryngotracheal stenosis|Tracheal stenosis]], otherwise known as an abnormal narrowing of the airway, is a possible long term complication. The most common symptom of stenosis is gradually-worsening difficulty with breathing ([[dyspnea]]). However incidence is low, ranging from 0.6 to 2.8% with increased rates if major bleeding or wound infections are present. A 2016 systematic review identified a higher rate of tracheal stenosis in individuals who underwent a surgical tracheostomy, as compared to PDT, however the difference was not statistically significant.{{Cite journal|last1=Dempsey|first1=Ged A.|last2=Morton|first2=Ben|last3=Hammell|first3=Clare|last4=Williams|first4=Lisa T.|last5=Smith|first5=Catrin Tudur|last6=Jones|first6=Terence|date=2016-03-01|title=Long-term Outcome Following Tracheostomy in Critical Care: A Systematic Review*|journal=Critical Care Medicine|language=en|volume=44|issue=3|pages=617–628|doi=10.1097/CCM.0000000000001382|pmid=26584197|s2cid=32649464|issn=0090-3493}} [74] => [75] => A 2000 Spanish study of bedside percutaneous tracheostomy reported overall complication rates of 10–15% and a procedural mortality of 0%,{{cite journal | vauthors = Añón JM, Gómez V, Escuela MP, De Paz V, Solana LF, De La Casa RM, Pérez JC, Zeballos E, Navarro L | title = Percutaneous tracheostomy: comparison of Ciaglia and Griggs techniques | journal = Critical Care | volume = 4 | issue = 2 | pages = 124–8 | year = 2000 | pmid = 11056749 | pmc = 29040 | doi = 10.1186/cc667 | doi-access = free }} which is comparable to those of other series reported in the literature from the Netherlands{{cite journal | vauthors = van Heurn LW, van Geffen GJ, Brink PR | title = Clinical experience with percutaneous dilatational tracheostomy: report of 150 cases | journal = The European Journal of Surgery = Acta Chirurgica | volume = 162 | issue = 7 | pages = 531–5 | date = July 1996 | pmid = 8874159 }}{{cite journal | vauthors = Polderman KH, Spijkstra JJ, de Bree R, Christiaans HM, Gelissen HP, Wester JP, Girbes AR | title = Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication | journal = Chest | volume = 123 | issue = 5 | pages = 1595–602 | date = May 2003 | pmid = 12740279 | doi = 10.1378/chest.123.5.1595 }} and the United States.{{cite journal | vauthors = Hill BB, Zweng TN, Maley RH, Charash WE, Toursarkissian B, Kearney PA | title = Percutaneous dilational tracheostomy: report of 356 cases | journal = The Journal of Trauma | volume = 41 | issue = 2 | pages = 238–43; discussion 243–4 | date = August 1996 | pmid = 8760530 | doi = 10.1097/00005373-199608000-00007 }}{{cite journal | vauthors = Powell DM, Price PD, Forrest LA | title = Review of percutaneous tracheostomy | journal = The Laryngoscope | volume = 108 | issue = 2 | pages = 170–7 | date = February 1998 | pmid = 9473064 | doi = 10.1097/00005537-199802000-00004 | s2cid = 44972690 }} A 2013 systematic review calculated procedural mortality to be 0.17% or 1 in 600 cases. Multiple systematic reviews identified no significant difference in rates of mortality, major bleeding, or wound infection between the percutaneous or open surgical methods.{{cite journal | vauthors = Klemm E, Nowak AK | title = Tracheotomy-Related Deaths | journal = Deutsches Ärzteblatt International | volume = 114 | issue = 16 | pages = 273–279 | date = April 2017 | pmid = 28502311 | pmc = 5437259 | doi = 10.3238/arztebl.2017.0273 }} [76] => [77] => Specifically a 2017 systematic review calculated the most common causes of death and their frequencies, out of all tracheotomies, to be hemorrhage (OST: 0.26%, PDT: 0.19%), loss of airway (OST: 0.21%, PDT: 0.20%), and misplacement of tube (OST: 0.11%, PDT: 0.20%). [78] => [79] => A 2003 American cadaveric study identified multiple tracheal ring fractures with the Ciaglia Blue Rhino technique as a complication occurring in 100% of their small series of cases.