BACKGROUND: A tracheotomy is a surgical procedure in which a cut or opening is made in the windpipe. The surgeon inserts a tube into the opening to bypass an obstruction, allowing air to get to the lungs, or remove secretions. It's performed if a person is not getting enough air to his lungs, if the person cannot breathe without help, or is having problems with mucus and other secretions getting into the windpipe. After the patient goes home, he will need help to manage the tracheotomy tube. He should avoid contact with water, food particles and other substances that could enter the opening and cause serious breathing problems.

LIVING WITH A TRACH: Patients with a trach are really dependent on the tube to live and it can be difficult to care for. The internal diameter of the tube is about three millimeters and any mucus that blocks the tube also blocks the airway. "It requires very meticulous care, nursing care, suctioning and monitoring," Diego Preciado, M.D., Ph.D., of Children's National Medical Center in Washington, D.C., told Ivanhoe. "Approximately 1 percent of the time kids can die because of a blocked trach tube. You can imagine having a young baby with all the cares that are required with a young baby just to begin with. On top of that you add a trach tube, it's often too complex for families to take care of on their own,"

ALTERNATIVE TO TRACHEOTOMY: In some cases, especially in children, surgeons are looking for alternatives to tracheotomies. One of the alternatives is a laryngeal tracheal reconstruction procedure. A segment of cartilage is taken from the rib cage and molded to reconstruct the front part of the airway. It's used when the airway or the upper trachea is scarred. This can happen because somebody is born with a narrowed airway or typically from scarring, which often occurs due to an intubation. "Typically we're dealing with the airway either just at the level of the vocal chords or just below the vocal chords in children, because this is the narrowest portion of the airway," said Dr. Preciado. "Approximately one in 300 one in 500 intubations in preemies or young children can lead to narrowing."

RISKS: The main risk of this procedure is that it won't work and a child needs a tracheotomy afterwards. "That's the primary risk is that you make the pathology worse in trying to fix it early on, such that when you fix it later it's harder," said Dr. Preciado. There are also risks that go along with typical surgical procedures such as infection, bleeding and airway obstruction.

FOR MORE INFORMATION, PLEASE CONTACT:
Children's National Medical Center
Washington, D.C.
1-888-884-BEAR