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Details About Tracheostomy
Whether, it is an obstruction of airways, elective surgery or trauma, the secure airways establishment is considered to be of paramount importance and a critical constituent before the commencement of any technique or surgery. The otolaryngologist is known to play a primary role in the scenarios of clinics when surgical airways for instance, tracheotomy is important. The surgical airways role has been discussed for the past few years. The chief goal of the tracheotomy is to secure and create artificial airways for the patients. The main aims for performing this procedure are several folds, but the major tracheotomy indications for tracheotomy includes: reducing the likelihood of the endotracheal tube complications such as Sub-Glottic Stenosis, promoting ventilator weaning by reducing circuit ventilator airway resistance, help manage aspiration, improved pulmonary toilet, assist respirations over a prolonged period, as well as bypass the obstruction of upper airway.
In the midline structure, the trachea is present at the anterior neck. It is usually angled to posterior slightly, and it caudally passes towards the sternal notch. The access of the trachea is improved by positioning the neck and head in the ‘sniffing’ posture. On the other hand, there was a padded object between the blades of the shoulder that will improve the anterior trachea presentation. If the cervical spinal stability is ensured, such maneuvers can be performed easily. Soft tissue deformity or midline shift, a short neck, and subcutaneous adiposity from the trauma might make it tedious to palpate the trachea. Nonetheless, it is comparatively accessible segment of the airways of infra-glottic to secure a definitive airway. The tubes of Tracheostomy usually come in diverse configurations. One of an important feature is a rigid or curved tube with a flange or neck-plate. All such tubes are known to permit the tracheobronchial toileting of sputum, ventilation, and oxygenation. Hence, such cuffed tubes offer seals for the ventilation of positive pressure, and it also protects against aspiration. Phonation is allowed by fenestrated tube. An inner cannula makes the tube simple and clean as it is coupled with the fenestrated tube that makes possible progression of phonation.
Contraindications for tracheotomy
The complete contraindications for tracheotomy are primarily rare, and it tends to comprise of infections of soft tissue of the neck as well as distorted anatomy, for instance, former major surgery of neck. The relative contraindications include severe respiratory distress with hypercapnia and refractory hypoxemia. The coagulation and Hematologic disorders are at times considered as contraindications, but previous studies suggest that tracheostomies can be performed safely in the neutropenic and thrombocytopenic patients after essential transfusions.