Tracheotome
Encyclopedia
A tracheotome is a medical instrument used to perform an incision in the trachea
with a cutting blade operated by a powered cannula. It is often called a tracheostomy tube because once it enters the stoma
in the trachea, a breathing tube
is connected to a ventilator and oxygen is provided to the lungs.
There are different types of tracheotomes. They can be made of metal
, plastic
or silicone
. Plastic and silicone are widely used since they reduce the complications from the tracheotomy procedure such as subglottic stenosis
and erosion of large blood vessel
s.
were being implemented at the time, but many would lead to severe complications and were difficult to operate. Most of them required special skills and well trained practitioners.
, cutting blade, specialized plunger and a motor unit. Once the staple was fixed to the neck of the patient, the blade moved forward the skin, fascia
and trachea to perform the incision. Then, a plunger moved forward and then backward to hold the tissues . Later, the tracheotome was removed from the patient and only the staple
remained in the neck to maintain the trachea open. These were the innovative features of the mechanized tracheotome which were different from the tracheotomes at the time. It was either spring or gas-powered operated.
, improved the design by reducing the size and including a rotatable adjustable cap at the mount of the tracheotome to control the depth of penetration in the incision. Its handle also allowed the recocking of the spring operated cutting blade.
to be in position and prevent their rotation. It also provided heated and/or humidified gas to patients dependent on the breathing machine.
Once the incisions are made by the tracheotome and the stomas are accessible, tracheotome tubes are placed in the trachea to provide oxygen to the lungs. Tubes have also been improved to reduce complications of infection and tissue damage. For instance, Alain Milhay from Amiens
, France
, invented a tracheotomy tube with shield for anesthesia
in 1983. This tube included a conduit for passing on anesthesia and ventilation
gases. At the time, other tubes were also been implemented for anesthesia application but their material composition was toxic and could give off caustic or toxic vapors.
, change of voice, infection, impaired swallowing and permanent scars may occur. This is why the procedure is only performed in case of emergency.
Vessels such as the carotid arteries or internal jugular veins could also be damaged if the incision and penetration of the blade is not accurate, with a higher risk in children and obese patients.
Vertebrate trachea
In tetrapod anatomy the trachea, or windpipe, is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells that produce mucus...
with a cutting blade operated by a powered cannula. It is often called a tracheostomy tube because once it enters the stoma
Stoma
In botany, a stoma is a pore, found in the leaf and stem epidermis that is used forgas exchange. The pore is bordered by a pair of specialized parenchyma cells known as guard cells that are responsible for regulating the size of the opening...
in the trachea, a breathing tube
Tracheal tube
A tracheal tube is a catheter that is inserted into the trachea in order for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate exchange of oxygen and carbon dioxide. Many different types of tracheal tubes are available, suited for different specific...
is connected to a ventilator and oxygen is provided to the lungs.
There are different types of tracheotomes. They can be made of metal
Metal
A metal , is an element, compound, or alloy that is a good conductor of both electricity and heat. Metals are usually malleable and shiny, that is they reflect most of incident light...
, plastic
Plastic
A plastic material is any of a wide range of synthetic or semi-synthetic organic solids used in the manufacture of industrial products. Plastics are typically polymers of high molecular mass, and may contain other substances to improve performance and/or reduce production costs...
or silicone
Silicone
Silicones are inert, synthetic compounds with a variety of forms and uses. Typically heat-resistant and rubber-like, they are used in sealants, adhesives, lubricants, medical applications , cookware, and insulation....
. Plastic and silicone are widely used since they reduce the complications from the tracheotomy procedure such as subglottic stenosis
Subglottic stenosis
Subglottic stenosis is a congenital or acquired narrowing of the subglottic airway. Although it is relatively rare, it is the third most common congenital airway problem . Subglottic stenosis can present as a life-threatening airway emergency...
and erosion of large blood vessel
Blood vessel
The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...
s.
