Tracheostomy

A tracheostomy is a surgical procedure that creates an opening in your neck and into your windpipe (trachea). This opening, called a stoma, allows a tube to be placed directly into your windpipe. This tube helps you breathe when your normal airway is blocked or when you need long-term support from a breathing machine (ventilator).

What is Tracheostomy?

A tracheostomy is a surgical procedure that creates a new pathway for air to enter your lungs. It involves making a small opening, called a stoma, in the front of your neck and directly into your windpipe (trachea). A hollow tube, known as a tracheostomy tube or cannula, is then placed through this opening to help you breathe.

This procedure bypasses your upper airway, which includes your nose, mouth, and voice box (larynx). It is performed by trained medical professionals, often when your natural breathing route is blocked or compromised. The tracheostomy tube can be temporary or permanent, depending on your medical needs. It allows air to go directly into your lungs, making breathing easier and safer in certain situations. Once the tube is in place, it helps to keep your airway open. It can also be connected to a breathing machine (ventilator) if you need assistance with breathing. The tube also provides a way to remove mucus and other secretions from your lungs more easily.

Why it's done

A tracheostomy is performed to help you breathe when your usual airway is blocked or damaged, or when you need long-term support for breathing. It provides a direct route for air to reach your lungs, bypassing any obstructions in your upper airway. This procedure can be life-saving in emergency situations or planned for ongoing medical conditions.

One common reason for a tracheostomy is to provide a clear airway when there is an obstruction above the windpipe (trachea). This blockage might be caused by swelling, a tumor, or a foreign object that cannot be removed easily. For example, severe swelling from an allergic reaction or injury can make it impossible to breathe normally. Another key reason is to provide a safe and stable airway for people who need long-term breathing support from a machine (ventilator). A tracheostomy can be more comfortable and safer than a breathing tube placed through the mouth or nose for extended periods. This is often the case for people with severe lung disease or nerve and muscle problems that affect breathing. Tracheostomies are also performed to help remove secretions from the lungs. Some conditions make it difficult for people to cough up mucus effectively. The tracheostomy tube allows healthcare providers to suction these secretions directly from the windpipe, preventing blockages and infections. It can also protect the lungs from food or liquids entering the windpipe (aspiration) in people with swallowing difficulties.

How to prepare

Preparing for a tracheostomy involves discussions with your medical team to understand the procedure and its purpose. You will likely undergo various tests to assess your overall health and airway. Your healthcare providers will explain what to expect and answer any questions you have, ensuring you are as ready as possible for the surgery.

Before a planned tracheostomy, your doctor will review your medical history and perform a physical exam. You may need blood tests, X-rays, or other imaging scans to get a clear picture of your airway and lung health. It is important to tell your doctor about any medications you are taking, including over-the-counter drugs, supplements, and herbal remedies. Your medical team will discuss the benefits and risks of the procedure with you and your family. They will explain how the tracheostomy will affect your breathing, speaking, and eating. You will have the opportunity to ask questions and express any concerns you may have. If the tracheostomy is an emergency, there may be less time for detailed preparation. However, medical staff will still provide as much information as possible under the circumstances. In both planned and emergency cases, you will be asked to sign a consent form, indicating that you understand and agree to the procedure.

What happens during

During a tracheostomy, you will receive anesthesia to ensure you do not feel pain. A surgeon will make a small incision in the front of your neck, usually below your Adam's apple. They will then create an opening in your windpipe (trachea) and insert a tracheostomy tube, securing it in place to establish a clear airway.

The procedure typically takes place in an operating room. You will be given general anesthesia, meaning you will be asleep and pain-free throughout the surgery. In some emergency situations, local anesthesia may be used to numb the area while you remain awake. The surgeon makes a small horizontal or vertical incision in the lower part of your neck. They carefully separate the neck muscles and tissues to reach the windpipe (trachea). A small opening, or stoma, is then created in the trachea itself. Once the opening is made, the tracheostomy tube is gently inserted through the stoma and into your windpipe. The tube is then secured with sutures (stitches) or a neck strap to prevent it from moving out of place. After the tube is in position, the incision around it may be partially closed, and a dressing will be applied.

Recovery & timeline

Recovery from a tracheostomy involves a hospital stay, during which you will learn how to care for your new airway. Initially, you may experience discomfort, and your ability to speak and eat might be affected. The timeline for recovery varies, but most people spend several days to weeks in the hospital learning to manage the tube and regain strength.

