A tracheostomy is a procedure that is performed on some critical care patients, in order to aid their recovery from a period of prolonged mechanical ventilation. Many of the patients in Bolton Critical Care who have been on a ventilator for more than a few days undergo this procedure, and it is performed to aid their recovery after a period of critical illness, when their breathing muscles will be weaker than before they became unwell.
A tracheostomy can be thought of as a kind of bridge between being on a ventilator and breathing without assistance. It allows the team to help manage secretions, and gradually reduce the amount of breathing support whilst the patient’s own breathing muscles regain strength. Once the procedure has been performed, the patient can usually be ‘woken up’ or brought out of their induced coma.
The procedure involves at least two specialist critical care doctors and a team of critical care nurses. The team will usually discuss the plan to carry out this procedure with you before it is performed. Tracheostomy does come with some risk, but these are outweighed by the intended benefits.
After a process of checking equipment and procedural details, an incision is made on the front of the neck, and through a series of steps, a plastic tube called a tracheostomy tube is inserted, which enters the windpipe at the front of the neck and passes down towards the lungs, a bit like the tube that connects the patient and ventilator via the mouth. This is then secured and attached to the ventilator to continue to support the breathing. Once this is confirmed to be safely working, the patient can usually begin to be woken up by switching medicines keeping them asleep.
At first, the patient will not be able to speak but this can be achieved later with a special valve. The critical care team has a variety of techniques to help communication. Initially the patient will not be able to eat either, but gradually they will be able to return to a normal diet. Whilst a patient is unable to eat in the normal way they will receive nutrition through a tube passing from their nose down to their stomach, which provides all the calories, vitamins and minerals they need. A tracheostomy can remain in place for as long as required, but when inserted during critical illness, it is usually fairly quickly reversed as the patient’s condition improves.
Later on, a small scar is present on the patient’s neck, but this is often hardly noticeable.
If you have any questions, or would like further information, you can ask one of the critical care team, and there are leaflets available from the Critical Care Unit.