{{cite journal | vauthors = Hotchkiss KS, McCaffrey JC | title = Laryngotracheal injury after percutaneous dilational tracheostomy in cadaver specimens | journal = The Laryngoscope | volume = 113 | issue = 1 | pages = 16–20 | date = January 2003 | pmid = 12514375 | doi = 10.1097/00005537-200301000-00003 | s2cid = 25597029 }} The comparative study above also identified ring fractures in 9 of 30 live patients while another small series identified ring fractures in 5 of their 20 patients.{{cite journal | vauthors = Byhahn C, Lischke V, Halbig S, Scheifler G, Westphal K | title = [Ciaglia blue rhino: a modified technique for percutaneous dilatation tracheostomy. Technique and early clinical results] | language = de | journal = Der Anaesthesist | volume = 49 | issue = 3 | pages = 202–6 | date = March 2000 | pmid = 10788989 | doi = 10.1007/s001010050815 | s2cid = 42582829 | trans-title = Ciaglia blue rhino: a modified technique for percutaneous dilatation tracheostomy. Technique and early clinical results }} The long term significance of tracheal ring fractures is unknown.{{citation needed|date=July 2014}} [80] => [81] => ==History== [82] => [[File:Tracheotomy1.jpg|thumb|alt=|A tracheostomy from prior to the 20th century]] [83] => [84] => ===Ancient history=== [85] => Tracheotomy was first potentially depicted on [[Egypt]]ian artifacts in 3600 BC.{{cite journal|author1=Steven E. Sittig|author2=James E. Pringnitz|title=Tracheostomy: evolution of an airway|journal=AARC Times|pages=48–51|date=February 2001|url=http://www.tracheostomy.com/resources/pdf/evolution.pdf|access-date=5 June 2008|archive-date=1 April 2017|archive-url=https://web.archive.org/web/20170401154951/http://www.tracheostomy.com/resources/pdf/evolution.pdf}} [[Hippocrates]] condemned the practice of tracheotomy as incurring an unacceptable risk of damage to the [[carotid artery]]. Warning against the possibility of death from inadvertent laceration of the carotid artery during tracheotomy, he instead advocated the practice of [[tracheal intubation]].{{cite journal | vauthors = Ferlito A, Rinaldo A, Shaha AR, Bradley PJ | title = Percutaneous tracheotomy | journal = Acta Oto-Laryngologica | volume = 123 | issue = 9 | pages = 1008–12 | date = December 2003 | pmid = 14710900 | doi = 10.1080/00016480310000485 | s2cid = 23470798 }} [86] => [87] => Despite the concerns of Hippocrates, it is believed that an early tracheotomy was performed by [[Asclepiades of Bithynia]], who lived in Rome around 100 BC.{{Cite journal|title=Hippocrates of Kos, the father of clinical medicine, and Asclepiades of Bithynia, the father of molecular medicine. Review|first=Christos|last=Yapijakis|date=4 July 2009|journal=In Vivo (Athens, Greece)|volume=23|issue=4|pages=507–514|pmid=19567383}} [[Galen]] and [[Aretaeus]], both of whom lived in Rome in the 2nd century AD, credit Asclepiades as being the first physician to perform a non-emergency tracheotomy. [[Antyllus]], another Roman-era Greek physician of the 2nd century AD, supported tracheotomy when treating oral diseases. He refined the technique to be more similar to that used in modern times, recommending that a [[Transverse plane|transverse]] incision be made between the third and fourth tracheal rings for the treatment of life-threatening airway obstruction. [88] => [89] => ===Medieval world=== [90] => The 7th century Byzantine physician [[Paul of Aegina]], an advocate of the procedure, acknowledged previous Greek authors' works on the subject of tracheotomies and provided descriptions of the procedure in his own works.{{cite book|page=3|title=Tracheotomy: Airway Management, Communication, and Swallowing, Second Edition|last=Myers|first=Eugene N.|isbn=978-1-59756-840-1|year=2007|publisher=Plural Publishing|author-link=Eugene Nicholas Myers}} In 1000, [[Albucasis|Abu al-Qasim al-Zahrawi]] (936–1013), an Arab who lived in [[Al-Andalus|Arabic Spain]], published the 30-volume ''[[Al-Tasrif|Kitab al-Tasrif]]'', the first illustrated work on surgery. He never performed a tracheotomy, but he did treat a slave girl who had cut her own throat in a suicide attempt. Al-Zahrawi (known to Europeans as ''Albucasis'') sewed up the wound and the girl recovered, thereby proving that an incision in the larynx could heal. Circa AD 1020, [[Avicenna]] (980–1037) described tracheal intubation in ''[[The Canon of Medicine]]'' in order to facilitate [[breathing]].