Immediately after the procedure, you will be closely monitored in the hospital. You may feel some pain or discomfort around the tracheostomy site, which can be managed with medication. It is common to have some swelling and redness initially. Your breathing will be carefully observed, and you may be connected to a breathing machine (ventilator) if needed. During your hospital stay, nurses and respiratory therapists will teach you and your family how to care for the tracheostomy tube. This includes how to clean the stoma, change dressings, and suction mucus from the tube. Learning these skills is crucial for preventing complications and ensuring safe breathing at home. Your ability to speak and eat will likely be affected at first. Speech therapists can help you learn techniques to speak with a tracheostomy tube, often using a speaking valve. Dietitians and speech therapists can also assist with swallowing difficulties, gradually reintroducing foods as appropriate. The overall recovery timeline depends on the reason for the tracheostomy and your general health, but it often involves a period of adjustment and learning.

Risks & side effects

Like any surgical procedure, a tracheostomy carries potential risks and side effects, although serious complications are rare. Immediate risks can include bleeding, infection, or damage to nearby structures. Long-term side effects may involve difficulty speaking, swallowing changes, or issues with the tracheostomy tube itself, such as blockages or displacement.

Immediate complications that can occur during or shortly after the surgery include bleeding at the incision site, infection, or damage to the esophagus (food pipe) or nerves in the neck. In rare cases, air can leak into the chest cavity, leading to a collapsed lung (pneumothorax). These complications are usually managed by the medical team. Long-term side effects can include infection around the stoma, which requires careful cleaning and hygiene. The tracheostomy tube can sometimes become blocked with mucus or accidentally dislodged (decannulated), which can be a medical emergency requiring immediate attention. You and your caregivers will be taught how to manage these situations. Other potential side effects include changes in your voice or difficulty speaking, as air no longer passes through your voice box (larynx) in the usual way. Swallowing difficulties are also possible, which may require dietary modifications or therapy. Scarring at the tracheostomy site is common. Your medical team will work with you to minimize these risks and manage any side effects that arise.

Success rate

The success of a tracheostomy is generally high in achieving its primary goal of establishing a clear airway and supporting breathing. While the procedure itself is effective, the overall outcome depends heavily on the underlying medical condition that necessitated the tracheostomy. Many people experience improved breathing and quality of life, though managing the tube requires ongoing care.

A tracheostomy is highly effective at providing an open airway when the natural airway is compromised. For people who need long-term breathing support, it can significantly improve comfort and reduce the risks associated with prolonged intubation through the mouth or nose. The procedure successfully creates the necessary opening in the windpipe. However, the ultimate success in terms of recovery and long-term health is closely tied to the reason the tracheostomy was performed. For example, a tracheostomy for a temporary airway obstruction due to an injury may lead to full recovery and eventual removal of the tube. In contrast, for someone with a chronic, progressive disease, the tracheostomy might be a permanent solution to maintain breathing. While the procedure itself is generally successful in creating an airway, managing the tracheostomy tube and preventing complications like infection or tube blockages is crucial for ongoing success. With proper care and support from healthcare providers, many people adapt well to living with a tracheostomy and experience a better quality of life due to improved breathing.

Frequently asked questions

Can I speak with a tracheostomy?

Yes, many people with a tracheostomy can learn to speak. Initially, it might be difficult because air bypasses your voice box (larynx). However, a speech therapist can help you use techniques, such as a speaking valve, which allows air to pass over your vocal cords, enabling you to produce sounds and speak.

Will I be able to eat and drink normally after a tracheostomy?

Eating and drinking can be challenging at first after a tracheostomy, as the tube may affect swallowing. A speech therapist can assess your swallowing ability and recommend strategies or dietary changes. Many people gradually regain the ability to eat and drink, though some may need continued modifications.

How long does a tracheostomy tube stay in?

The length of time a tracheostomy tube stays in varies greatly. It can be temporary, removed once your underlying condition improves and you can breathe on your own. For other conditions, such as chronic breathing problems or permanent airway obstruction, the tracheostomy may be permanent and remain in place indefinitely.

What happens if the tracheostomy tube comes out?

If your tracheostomy tube comes out (decannulation), it can be a serious situation. If you are trained, you or a caregiver should try to reinsert a spare tube immediately. If you cannot, or if you experience severe breathing difficulty, seek emergency medical help right away. Always have a plan for this possibility.

How do I clean my tracheostomy site?

Cleaning your tracheostomy site (stoma) is vital to prevent infection. Your healthcare team will teach you specific cleaning techniques, usually involving sterile saline solution and gauze. This typically includes cleaning around the tube, changing dressings, and sometimes cleaning the inner part of the tube itself, following your doctor's instructions.

Can I go home with a tracheostomy?

Yes, many people with a tracheostomy return home. Before discharge, you and your caregivers will receive extensive training on how to care for the tracheostomy tube, manage emergencies, and recognize signs of complications. Home care support and follow-up appointments with your medical team are usually arranged to ensure a safe transition.

Sources

• MedlinePlus — Tracheostomy
• Mayo Clinic — Tracheostomy
• Cochrane Library — Tracheostomy