Tracheostomy and cancer
A tracheostomy is a surgical procedure that involves creating an opening in the neck to access the trachea, allowing for direct airway management. This intervention is commonly performed on patients who experience breathing difficulties due to various types of cancer, including laryngeal, neck, tongue, oral, thyroid, and some congenital cancers. The procedure typically involves the insertion of a tracheostomy tube to facilitate breathing, and it can be necessary for patients with upper airway obstruction, those recovering from surgery, or individuals who need prolonged mechanical ventilation.
Preparation for tracheostomy includes stopping certain medications and fasting prior to the procedure, which is usually done under general anesthesia, although emergency cases may be managed at the bedside. Post-operative care is crucial, as patients may initially be unable to speak or eat normally, relying instead on alternative communication methods and nutritional support until they adjust to the tube.
While tracheostomies can be temporary, they significantly improve respiratory function and ease the management of secretions. Patients typically require ongoing care and training to maintain the tracheostomy and manage potential complications, but many can resume normal activities as they recover. Overall, tracheostomy is a valuable procedure that can greatly enhance the quality of life for individuals facing respiratory challenges related to cancer.
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Subject Terms
Tracheostomy and cancer
ALSO KNOWN AS: Tracheotomy, trach tube
DEFINITION: Tracheostomy is a surgical procedure performed to aid breathing. An incision is made in the neck, just below the larynx (voice box), to directly access the trachea (windpipe). A tracheostomy tube is inserted through the opening, called a stoma, to keep the airway open. The tracheostomy tube may be connected to oxygen or mechanical ventilation.
Cancers treated:Laryngeal cancer, neck cancer, tongue cancer, oral cancer, thyroid cancer, and some congenital cancers
Why performed: A tracheostomy is performed for patients with an upper airway obstruction, difficulty breathing, or excess secretions in the airway. It is also performed for patients recovering after tracheal or laryngeal surgery and those with difficulty being weaned from mechanical ventilation.
Patient preparation:Patients with a planned tracheostomy must stop taking aspirin and products containing aspirin, ibuprofen, and anticoagulants, as directed by the physician, one week before the procedure. They also typically must not eat or drink for eight hours beforehand.
Steps of the procedure: The procedure is usually performed by a surgeon in an operating room while the patient is under general anesthesia. In emergent cases, the procedure may be performed at the patient’s bedside in an emergency room or an intensive care unit (ICU). If the procedure is emergent, then the patient lies on the back with a rolled-up towel between the shoulders. A local anesthetic is injected, and the procedure is performed.
In nonemergent cases, an intravenous (IV) line is inserted into the patient’s arm to deliver medications. A small clip placed on the patient’s finger is attached to an oximeter monitor to check the patient’s blood oxygen level during the procedure. Electrodes wired to the patient’s chest monitor the patient’s heart rhythm via electrocardiography (EKG). The patient receives general anesthesia through the IV. The neck is cleaned, and sterile drapes are placed around the surgical area. Incisions are made in the neck and through the second and third tracheal rings to create an opening in the trachea. The tracheostomy tube is inserted into the opening. Tape or stitches hold the tube in place.
Another technique, called tube-free tracheostomy, may be performed when a long-term tracheostomy is anticipated. A permanent opening in the trachea is created with skin and muscle flaps. After a one-month recovery period, the patient is usually able to talk efficiently by contracting the neck muscles, without the use of valves or devices.
Advances have been made in tracheostomy procedures in the twenty-first century. Percutaneous tracheostomy involves placing a bronchoscope alongside the endotracheal tube during surgery. This technique allows for clear visualization during the surgery and continued use of mechanical ventilation after the surgery if necessary. Further, doctors are able to tailor tracheostomy devices to patients, their anatomy, and their medical needs.
After the procedure: The patient will not be able to talk or eat by mouth immediately after the procedure and while remaining on mechanical ventilation. Most patients will need several days to adjust to breathing through the trach tube. Nutrition is given directly into the stomach through a percutaneous endoscopic gastrostomy tube until the tracheostomy tube is removed. The patient will communicate with others by writing and nonverbal communication in response to questions. With training and an adaptive valve on the tracheostomy, most patients are able to resume speaking as they adjust to the tracheostomy. A speech therapist can help the patient learn to speak with the tube in place.
Antibiotics may be given to reduce the risk of infection. A nurse or respiratory therapist will remove secretions from the trach tube using a suction device to clear the breathing passages.
A tracheostomy is not necessarily permanent. The patient’s condition and the purpose of the tracheostomy will determine when and if the tube can be removed. If the tube is eventually removed, then the area heals quickly, leaving a small scar.
The patient and caregiver will learn how to care for the tracheostomy before leaving the hospital. The patient is usually able to go home three to five days after the procedure, depending on their medical condition and rate of recovery. Some patients go home with mechanical ventilation, depending on their condition. A nurse will teach the patient and caregiver how to care for the equipment; suction, clean, and change the tube; and manage emergencies. Routine tracheostomy care must be performed at least once daily at home. A loose covering or tracheostomy cover is recommended to prevent foreign particles from entering the stoma. The patient must take precautions to avoid getting water in the opening.
The patient will feel some pain and discomfort in the neck area for about one week after the procedure, and pain medication will be prescribed as needed. It may take up to one month for the patient to heal completely. Most activities can eventually be resumed within six weeks after the procedure.
Risks: Like all surgeries, the tracheostomy procedure has risks. Complications are rare but may include bleeding, damage to the larynx or airway with a permanent change to the voice, need for further surgery, infection, scarring of the airway or neck, or impaired swallowing function. The healthcare team will discuss the potential risks of the procedure with the patient and their family or caregiver beforehand if the tracheostomy is not being performed as an emergent procedure.
Results: A tracheostomy can help the patient breathe more easily and allows the healthcare provider to clear secretions from the patient’s breathing passages. In many cases, the tracheostomy is temporary and is removed when the patient is able to breathe without the help of a ventilator.
Bibliography
Angel, Luis, et al. "Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19." The Annals of Thoracic Surgery, vol. 110, no. 3, 2020, pp. 1006-1011, doi.org/10.1016/j.athoracsur.2020.04.010. Accessed 23 June 2024.
Cooper, Sue, ed. Tracheostomy Care. Hoboken: Wiley, 2006.
Hadjiliadis, Denis, and Paul F. Harron. “Tracheostomy.” MedlinePlus, 22 Jan. 2023, medlineplus.gov/ency/article/002955.htm. Accessed 23 June 2024.
Pandian, Vinciya, et al. "Improving Airway Management and Tracheostomy Care through Interprofessional Collaboration: Aligning Timing, Technique, and Teamwork." Journal of Thoracic Disease, vol. 15, no. 5, 2023, pp. 2363-2370, doi.org/10.21037/jtd-23-205. Accessed 23 June 2024.
“Tracheostomy.” Mayo Clinic, 22 Oct. 2019, www.mayoclinic.org/tests-procedures/tracheostomy/about/pac-20384673. Accessed 23 June 2024.
“Tracheostomy.” Johns Hopkins Medicine, www.hopkinsmedicine.org/tracheostomy. Accessed 23 June 2024.