{{cite book|author=Patricia Skinner|title=The Gale Encyclopedia of Alternative Medicine| veditors = Fundukian LJ |chapter=Unani-tibbi |publisher= [[Gale (publisher)|Gale Cengage]]|location=[[Farmington Hills, Michigan]]|edition=3rd|year=2008|isbn=978-1-4144-4872-5 |chapter-url= http://findarticles.com/p/articles/mi_g2603/is_0007/ai_2603000716/}} The first clear description of the tracheotomy operation for treating asphyxiation was given by [[Ibn Zuhr]] (1091–1161) in the 12th century. According to Mostafa Shehata, Ibn Zuhr (also known as Avenzoar) successfully practiced the tracheotomy procedure on a goat, justifying Galen's approval of the operation.{{cite journal|author=Mostafa Shehata|title=The Ear, Nose and Throat in Islamic Medicine|journal=Journal of the International Society for the History of Islamic Medicine|volume=2|issue=3|pages=2–5|date=April 2003|issn=1303-667X|url=http://www.ishim.net/ishimj/3/01.pdf}} [91] => [92] => ===16th–18th centuries=== [93] => [[File:Girolamo Fabrizi d'Acquapendente.jpg|thumb|[[Hieronymus Fabricius]] (1533–1619) was the first to introduce the idea of a tracheostomy tube]] [94] => The European [[Renaissance]] brought with it significant advances in all scientific fields, particularly surgery. Increased knowledge of anatomy was a major factor in these developments. Surgeons became increasingly open to experimental surgery on the trachea. During this period, many surgeons attempted to perform tracheotomies, for various reasons and with various methods. Many suggestions were put forward, but little actual progress was made toward making the procedure more successful. The tracheotomy remained a dangerous operation with a very low success rate,{{quantify|date=January 2012}} and many surgeons still considered the tracheotomy to be a useless and dangerous procedure. The high mortality rate{{quantify|date=January 2012}} for this operation, which had not improved, supported their position. From the period 1500 to 1832 there are only 28 known reports of tracheotomy.{{cite journal |first=E.W. |last=Goodall |title=The story of tracheostomy|journal=British Journal of Children's Diseases |volume=31 |pages=167–76, 253–72 |year=1934}} [95] => [96] => In 1543, [[Andreas Vesalius]] (1514–1564) wrote that tracheal intubation and subsequent [[artificial respiration]] could be life-saving. [[Antonio Musa Brassavola]] (1490–1554) of [[Ferrara]] treated a patient with [[peritonsillar abscess]] by tracheotomy after the patient had been refused by [[barber surgeon]]s. The patient apparently made a complete recovery, and Brassavola published his account in 1546. This operation has been identified as the first recorded successful tracheostomy, despite many ancient references to the trachea and possibly to its opening. [[Ambroise Paré]] (1510–1590) described suture of tracheal lacerations in the mid-16th century. One patient survived despite a concomitant injury to the internal jugular vein. Another sustained wounds to the trachea and esophagus and died. [97] => [98] => Towards the end of the 16th century, anatomist and surgeon [[Hieronymus Fabricius]] (1533–1619) described a useful technique for tracheotomy in his writings, although he had never actually performed the operation himself. He advised using a vertical incision and was the first to introduce the idea of a tracheostomy tube. This was a straight, short [[cannula]] that incorporated wings to prevent the tube from advancing too far into the trachea. He recommended the operation only as a last resort, to be used in cases of [[airway]] obstruction by [[Foreign body|foreign bodies]] or [[secretion]]s. Fabricius' description of the tracheotomy procedure is similar to that used today. [[Giulio Cesare Casseri]] (1552–1616) succeeded Fabricius as professor of anatomy at the University of Padua and published his own writings regarding technique and equipment for tracheotomy. Casseri recommended using a curved silver tube with several holes in it. [[Marco Aurelio Severino]] (1580–1656), a skillful surgeon and anatomist, performed multiple successful tracheotomies during a [[diphtheria]] [[epidemic]] in [[Naples]] in 1610, using the vertical incision technique recommended by Fabricius. He also developed his own version of a trocar.