why is going from a ventilator to tracheotomy better is the ventilator still has to be used on the trach?
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Of course this depends on the issue. A tracheotomy is basically bypassing the upper respiratory system but everything still remain the same. This can eliminate some of the issues people have with breathing which required the ventilator in the first place. For example if someone goes into anaphylactic shock and their upper airways close at first a ventilator might be able to push air through the blockage. But then a tracheotomy might cause the patient to breathe on their own without a ventilator. The trauma, lack of oxygen, sedatives, etc. might still require them to be on a ventilator at first though, and just to be on the safe side the ventilator is usually connected anyway. Even if there is no upper airways issues there is still a lot of volume and restrictions that can by bypassed. So the ventilator works better when it is connected more directly to the lungs then when it have to go through the upper airways.
Ventilators and Tracheostomies are in a sense different procedures and require different patients, here’s the main thing to get.
Ventilators replace the function of your diaphragm and chest muscles pulling air in and out. So when someone is unable to breathe on their own, a ventilator solves the issue.
A tracheostomy is a surgical hole in the neck slightly below the adam’s Apple. It’s used when something is wrong with the area above the hole that would basically prevent breathing. This could be a blockage, birth defects, or a crushed airway.
Tracheostomies can actually be hooked up to ventilators because again ventilators replace breathing, tracheostomies only bypass the upper airway (mainly the mouth and nose)
Here’s the benefit though, assuming you regain your ability to breathe you can basically function normally and independently with a tracheostomy, so if someone is getting one after being removed from a ventilator, it may not be that the tracheostomy is better, but that now they’ll be able to breathe on their own by bypassing that upper airway, letting them live again Basically
I think you’re referring to the transition from ventilating through a endotracheal tube (in the mouth through the vocal cords) to ventilating through a tracheostomy tube (in the neck).
We do this all the time when a patient is anticipated to need continued ventilation for a while longer, and yes, it doesn’t change the way we ventilate them, at least to begin with.
By far the biggest reason is that you need a lot of sedation and pain relief drugs to tolerate a tube going through the vocal cords. Essentially, the patient has to be kept in a coma, or at least in a bit of a stupor.
Once you insert a tracheostomy and remove the endotracheal tube, you can stop all those drugs, wake the patient up, and once they’re awake, they are in a much better place to be rehabilitated and eventually weaned off the ventilator. They can eat, they can communicate, they can exercise, and once ready, a special device called a speaking valve allows them to start talking with the tracheostomy in. Eventually the ventilator can go and the tracheostomy can stay in for a little longer, keeping their airway open and safe.
Occasionally tracheostomy tubes are inserted to bypass big problems in the throat (like large tumours or abscesses) but these patients tend not to need to be ventilated for very long; it’s mainly to provide an alternative route to breathe through.
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