Ventilation of Neck Breathers Undergoing a Diagnostic Procedure or Surgery

Receiving sedation while undergoing a diagnostic procedure (i.e. colonoscopy) or general anesthesia while undergoing surgery is challenging for neck breathers including laryngectomees.

Unfortunately, most medical personnel including nurses, medical technicians, surgeons and anesthesiologists caring for a laryngectomees before, during, and after surgery are not familiar with their unique anatomy, how they speak, and how to manage their airways. This lack of familiarity is because of the significant success of laryngeal conservation treatment  that has in turn reduced the number of patients undergoing total laryngectomy. As a result many health providers have less contact than ever with laryngectomees. A manuscript explaining the special needs of laryngectomees and other neck breathers is available on this link. 

 Tracheotomy tube

Do front-line emergency staff appreciate the difference between patients with tracheostomy and those who also had laryngectomy?

In an emergency setting it is vital that the medical staff can appreciate the difference between patients who had laryngectomy and are total neck breathers and those who had tracheostomy for another reason and can still breath from their nose.  This is vital so so that oxygen can be administered in an appropriate manner either to the stoma ( in those who are laryngectomees) or to the nose ( in those who are not).  A survey performed in Birmingham England ascertained the level of emergency healthcare personnel's knowledge with regards to distinguishing between a tracheostomy and a laryngectomy patient, and the emergency management of such patients.

Forty-four accident and emergency medical staff (28 doctors, nine nurses and seven paramedics) completed a questionnaire to ascertain (1) their confidence at differentiating between a laryngectomy and tracheostomy stoma; (2) knowledge of the appropriate site for oxygen delivery if needed; and (3) overall level of training on this subject.

The study published in Journal of laryngology and Otology showed that there were significant gaps in knowledge, particularly with regards to fundamental differences between a tracheostomy and a laryngectomy as less than 5 per cent were able to describe the anatomical difference. Only 41 per cent of the participants were able to correctly identified the route of oxygen administration in laryngectomy patients.

The authors concluded that in In this cohort of emergency staff, the fundamental difference between a laryngectomy and a tracheostomy was poorly understood and that this lack of awareness of front-line emergency staff needs to be addressed in order to maximize patient safety.

A video explaining how to recognize and treat total and partial neck breathers is available.