History
The tracheostomy procedure is an ancient medical procedure which dates back to 2000 BC. There are some records of physicians performing tracheostomy to save the lives of children and sick people from choking. However, several complications were also common after the procedure was performed due to the severity of the infections and other diseases causing the oxygen obstruction. It was not until the mid 1900s that this medical tool was improved. The introduction of the mechanized tracheotome illustrates how the procedure and the device were improved. The introduction of the mechanized tracheotome by Joseph John Amato in 1972, North Riverside, provided a quicker, cleaner and precise cut which reduced the possibility of tissue damage and infection. Previous procedures for tracheotomyTracheotomy
Among the oldest described surgical procedures, tracheotomy consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea...
were being implemented at the time, but many would lead to severe complications and were difficult to operate. Most of them required special skills and well trained practitioners.
Mechanized Tracheotome
The mechanized tracheotome consisted of a stapleStaple
-Trade:*The Staple, in English historiography, the entire medieval system of trade and its taxation*Staple Inn, a building on the south side of High Holborn in London, England.*Statute of the Staple, a statute passed in 1353 by the Parliament of England...
, cutting blade, specialized plunger and a motor unit. Once the staple was fixed to the neck of the patient, the blade moved forward the skin, fascia
Fascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...
and trachea to perform the incision. Then, a plunger moved forward and then backward to hold the tissues . Later, the tracheotome was removed from the patient and only the staple
Staple
-Trade:*The Staple, in English historiography, the entire medieval system of trade and its taxation*Staple Inn, a building on the south side of High Holborn in London, England.*Statute of the Staple, a statute passed in 1353 by the Parliament of England...
remained in the neck to maintain the trachea open. These were the innovative features of the mechanized tracheotome which were different from the tracheotomes at the time. It was either spring or gas-powered operated.
Spring Operated Tracheotome
Other tracheotomes such as the spring operated tracheotome designed by Adamson Howard in 1985, FloridaFlorida
Florida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it...
, improved the design by reducing the size and including a rotatable adjustable cap at the mount of the tracheotome to control the depth of penetration in the incision. Its handle also allowed the recocking of the spring operated cutting blade.
Other Adaptations
Leslie William Peterson also made significant contributions to the improvement of the tracheostome. In 2006, his tracheal tube/catheter adaptor cap was introduced and consisted in a cap with two separate projections that allowed the catheterCatheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
to be in position and prevent their rotation. It also provided heated and/or humidified gas to patients dependent on the breathing machine.
Once the incisions are made by the tracheotome and the stomas are accessible, tracheotome tubes are placed in the trachea to provide oxygen to the lungs. Tubes have also been improved to reduce complications of infection and tissue damage. For instance, Alain Milhay from Amiens
Amiens
Amiens is a city and commune in northern France, north of Paris and south-west of Lille. It is the capital of the Somme department in Picardy...
, France
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
, invented a tracheotomy tube with shield for anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
in 1983. This tube included a conduit for passing on anesthesia and ventilation
Ventilation (physiology)
In respiratory physiology, ventilation is the rate at which gas enters or leaves the lung. It is categorized under the following definitions:-Sample values:...
gases. At the time, other tubes were also been implemented for anesthesia application but their material composition was toxic and could give off caustic or toxic vapors.
Advantages
Tracheotomes became very inexpensive medical tools and easy devices to operate. The use of tracheotomes provides immediate oxygen supplies to patients by bypassing obstructions in the upper airway. Tracheotomes provide another alternative for airflow when there are glottic pathological conditions such as neoplasm and bilateral vocal cord paralysis. Also, air obstruction due to neck trauma and facial fracture can be alleviated with the tracheotome incision and oxygen supply.Complications
Patients may develop different complications after the incision is made with the tracheotome. Although these may be rare, bleeding, air obstruction, damage to the larynxLarynx
The larynx , commonly called the voice box, is an organ in the neck of amphibians, reptiles and mammals involved in breathing, sound production, and protecting the trachea against food aspiration. It manipulates pitch and volume...
, change of voice, infection, impaired swallowing and permanent scars may occur. This is why the procedure is only performed in case of emergency.
Vessels such as the carotid arteries or internal jugular veins could also be damaged if the incision and penetration of the blade is not accurate, with a higher risk in children and obese patients.
Tracheotome tubes used in conjunction with Tracheotomes
- Single Cannula Silicone Tube
- Tube with inner cannula
- Metal tube with inner cannula and obturator
- Fenestrated tubes
- Montgomery T-tubes