Chapter 12: Respiratory care, CPR and blood transfusion
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Definition
A tracheostomy is the creation of a permanent or temporary opening (stoma) in the anterior wall of the trachea to facilitate ventilation (Figure 12.34). The opening is commonly made at the level of the second or third cartilaginous rings and is usually maintained by the use of a tracheostomy tube (Adam et al. [3]). A tracheostomy may be created surgically or percutaneously, and as either an elective (planned) or non‐elective (unplanned/emergency) procedure.
Figure 12.34 (a) Anatomy of the head and neck. (b) Tracheostomy. (c) Laryngectomy.
A total laryngectomy is the surgical removal of the larynx (Figure 12.34). The end of the trachea is stitched to the skin of the anterior neck and forms a permanent and irreversible stoma. The upper airway is no longer connected to the trachea and lungs, and all ventilation takes place via the laryngectomy stoma (Bonvento et al. [28]). Because the larynx has been removed, the patient is unable to phonate using their vocal cords so alternative methods of communication and voice facilitation must be used instead (Ward and Van As‐Brooks [280]).
Regardless of whether the newly created stoma is permanent or temporary, a patient with a tracheostomy or laryngectomy may be referred to as a ‘neck breather’ or as having an ‘altered airway’.
