Tracheostomy — What Does It Mean?

What is a tracheostomy?

A tracheostomy (tray-kee-OS-tuh-me) is an opening cut into the windpipe, or trachea. It is used as an airway for breathing.  After the opening is made, a small tube is inserted to let air in, and to attach a breathing machine (mechanical ventilator) if needed. Mucus can more easily be coughed up and out or removed with a suction catheter.

Why would someone need a tracheostomy?

Some reasons a person may need a tracheostomy include:

  • Having a breathing tube (endotracheal [end-o-TRAK-eall] tube) for one to two weeks and on a machine that helps a patient to breathe (a ventilator)
  • Having mucus in the lungs and not being able to cough strongly enough to remove it
  • An allergic reaction that has made the airway swell and possibly close
  • Surgery of the head or neck

How is a tracheostomy better than an endotracheal tube?

Advantages of the tracheostomy include:

  • More comfort
  • Easier cleaning of the mouth and face
  • May allow swallowing and the ability to eat and drink
  • May allow speech with the help of a speaking device
  • May help weaning from the ventilator
  • May reduce swelling in the airway and mouth caused by having an endo-tracheal tube in place for a long time

Who will perform the tracheostomy?

A doctor will perform this surgery in the operating room or at the bedside in the intensive care unit.

What happens when the patient doesn’t need the ventilator to breathe anymore?

When someone is “weaned” (able to breathe without the help of a ventilator), the tracheostomy may still be needed for some time to help the patient breathe more easily and cough out mucus.  The patient must be able to cough and breathe deeply before the tracheostomy tube is taken out.

Can a person speak with a tracheostomy?

There are devices that can help some patients speak.  The device can be put over the end of the tracheostomy tube.  When the patient takes a breath, the valve opens to let air into the lungs.  When the patient breathes out, the valve closes.  Then all the air passes through the vocal cords and out of the mouth or nose.  The movement of air through the vocal cords lets the patient speak as long as he or she can take a deep enough breath to push air through the windpipe.

Not all patients who have a tracheostomy tube can use a speaking device.  The patient can be evaluated by the health care team to decide if this is possible.  Specific instructions will be given if the patient is able to use a speaking device.

How is the tracheostomy tube removed?

When the patient no longer needs the tracheostomy tube, the doctor may cover the opening with a plug to test the patient’s breathing for a period of time.  Once the tube is removed, the hole in the skin will be covered with sterile gauze.  The wall of the windpipe and the hole in the skin may close in time.  Occasionally, depending on why the tracheostomy was performed, the hole is permanently left open.  This hole is called a stoma.

Reviewed 2011

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