Tracheostomy Is Commonly Used to Assist Elderly With Breathing
A tracheostomy like that undergone by Pope John Paul II on Thursday is a relatively common procedure among the elderly who are sick and having difficulty breathing, experts said Thursday, and it can be even more beneficial to Parkinson’s disease patients, such as the pontiff, whose breathing is already impaired.
“The immediate benefit is that it reduces the amount of air you have to move [with your lungs] with every breath by 50%,” said Dr. Dale Rice, an ear, nose and throat specialist at USC’s Keck School of Medicine. “That decreases the work of breathing pretty significantly.”
Others speculated, however, that the primary motivation for performing the tracheostomy on the pope was to ease or eliminate the choking sensations he has been experiencing. That in turn would help prevent the development of aspiration pneumonia, a serious disease that develops when fluids from the oral cavity enter the lungs.
“I’m not sure [easing] breathing is the primary motive in this case,” said Dr. Zab Mosenifar, director of pulmonary and critical care at Cedars-Sinai Medical Center in Los Angeles. “I think they are trying to prevent pneumonia.”
In either scenario, the pope’s underlying disease is most likely at the root of his problems. Even when Parkinson’s patients do not have the flu or pneumonia, they have more difficulty breathing than others of their age, said Dr. Jeff Bronstein of UCLA. Their chest muscles are weakened, their muscle responses are slower, their stooped posture compresses their lungs, and their decreased lung capacity makes breathing deeply much harder, he said.
By making a small opening in a patient’s neck and trachea, or windpipe, physicians create a much shorter route from the lungs to the outside air, minimizing the effort required to breathe. If breathing remains a problem, the tracheostomy tube in the opening can be attached to a respirator.
The muscle problems associated with Parkinson’s also make it more difficult for patients to cough up fluids that collect in the throat, increasing the likelihood that the fluids will seep into the lungs and cause infection. The inflatable cuff that holds the tracheostomy tube in place blocks the trachea, Mosenifar said, preventing that from happening.
The tube also makes it easier to suction out mucus and fluids that may build up in the throat, said Dr. Barbara Paris of Maimonides Medical Center in New York. Physicians can insert a smaller tube through the tracheostomy tube, rather than having to go through the nose, as they would if the tracheostomy had not been performed.
Although a tracheostomy is considered a safe procedure, some risks are associated with the 30-minute surgery, particularly during and immediately afterward. Foremost among them are excessive bleeding and an increased risk of infection. There is also a small chance of the tube pushing air into the chest cavity, which would compress the lungs and make breathing even more difficult.
Eating is compromised by the tube because the patient cannot swallow. Some nutrition can be given intravenously, but the more likely approach is to insert a tube through the nose and into the stomach so liquid food can be given. For a long-term tracheostomy, a tube may be inserted through the abdomen into the stomach, a procedure that is ultimately more comfortable for the patient.
Although the pope will probably be told not to talk for a day or two to give his throat time to recuperate, he eventually should be able to converse with minimal difficulty. Speech is possible when the tube is physically blocked. If the tube is left in for a long time, a valve can be installed so that the patient can speak more easily.
Generally, the tube is left in place five to seven days, usually enough time for the problem to be resolved. But if physicians have inserted it to prevent choking and pneumonia, Mosenifar said, it will probably be left in permanently.
