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What Is a Tracheostomy?
A tracheostomy is an artificial airway that allows passage of air directly
into the trachea to the lungs, bypassing the mouth and pharynx.
Air is normally inhaled through the nose and mouth and passes
through the trachea (the “windpipe”), which branches into the main Tracheostomy is a surgical procedure
in which a breathing tube is placed in the
bronchi and enters the lungs. Patients who are ill and not able to trachea through a small incision
breathe on their own or who have head and neck cancer obstruct- in the front of the neck.
Thyroid
ing their airway may require a breathing tube. There are 2 main types
Incision
of breathing tubes: an endotracheal tube and a tracheostomy tube.
An endotracheal tube is typically inserted through the mouth
Trachea TONGUE
or nose, and the tip sits within the trachea. Patients who receive
this type are connected to a machine called a ventilator that helps
Vocal cords
them breathe. Prolonged intubation with an endotracheal tube
predisposes patients to complications such as pneumonia and Trachea

narrowing of the trachea (tracheal stenosis). Long-term use of an Esophagus

endotracheal tube through the mouth or nose is not comfortable,
and patients are not able to talk while it is in place. Under most
circumstances, patients are not able to go home with an endo-
tracheal tube because they must be connected to a ventilator
at all times.
A tracheostomy tube (“trach”) is considered when intubation
is expected to last more than 1 or 2 weeks. A tracheostomy tube is
very short and wide and is surgically placed directly into the tra-
chea. It can be connected to a ventilator to assist with breathing or
may be open to air to bypass an obstruction. This avoids having a
tube in the nose or mouth, which makes patients more comfort-
able and decreases risk of pneumonia. The risk of tracheal stenosis
is lower with a trach compared with an endotracheal tube. Most
importantly, patients can be weaned from a ventilator faster with a
trach than with an endotracheal tube. As the ability to breathe
improves, patients may be disconnected from the ventilator while
the trach remains in place. If they need help breathing again, they
may be reconnected at any time. A trach that is open to air can be
very discreet and can be hidden under clothing.
Tracheostomy Tube Placement
A tracheostomy requires a surgical procedure under anesthesia in
the operating room or the intensive care unit by a surgeon, pul-
monologist, or intensive care physician. The operation involves
making a 1-inch cut in the middle of the neck through the skin and
in between the cartilage rings of the trachea. The tracheostomy
tube is then inserted into the trachea as the existing endotracheal
tube is slowly pulled out from the nose or mouth. The trach is
then secured in place while the wound heals. As a patient’s
breathing improves, the trach tube may be exchanged for smaller
sizes until it is eventually capped, allowing patients to breathe
through the mouth and nose. When the trach is no longer
needed, it can be removed, and the hole will heal by itself or can
be closed surgically.
Breathing tube
Inflatable cuff
Tracheostomy breathing options
The breathing tube can be connected to a
ventilator when necessary or left open for
a patient to breathe on their own.
Special Considerations
Tracheostomy tubes may be temporary or permanent. When patients
can breathe on their own without the help of a machine, a Passy-Muir
valve can be placed. This allows patients to talk with the tracheostomy
tube in place. Alternatively, once the tracheostomy tube has been
reduced to a small size, a patient may speak by occluding it with a
finger, given proper safety training.
The hole connecting the skin to the trachea needs to heal for a
few weeks after surgery. If the tracheostomy tube is dislodged dur-
ing this period, immediate attention by a health care professional is
warranted. After the initial healing period, the tracheostomy tube
can be removed, cleaned, and replaced by a patient or caregivers.
Minor bleeding from a tracheostomy tube may be caused by
physical trauma from suctioning. However, recurrent or major
bleeding can be a warning sign of a serious problem and should be
immediately evaluated by a physician.
FOR MORE INFORMATION
Mayo Clinic
https://www.mayoclinic.org/tests-procedures/tracheostomy/
about/pac-20384673

Authors: Ioana Baiu, MD, MPH; Leah Backhus, MD, MPH
Author Affiliations: Stanford University, Stanford, California.
Conflict of Interest Disclosures: None reported.
Source: Engels PT, Bagshaw SM, Meier M, Brindley PG. Tracheostomy: from insertion
to decannulation. Can J Surg. 2009;52(5):427-433.
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