Tracheostomy
What is Tracheostomy?
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Why do you need Tracheostomy?
Tracheostomy is indicated for:
- Upper airway obstruction:
- Trauma (e.g., facial fractures, laryngeal injury).
- Tumors (e.g., laryngeal cancer).
- Infections (e.g., epiglottitis, Ludwig’s angina).
- Prolonged mechanical ventilation:
- Patients requiring ventilation >10–14 days (e.g., ARDS, stroke, neuromuscular disease like ALS).
- Reduces risk of laryngeal injury from prolonged endotracheal intubation.
- Neurologic conditions:
- Inability to protect airway (e.g., coma, severe stroke, Guillain-Barré syndrome).
- Excessive secretions (e.g., in spinal cord injury).
- Emergency airway management:
- Failed intubation or severe facial trauma where oral/nasal intubation isn’t possible.
The procedure aims to secure the airway, improve ventilation, and facilitate weaning from mechanical ventilation.
Why Do Tracheostomy Costs Vary in Philippines?
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Tracheostomy Procedure
The procedure can be elective or emergent, with two main approaches:
- Before Procedure Evaluation:
- Assessment:
- Clinical evaluation: Airway obstruction, respiratory distress, or ventilator dependence.
- Imaging (e.g., CT neck) assesses anatomy (e.g., tumors, neck masses).
- Blood tests ensure normal coagulation (e.g., INR, platelet count) to minimize bleeding risk.
- Patients on ventilators are optimized (e.g., adequate oxygenation, sedation).
- Consent is obtained, explaining risks and tracheostomy care.
- Assessment:
- Surgical Techniques:
- Open Tracheostomy:
- Performed in the operating room or ICU under general anesthesia (or local anesthesia in emergencies), lasting 30–60 minutes.
- The patient is positioned supine with the neck extended (a shoulder roll helps).
- A 2–3 cm horizontal incision is made midway between the cricoid cartilage and sternal notch.
- The strap muscles are separated, and the thyroid isthmus is retracted or divided.
- A window is created in the trachea (typically between the 2nd and 3rd tracheal rings) using a vertical or horizontal incision.
- A tracheostomy tube (size 6–8 for adults) is inserted, secured with sutures or a strap, and connected to a ventilator or oxygen if needed.
- A chest X-ray confirms tube placement and rules out pneumothorax.
- Percutaneous Dilational Tracheostomy (PDT):
- Minimally invasive, often performed at the bedside in ICU under sedation (e.g., propofol, fentanyl), lasting 15–30 minutes.
- Preferred for elective cases in ventilated patients.
- A needle is inserted into the trachea under bronchoscopic guidance, followed by a guidewire.
- Serial dilators (Seldinger technique) create the stoma, and the tracheostomy tube is inserted.
- Less scarring, lower infection risk, but not suitable for emergencies or distorted anatomy (e.g., tumors).
- Emergency Tracheostomy:
- Rare, performed when cricothyrotomy (a simpler emergency airway procedure) isn’t feasible.
- Done under local anesthesia with minimal preparation; higher complication risk.
- Open Tracheostomy:
- After Procedure:
- Patients are monitored in the ICU or ward for 1–5 days.
- The tracheostomy tube is checked for patency; suctioning removes mucus or blood.
- Pain is managed with analgesics (e.g., paracetamol).
- Speech therapy (if awake) helps with communication (e.g., speaking valves).
- The first tube change occurs after 5–7 days (to allow tract formation), then weekly or as needed.
Recovery After Tracheostomy
- Hospital Stay: 1–5 days for the procedure; longer if on prolonged ventilation (weeks to months).
- Post-Procedure Care:
- Pain at the site for 3–5 days, managed with analgesics.
- Regular suctioning (every 4–6 hours initially) keeps the tube clear of mucus.
- Humidified air prevents drying of secretions; saline nebulization may be used.
- Inner cannula (if present) is cleaned daily; the outer tube is changed weekly.
- Patients/families are trained on tracheostomy care (e.g., suctioning, cleaning) before discharge.
- Activity/Diet:
- Light activities (e.g., sitting, walking) in 1–2 days; strenuous activities avoided until decannulation (tube removal).
- Swallowing may be impaired initially; a speech therapist assesses risk of aspiration.
- Diet: Liquids to soft foods, often via feeding tube (e.g., nasogastric) if aspiration risk is high.
- Follow-Up:
- Weekly visits to monitor the stoma and tube; ENT evaluation for decannulation readiness.
- Decannulation (tube removal): Once the underlying condition resolves (e.g., airway obstruction cleared, ventilator weaned), typically 2 weeks to months.
Most resume normal activities in 2–4 weeks (if not ventilator-dependent). Success rates are >95% for securing the airway; long-term outcomes depend on the underlying condition (e.g., cancer, neurologic recovery).
Risks and Complications
- Immediate Risks: Bleeding (1–3%, higher in PDT), pneumothorax (1–2%), tube dislodgement (1–5%), false tract creation.
- Early Complications: Infection (stomal cellulitis, 3–5%), obstruction (mucus plugging, requiring suctioning), accidental decannulation.
- Late Complications: Tracheal stenosis (1–5%), tracheomalacia, granulation tissue, tracheoesophageal fistula (rare).
- General Risks: Anesthesia reactions, subcutaneous emphysema.
Report fever, difficulty breathing, or excessive bleeding promptly.
Frequently Asked Questions (FAQs)
What causes the need for tracheostomy?
Upper airway obstruction, prolonged ventilation, or inability to protect the airway (e.g., coma, neurologic disease).
Is tracheostomy permanent?
Not always; temporary in many cases (e.g., trauma, ventilation), permanent if the underlying condition persists (e.g., laryngeal cancer).
Can I speak with a tracheostomy?
Yes, with a speaking valve (e.g., Passy-Muir) or fenestrated tube, once stable; speech therapy helps.
How soon can I resume activities?
Light activities in 1–2 days; normal routines in 2–4 weeks (if not ventilator-dependent).
Is tracheostomy covered by insurance in India?
Yes, for emergencies or medical necessity; confirm with your provider.
Signs of complications?
Fever, difficulty breathing, bleeding, or tube blockage.
Can I eat normally with a tracheostomy?
Swallowing may be challenging initially; a feeding tube may be used until safe to eat, guided by a swallow assessment.
Lifestyle changes post-tracheostomy?
Tracheostomy care (suctioning, cleaning), avoid swimming (risk of water entering stoma), speech/swallowing therapy, regular follow-ups.
Conclusion
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Looking for Best Hospitals for Tracheostomy
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
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Angeles City |
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Antipolo |
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Bacolod |
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Bacoor |
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Baguio |
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Butuan |
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Cagayan de Oro |
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Caloocan |
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Cebu City |
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Dasmariñas |
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Davao City |
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General Santos |
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General Trias |
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Iligan |
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Iloilo City |
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Las Piñas |
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Makati |
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Malolos |
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Manila |
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Muntinlupa |
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Parañaque |
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Pasay |
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Pasig |
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Puerto Princesa |
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Quezon City |
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San Fernando |
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San Jose del Monte |
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Taguig |
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Valenzuela |
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Zamboanga City |
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Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.