{{cite journal | vauthors = Sedvall G, Farde L, Nybäck H, Pauli S, Persson A, Savic I, Wiesel FA | title = Recent advances in psychiatric brain imaging | journal = Acta Radiologica. Supplementum | volume = 374 | issue = 5179 | pages = 113–5 | year = 1960 | pmid = 1966956| pmc = 1966956 | doi = 10.1136/bmj.1.5179.1129 }} [99] => [100] => In 1620 the French surgeon [[Nicholas Habicot]] (1550–1624), surgeon of the [[Duke of Nemours]] and anatomist, published a report of four successful "bronchotomies" which he had performed.{{cite book|author=Nicholas Habicot|title=Question chirurgicale par laquelle il est démonstré que le Chirurgien doit assurément practiquer l'operation de la Bronchotomie, vulgairement dicte Laryngotomie, ou perforation de la fluste ou du polmon|publisher=Corrozet|location=Paris|language=fr|year=1620|page=108}} One of these is the first recorded case of a tracheotomy for the removal of a foreign body, in this instance a blood clot in the larynx of a stabbing victim. He also described the first tracheotomy to be performed on a [[Pediatrics|pediatric]] patient. A 14-year-old boy swallowed a bag containing 9 gold coins in an attempt to prevent its theft by a [[highwayman]]. The object became lodged in his [[esophagus]], obstructing his trachea. Habicot suggested that the operation might also be effective for patients with inflammation of the larynx. He developed equipment for this surgical procedure which displayed similarities to modern designs (except for his use of a single-tube cannula).{{citation needed|date=January 2022}} [101] => [102] => [[Sanctorius]] (1561–1636) is believed to be the first to use a trocar in the operation, and he recommended leaving the cannula in place for a few days following the operation.{{cite book|author=Sanctorii Sanctorii |title=Sanctorii Sanctorii Commentaria in primum fen, primi libri canonis Avicennæ |publisher=Apud Marcum Antonium Brogiollum |location=Venetiis |language=la |year=1646 |page=1120 |ol=15197097M |url=https://openlibrary.org/works/OL5226737W/Sanctorii_Sanctorii_Commentaria_in_primum_fen_primi_libri_canonis_Auicennæ_.. |author-link=Sanctorius }} Early tracheostomy devices are illustrated in Habicot's ''Question Chirurgicale'' and Casseri's posthumous ''Tabulae anatomicae'' in 1627.{{cite book|author=Julius Casserius (Giulio Casserio) and Daniel Bucretius|title=Tabulae anatomicae LXXIIX ... Daniel Bucretius ... XX. que deerant supplevit & omnium explicationes addidit|publisher=Impensis & coelo Matthaei Meriani|location=Francofurti|language=la|year=1632|url=http://www.antiqbook.com/boox/gac/089233.shtml}}{{Dead link|date=July 2018 |bot=InternetArchiveBot |fix-attempted=no }} Thomas Fienus (1567–1631), Professor of Medicine at the [[Old University of Leuven|University of Louvain]], was the first to use the word "tracheotomy" in 1649, but this term was not commonly used until a century later.{{cite journal | vauthors = Cawthorne T, Hewlett AB, Ranger D | title = Tracheostomy in a respiratory unit at a neurological hospital | journal = Proceedings of the Royal Society of Medicine | volume = 52 | issue = 6 | pages = 403–5 | date = June 1959 | pmid = 13667911 | pmc = 1871130 | doi=10.1177/003591575905200602}} Georg Detharding (1671–1747), professor of anatomy at the [[University of Rostock]], treated a drowning victim with tracheostomy in 1714.