What Is a Tracheostomy?
A tracheostomy is a hole in your windpipe that a doctor makes to help you breathe. You’re usually “asleep” when you get one, though not always, if it’s an emergency.
The doctor usually puts a tracheostomy tube, sometimes called a trach (pronounced “trake”) tube, through the hole and into your lungs.
Tracheotomy (without the “s”) refers to the cut the surgeon makes into your windpipe, and a tracheostomy is the opening itself. But some people use both terms to mean the same thing.
A tracheostomy is usually a temporary solution that helps you breathe more easily while a medical issue -- such as swelling in your airway -- clears up.
Your doctor will usually remove the tube and close the hole once you can breathe on your own. But if there’s serious damage to your windpipe, paralysis of your vocal cords, or a critical situation such as a coma, you may need a tracheostomy for a long time.
Reasons for Tracheostomy
The main reason you would need a tracheostomy is that you can’t get enough air into your lungs. This could be because something in your upper airway is blocking it. The doctor cuts below the injured or blocked part of the airway to get air to your lungs.
You could need a tracheostomy because of:
- A tumor
- Seizing vocal cords
- A spasm of your voice box (larynx)
- Injury to your windpipe or airway
- Swelling of your tongue, mouth, or airway
- Food or something else stuck in your airway
- Severe sleep apnea
- Other illnesses that cause breathing problems
- Surgery on your face or to take out your larynx (laryngectomy)
- Birth defects that affect your airways
Most times, your doctor plans a tracheostomy in advance. But they sometimes need to be done outside a hospital, such as at the scene of an accident. Emergency tracheostomies can be hard and have a higher chance of complications.
In some cases, nothing is blocking your airway, but a serious illness is keeping you from breathing the way you should. If this happens, treatment usually starts with a tube that goes down into the airway through your nose or mouth (intubation). But this can be uncomfortable and may lead to injury, ulcers, and infection if it’s left in too long. So if you’re going to need long-term help with breathing, your doctor may suggest a tracheostomy. This can happen with:
- A massive heart attack
- Damage to the chest wall
- Lung disease
- A spinal cord injury
- A severe allergic reaction
- Problems with the muscle below your lungs that helps you breathe (diaphragm)
- Paralysis or other conditions that make it hard to clear your airways
Your doctor will look at your overall health when deciding whether to do a tracheostomy. They’ll do a physical exam, check how well your neck moves, and learn about your health history.
If there are no issues, the doctor will explain the surgery to you and talk with you about the pros and cons.
There are two ways to do the procedure:
- Surgical tracheostomy. You lie facing up. A nurse cleans your chest and neck with a germ-killing antiseptic. An anesthesiologist gives you general anesthesia to make you sleep so you don’t feel any pain. Once you’re asleep, the surgeon will cut into the skin on the lower half of your neck between your larynx and the top of your chest. They part the muscle below and may need to move or cut the thyroid gland to get to your windpipe. Then, the surgeon cuts a hole in your windpipe and puts in the tube. Stitches, surgical tape, or a Velcro strap will hold it in place.
- Minimally invasive tracheostomy. In a less invasive version of the operation, the doctor threads a special lens through your mouth to see inside your throat so they can make a hole in your windpipe with a needle. This is called a percutaneous tracheotomy.
If it’s an emergency, like when you suddenly can’t breathe at all, you may be awake during the procedure. A doctor or other member of the medical team may do the surgery after injecting drugs to numb your neck.
Expect to stay in the hospital for at least a few days after a tracheostomy. Your medical team will help you manage:
- Your trach tube. You’ll need to know how to clean and change it to avoid problems such as irritation and infection. You may also learn to use a special machine that vacuums material away from your windpipe or throat.
- Speech. You probably won’t be able to speak the way you usually would after your tracheostomy. You might not be able to talk at all. A speech therapist or other health care worker may give you devices or techniques to help you communicate and, as soon as possible, to talk.
- Food. As your tracheostomy heals, it will be very hard to swallow. You’ll probably get your nutrients by IV or through a feeding tube that goes into your stomach.
- Lung irritation. The air that gets to your lungs may be drier because it won’t pass through your moist nose or mouth. That can irritate the tissue inside and cause extra mucus and coughing. Nurses can teach you how to use saline solution, humidifiers, and other methods to help lessen the irritation and loosen the mucus so it’s easier to cough up.
A tracheostomy is a fairly common procedure, and it’s especially safe if it’s done in a hospital. But there can be complications. Risks during or soon after a tracheostomy include:
- Damage to other areas of your neck
- Air trapped in nearby tissues
- A collapsed lung
- Problems with the trach tube
- Blood that collects in your neck and presses on your trachea
Complications that can happen later include:
- Infection around the tracheostomy or in your airways
- Windpipe damage or scarring
- A hole (fistula) between your esophagus and trachea
- Irritation, which can lead to an increase in mucus
If your tracheostomy is temporary, your doctor will decide when to remove the tube and let the opening heal. You may have a small scar.
A permanent tracheostomy tends to narrow over time. You may need to have more surgery to widen it. Your medical team will help you learn how to care for your tracheostomy.
Call your doctor right away if you have problems like unusual pain or discomfort, an uneven heartbeat, or trouble breathing.