please see the overview section “The Pulmonary
System.”
See also ALVEOLUS; EPIGLOTTIS; TRACHEOSTOMY.
tracheostomy A surgical opening created in the
TRACHEAto allow air to enter the LUNGS, bypassing
the upper THROATand MOUTH. A tracheostomy may
be temporary or permanent. The doctor may per-
form a tracheostomy when extensive surgery such
as to treat laryngealCANCERresults in removing
the shared structures of the throat that allow air to
flow into the trachea, or when neurologic damage
necessitates long-term MECHANICAL VENTILATION.
SWALLOWING DISORDERSthat impede normal epiglot-
tal function (which keeps food and water from
entering the trachea) and SLEEP APNEAthat fails to
respond to other treatments may also make tra-
cheostomy necessary.
In most cases the doctor performs tracheostomy
with the person under general ANESTHESIA. The
incision is typically between the second and third
or third and fourth tracheal cartilages in the front
of the neck, to make an opening about an inch to
an inch and a quarter (2 to 3 centimeters) in
length. The doctor then inserts a tube into the
opening to maintain a passageway into the tra-
chea. The kind of tube and finishing process for
the incision depends on whether the doctor
intends the tracheostomy to be temporary or per-
manent. An inflatable cuff may hold the tra-
cheostomy tube in place, though some designs are
cuffless. Most tracheostomies use an inner and
outer cannula (tube), allowing removal of the
inner cannula for cleaning. A device called an
obturator allows changing of the entire tra-
cheostomy tube and guides reinsertion of the new
tube.
Most people who are conscious are able to
resume regular eating and speaking. Speech
requires closing off the tracheostomy tube to bring
air through the throat and past the VOCAL CORDS.
Potential complications of tracheostomy include
bleeding after the OPERATION, INFECTION, and block-
age of the tube with mucus or foreign material
that enters the tube from the outside. Conscien-
tious hygiene, including daily cleansing of the tra-
cheostomy site and tube, is essential. It is
important to humidify the air breathed into the
tracheostomy, such as with a room humidifier or
moist gauze (rewetted as needed) placed over the
tube opening. Home health nursing agencies pro-
vide education and training in how to care for a
tracheostomy for people who have tracheostomies
and their family members or caregivers. Even a
long-term stoma will heal closed should the per-
son’s condition improve such that normal BREATH-
INGability returns and the doctor can remove the
tube.
See also EPIGLOTTIS; OXYGEN THERAPY; SPINAL CORD
INJURY; TRAUMATIC BRAIN INJURY(TBI).wheeze See BREATH SOUNDS.234 The Pulmonary System