As the American Cancer Society (ACS) explains, a tracheostomy is an opening that is made in the front of the neck to create a separate airway to give someone an alternative way to breathe. A tube is inserted into the opening that serves as the airway.
The term “tracheostomy” describes what the procedure is: An “ostomy” is an “artificial opening,” while the “trach” part refers to the trachea, or windpipe, which is an airway into the lungs.
There are two types of tracheostomy tubes: cuffed or uncuffed.
Cuffed tracheostomy tube
Cuffed tubes are used when someone is on a breathing machine and being monitored by a healthcare professional.
The cuff is the seal that will inflate to keep air from leaking out around the tube. When it is inflated, air is forced to go through the tube instead of going to the lungs. It also prevents anything else, including saliva and food, from accidentally getting into the lungs.
Uncuffed tracheostomy tube
An uncuffed tube is used if the person with the tracheostomy does not need a breathing machine. Because the tube is uncuffed, some airflow will go around the tube.
In some cases, chronic aspirators may have a cuff that is kept inflated even if the person does not need a ventilator.
Some tracheostomies may also have an inner cannula, which is often locked into place to make cleaning easier.
A tracheostomy is typically needed either temporarily or permanently. The ACS explains that a temporary tracheostomy is sometimes needed in someone who has to be on a ventilator because of a heart attack, a stroke, or severe pneumonia.
Tracheostomies are sometimes recommended for people who are critically ill with COVID-19 and require ventilation.
A permanent tracheostomy is sometimes necessary for someone who has had a medical condition, such as cancer or an injury, though this is not always the case. They are most commonly used when there is a prolonged need for a ventilator without a likelihood of coming off of it for any reason.
In infants, prematurity and lung disease of prematurity are the most common reasons to need a tracheostomy.
A tracheostomy is a possible necessity in the following situations:
- having been intubated for a very long time
- an inability to be intubated
- needing to wean off of a ventilator
- needing to manage lung secretions
- airway obstruction
- severe obstructive sleep apnea
- vocal cord paralysis
- head and neck injuries
- needing to protect the airways
A surgeon may perform a tracheostomy during a planned surgery, in which the person undergoing the procedure is under anesthesia. If they receive a local anesthetic, they will be awake for the procedure. The surgeon will make an opening in the trachea, then insert a tube that connects through the neck outside.
Additionally, a tracheostomy is sometimes done as a bedside procedure, which may be necessary in an emergency. This means that the procedure is performed right in the person’s room. For people with COVID-19, bedside tracheostomies can help minimize the spread of the virus.
Whether the procedure takes place in the person’s room or in the operating room, medication is typically administered to ensure that the person does not experience pain. However, there can be instances when someone is in acute distress, and the healthcare professional has to perform a tracheostomy immediately without any medication.
No matter how the procedure is performed, it allows the person to breathe through the neck opening as they would through their mouth or nose. Alternatively, if the person’s lungs are not working correctly — such as if they are on a ventilator — the breathing machine will push air out through the tracheostomy.
Tracheostomy complications typically occur at three specific times:
- immediately (during the procedure)
- early (within 7 days of the procedure)
- later (after 7 days following the procedure)
Immediate complications of a tracheostomy
Early complications of a tracheostomy
- excessive bleeding
- a collapsed lung
- problems with swallowing
Later complications of a tracheostomy
- a tracheoesophageal fistula
- problems with swallowing
- an infection
- a tracheo-innominate fistula
- accidental decannulation
- mucus plugging the tube
What happens after a tracheostomy depends on why the tracheostomy was performed. For instance, if the tracheostomy is temporary, the care team will make a plan to help the trachea heal before the tracheostomy is removed.
The amount of time required for the healing of the trachea depends on how long it has been in place. If it has been in place for a long period of time, there is a high risk of it requiring surgery to close it fully.
If the tracheostomy is permanent, a medical professional will provide training on how to care for and live with it. If the person has a caregiver, this training is typically given to the caregiver.
When a child requires a permanent tracheostomy, more than one caregiver will likely receive this training.
Specific care for the tracheostomy will also depend on the exact type, what other medical conditions are present, and how capable the individual is of caring for themselves. Here are some general tips for living with a tracheostomy:
- Clean the skin around the tracheostomy two or three times per day.
- Suction the tracheostomy tube regularly to remove accumulated mucus.
- Inspect the mucus color and watch for symptoms of an infection, such as color changes in the mucus.
- Keep the tracheostomy covered with a waterproof cover when taking a shower or around water.
- Change the tube every 1–3 months or weekly, depending on the instructions given by your healthcare professionals.
- Always have a replacement tube available in case of an emergency.
- Speech, physical, and occupation therapy are sometimes needed to learn how to talk and eat with a tracheostomy.
The following are some other questions that people asked about tracheostomies. Dr. Nicole Aaronson, M.D., has provided the answers.
How long can you live with a tracheostomy?
Some people will have a tracheostomy for the rest of their lives. Others will be decannulated. There is no maximum length of time. The reason for the tracheostomy typically determines how long it will need to remain in place.
Can you speak with a tracheostomy?
It is possible to speak if a speaking valve cap is being used on the tracheostomy and if the vocal cords are otherwise intact. A speaking valve is a one-way valve that allows air to come in through the tracheostomy but that closes on exhalation, forcing the air up through the vocal cords.
Is a tracheostomy better than a ventilator?
A tracheostomy allows a better ability to suction the airways, whether or not a ventilator is needed. Being off the ventilator allows the person more mobility and the ability to undergo physical therapy and occupational therapy in the move toward recovery.
Why do people with COVID-19 get tracheostomies?
Some of these reasons are the same as for other people with prolonged intubation. Reduced trauma to the larynx from having a breathing tube in place, an improved ability to suction the airways, decreased sedation needs (as endotracheal tubes are uncomfortable), and an improved ability to participate in rehabilitation or therapy are all important benefits.
A tracheostomy is an artificial airway that connects the trachea to the outside to allow someone to breathe.
It is typically temporary or permanent, depending on the reason it is required. If the tracheostomy is permanent, a medical professional will provide training and care tips to the person with the tracheostomy or their caregiver.