{{cite book|author=Georges Detharding|title=Geschichte jetzlebender Gelehrten, als eine Fortsetzung des Jetzlebenden|editor1=Von Ernst Ludwig Rathlef |editor2=Gabriel Wilhelm Goetten |editor3=Johann Christoph Strodtmann |chapter=De methodo subveniendi submersis per laryngotomiam (1714)|publisher=Berlegts Joachim Undreas Deek|location=Zelle|year=1745|page=20|chapter-url=https://books.google.com/books?id=flM5AAAAMAAJ&pg=PA6}}{{cite journal | vauthors = Price JL | title = The evolution of breathing machines | journal = Medical History | volume = 6 | issue = 1 | pages = 67–72 | date = January 1962 | pmid = 14488739 | pmc = 1034674 | doi = 10.1017/s0025727300026867 }}{{cite journal | vauthors = Wischhusen HG, Schumacher GH | title = [Curriculum vitae of the professor of anatomy, botany and higher mathematics Georg Detharding (1671–1747) at the University of Rostock (author's transl)] | language = de | journal = Anatomischer Anzeiger | volume = 142 | issue = 1–2 | pages = 133–40 | year = 1977 | pmid = 339777 | trans-title = Curriculum vitae of the professor of anatomy, botany and higher mathematics Georg Detharding (1671–1747) at the University of Rostock }} [103] => [104] => ===19th century=== [105] => In the 1820s, the tracheotomy began to be recognized as a legitimate means of treating severe airway obstruction. In 1832, French physician [[Pierre Bretonneau]] employed it as a last resort to treat a case of [[diphtheria]].{{cite journal|author=Armand Trousseau|title=Mémoire sur un cas de tracheotomie pratiquée dans la période extrème de croup|journal=Journal des connaissances médico-chirurgicales|volume=1|issue=5|page=41|year=1833|author-link=Armand Trousseau}} In 1852, Bretonneau's student [[Armand Trousseau]] reported a series of 169 tracheotomies (158 of which were for [[croup]], and 11 for "chronic maladies of the larynx"){{cite book|author=Armand Trousseau|title=Annales de médecine belge et étrangère|editor=Jean Lequime and J. de Biefve|chapter=Nouvelles recherches sur la trachéotomie pratiquée dans la période extrême du croup|publisher=Imprimerie et Librairie Société Encyclographiques des Sciences Médicales|location=Brussels|year=1852|pages=279–288|chapter-url=https://books.google.com/books?id=khsUAAAAQAAJ&pg=PA279|author-link=Armand Trousseau}} In 1858, John Snow was the first to report tracheotomy and cannulation of the trachea for the administration of chloroform anesthesia in an animal model.{{cite book| vauthors = Snow J | veditors = Richardson BW |title=On chloroform and other anaesthetics: their action and administration|chapter=Fatal cases of inhalation of chloroform, Treatment of suspended animation from chloroform|pages=[https://archive.org/details/onchloroformothe1858snow/page/120 120]–200, 251–62|publisher=John Churchill|location=London|year=1858|chapter-url=https://archive.org/details/onchloroformothe1858snow| quote = john snow. }} In 1871, the German surgeon [[Friedrich Trendelenburg]] (1844–1924) published a paper describing the first successful [[Choice|elective]] human tracheotomy to be performed for the purpose of administration of general anesthesia.{{cite journal|first=F|last=Trendelenburg|author-link=Friedrich Trendelenburg|title=Beiträge zu den Operationen an den Luftwegen|trans-title=Contributions to airways surgery|language=de|journal=Archiv für Klinische Chirurgie|volume=12|pages=112–33|year=1871}} In 1880, the Scottish surgeon [[William Macewen]] (1848–1924) reported on his use of orotracheal intubation as an alternative to tracheotomy to allow a patient with glottic edema to breathe, as well as in the setting of general anesthesia with [[chloroform]].{{cite journal | vauthors = Macewen W | title = General Observations on the Introduction of Tracheal Tubes by the Mouth, Instead of Performing Tracheotomy or Laryngotomy | journal = British Medical Journal | volume = 2 | issue = 1021 | pages = 122–4 | date = July 1880 | pmid = 20749630 | pmc = 2241154 | doi = 10.1136/bmj.2.1021.122 }}{{cite journal | vauthors = Macewen W | title = Clinical Observations on the Introduction of Tracheal Tubes by the Mouth, Instead of Performing Tracheotomy or Laryngotomy | journal = British Medical Journal | volume = 2 | issue = 1022 | pages = 163–5 | date = July 1880 | pmid = 20749636 | pmc = 2241109 | doi = 10.1136/bmj.2.1022.163 | author-link = William Macewen }} At last, in 1880 [[Morell Mackenzie]]'s book discussed the symptoms indicating a tracheotomy and when the operation is absolutely necessary. [106] => [107] => ===20th century=== [108] => [[File:Cricothyrotomy.png|thumb|upright|Laryngeal structures, trachea (1–4) and invasive procedures (A–B) (1) Thyroid cartilage (2) Cricothyroid ligament (3) Cricoid cartilage (4) Trachea (A) Cricothyrotomy (B) Tracheotomy|alt=]] [109] => [110] => In the early 20th century, physicians began to use the tracheotomy in the treatment of patients affected by paralytic [[poliomyelitis]] who required [[mechanical ventilation]]. However, surgeons continued to debate various aspects of the tracheotomy well into the 20th century. Many techniques were described and employed, along with many different [[surgical instrument]]s and tracheal tubes. Surgeons could not seem to reach a consensus on where or how the tracheal incision should be made, arguing whether the "high tracheotomy" or the "low tracheotomy" was more beneficial. The currently used surgical tracheotomy technique was described in 1909 by [[Chevalier Jackson]] of [[Pittsburgh]], [[Pennsylvania]]. Jackson emphasised the importance of postoperative care, which dramatically reduced the death rate. By 1965, the surgical anatomy was thoroughly and widely understood, [[antibiotic]]s were widely available and useful for treating postoperative infections, and other major complications had also become more manageable. [111] => [112] => ==Society and culture== [113] => Notable individuals who have or have had a tracheotomy include [[Mika Häkkinen]], [[Stephen Hawking]], [[Connie Culp]], [[Christopher Reeve]],{{Cite web|url=http://www.chrisreevehomepage.com/biography.html|title=Biography (Christopher Reeve Homepage) |website=www.chrisreevehomepage.com |access-date=2018-12-19}} [[Roy Horn]], [[William Rehnquist]], [[Gabby Giffords]], [[George Michael]], [[Val Kilmer]],{{cite web |last1=Day |first1=Nate |title=Val Kilmer says he's doing great after tracheotomy: 'I feel a lot better than I sound' |url=https://www.foxnews.com/entertainment/val-kilmer-doing-a-lot-better-after-tracheotomy |website=Fox News |access-date=14 June 2022 |date=3 August 2020}} and many others.{{Cite web|url=http://www.tracheostomy.com/resources/more/famous/index.htm|title=Famous people who have or have had Tracheostomies|website=www.tracheostomy.com|access-date=2018-12-19|archive-date=24 December 2018|archive-url=https://web.archive.org/web/20181224075316/http://www.tracheostomy.com/resources/more/famous/index.htm}} [114] => [115] => Across movies and TV shows, there are many situations where an emergency procedure is done on an individual's neck to re-establish an airway. An example is in the 2008 horror film, ''[[Saw V]]'', in which a character being drowned from the neck up performs a manual tracheotomy, stabbing his neck with a pen to create an airway to breathe through. The most common procedure is a [[cricothyrotomy]] (or "crike"), which is an incision through the skin and cricothyroid membrane. This is often confused or misnamed as a tracheotomy (or "trach") and vice versa. However, they are quite different based on location of the opening and length of time the alternate airway is needed. [116] => {{Clear}} [117] => [118] => ==References== [119] => {{Reflist}} [120] => [121] => ==Further reading== [122] => {{Refbegin}} [123] => * {{cite journal | vauthors = Plotnikow GA, Roux N, Feld V, Gogniat E, Villalba D, Ribero NV, Sartore M, Bosso M, Quiroga C, Leiva V, Scrigna M, Puchulu F, Distéfano E, Scapellato JL, Intile D, Planells F, Noval D, Buñirigo P, Jofré R, Nielsen ED | title = Evaluation of tracheal cuff pressure variation in spontaneously breathing patients | journal = International Journal of Critical Illness and Injury Science | volume = 3 | issue = 4 | pages = 262–8 | date = October 2013 | pmid = 24459624 | pmc = 3891193 | doi = 10.4103/2229-5151.124148 | doi-access = free }} [124] => {{Refend}} [125] => [126] => == External