ICU Day 27 – Tracheostomy

Rachana went through a surgical Tracheostomy procedure this afternoon. She came back in a couple of hours and  was off the sedatives in less than an hour. She was in some pain and was given a few shots to manage that. Once the pain was under control she was so much better than when the tubes were in her mouth. She was mouthing words and generally looking better. So now she has a small hole in the front of her neck that in tubing into her windpipe. The outside of this tube is connected to the ventilator. Her mouth is open without anything obstructing it but she still can’t speak as the air from the lungs breathing out is coming out of this pipe and not hitting the vocal cords in her mouth – so she can move her lips and mouth but she has no voice. When she is off the ventilator, they can redirect the air to come out of her mouth and then her voice will be back. she went through this procedure like a champ, wasn’t afraid and also asked the doctors some questions.


Leading up to the tracheostomy procedure, Rachana was quite stable and showed improvements.  In the last 2 days her BP has hovering around 130/80 (normal range), her heart rate was between 80-110 (normal), got low grade fever just once, and her breathing had significantly slowed down to about 15-20 breaths per minute, which again is quite normal. Her ventilator settings had been dropping daily and were at 50% O2 and 8 peep. She was was on minimal pain and sedative medicines. All these signs about a week ago would have meant that they would do the breathing tests for a few days and remove the tubes and the ventilator. But because she was already at the 3 week mark, they didn’t have the luxury or monitoring her progress for a few more days, as that would have meant keeping the tubes in her mouth for longer and risk infections and other damage to the throat. The tubes are designed to be in for  about 2 weeks and they were already stretching the regular protocols. The doctors also believed that she will perhaps more than a ‘few days’ for her to get better and get off the ventilator, all leading to the decision of putting in the trach.

Because her platelets were low and they were transfusing it almost every other day, they did not want to take the risk of doing two procedures in the same day, and therefore delayed putting in the feeding tube in her stomach. Typically the tube is put without a incision by using a needle under guiding machine, but there is always the possibility of complications leading to an incision and the surgeons were didn’t want to take that risk immediately after the tracheostomy. So for now she will have a tube going into her stomach through the nose. This will be in place for a few days until they decide to do the procedure to insert the PEG feeding tube, perhaps on Monday.