links == [127] => {{Wiktionary|tracheotomy|pharyngotomy|laryngotomy|tracheostomy|Position=left}} [128] => {{Commons category|position=}} [129] => {{Refbegin}} [130] => * [http://www.tracheotomy.info Tracheotomy Info] (A community for tracheotomy-wearers and the people who love them) at tracheotomy.info [131] => * [http://www.trachs.com Tracheostomy Products and Support] (Online resource for tracheostomy products, supplies and support) at trachs.com [132] => * [http://www.tracheostomy.com Aaron's tracheostomy page] (Caring for a tracheostomy) at tracheostomy.com [133] => * [http://www.drtbalu.com/tracheostomy.html (Pictures with video clipping)] at drtbalu.com [134] => * [http://www.translaryngealtracheostomyfantoni.it Translaryngeal tracheostomy] {{Webarchive|url=https://web.archive.org/web/20170911163221/http://translaryngealtracheostomyfantoni.it/ |date=11 September 2017 }} [135] => * {{DorlandsDict|eight/000109880|Tracheotomy}} [136] => * [https://web.archive.org/web/20091227151738/http://smiths-medical.com/education-resources/videos/airway/index.html Smiths Medical Tracheostomy Training Videos] [137] => * [https://www.youtube.com/watch?v=YE-n8cgl77Q A Video of Rescue Breathing for Laryngectomees and Neck Breathers] [138] => * [http://www.wdl.org/en/item/7385 "Book of Simplification Concerning Therapeutics and Diet"], is a manuscript from 1497 that discusses tracheotomies [139] => * [https://www.tracheostomyeducation.com An all inclusive resource about tracheostomy including articles and courses for medical professionals, caregivers and patients] [140] => * [http://www.TrachResource.com Site and blog with information about tracheostomies] [141] => * [http://www.globaltrach.org Global Tracheostomy Collaborative. International collaborative with resources for hospitals, caregivers, and patients about tracheostomies, including international research] [142] => * [http://vts.uni-ulm.de/doc.asp?id=6821 Dilatational Tracheostomy On An Intensive Care Unit] [143] => {{Refend}} [144] => [145] => {{Respiratory system surgeries and other procedures}} [146] => {{Authority control}} [147] => [148] => {{DEFAULTSORT:Tracheotomy}} [149] => [[Category:Airway management]] [150] => [[Category:Emergency medical procedures]] [151] => [[Category:Otorhinolaryngology]] [152] => [[Category:Sleep surgery]] [153] => [[Category:Trachea surgery]] [] => )
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Tracheotomy

A tracheotomy is a surgical procedure in which an incision is made in the trachea, or windpipe, to create an opening. This opening, called a stoma, allows air to bypass the nose and mouth and enter the lungs directly.

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This opening, called a stoma, allows air to bypass the nose and mouth and enter the lungs directly. Tracheotomies are typically performed in emergency situations, such as when a patient is unable to breathe or is at risk of suffocation due to an obstruction in the upper airway. They can also be done in a planned manner for long-term ventilation or for easier access to the airway during surgeries. This procedure has been practiced for centuries and has saved countless lives. The Wikipedia page on tracheotomy provides extensive information about the history, indications, techniques, complications, and management of this surgical procedure. It also delves into the different types of tracheostomy tubes, post-operative care, and the potential risks and benefits associated with this intervention. Readers can also find detailed information on the steps involved in a tracheotomy, including pre-operative evaluation, anesthesia, incision, and post-operative care. Additionally, the article covers the role of tracheotomies in various medical fields, such as pediatrics, critical care, and otolaryngology. Overall, the Wikipedia page on tracheotomy serves as a comprehensive resource for understanding this important surgical procedure and its implications for patient care.

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