Tracheostomy: Why It’s Done and What to Expect
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What Is a Tracheostomy?

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Updated on October 8, 2024
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A tracheostomy is a small hole that’s surgically made at the front of the neck and into the windpipe, or trachea. It helps the lungs fill with air and may be performed when an obstruction or medical condition prevents breathing.

Overview

What Is a Tracheostomy?

A tracheostomy is a surgically created hole running through the front of the neck and into the trachea. A small tube is placed here to keep the airway open so you can breathe.

The term “tracheostomy” refers to the opening made in the trachea, but the procedure in which this is done is called a “tracheotomy.” Sometimes the two terms are used interchangeably.

Depending on the reason for a tracheotomy, the tracheostomy itself may be temporary or permanent. A permanent tracheostomy may be needed if part of your voice box (larynx) is removed due to conditions such as cancer.

There are two types of tracheotomies: open or percutaneous.

 In non-emergency tracheotomies, technique choice depends on a patient’s physique and ability to hyperextend their neck. The severity of respiratory disease is also an important variable.

Open Tracheotomy

In an open tracheotomy, a surgeon makes a small horizontal cut at the front of the neck. After exposing the neck muscles and cutting into the windpipe, a tube is inserted into the tracheostomy hole.

Percutaneous Dilatational Tracheotomy 

A percutaneous dilatational tracheotomy is minimally invasive. It still requires a small incision, but a practitioner doesn’t cut into the windpipe.

Instead, a camera is inserted into the mouth to visualize the inside of the trachea (windpipe). Then, a needle is used to create an opening in the windpipe. This opening is dilated to place the tracheostomy tube.

A percutaneous tracheotomy may have lower rates of infection and scarring than an open tracheotomy.

However, according to research, there’s no difference in mortality or severe adverse effects between open and percutaneous tracheotomies.

 In addition, both types involve a long-term concern for tracheal stenosis,

 a narrowing of the trachea that can be caused by inflammation, making it harder to breathe.

Who Typically Needs a Tracheotomy?

A tracheotomy may be necessary if you have:

  • Blocked airways due to secretions or large objects
  • Long-term use of ventilators, which are breathing machines that help people breathe by supplying oxygen through a tube

  • Neck tumors
  • Chronic pulmonary (lung) disease
  • Neuromuscular diseases that affect the breathing muscles
  • Narrowing of the airway between the trachea and vocal cords
  • Facial burns
  • Allergic reaction that prevents breathing
  • Neck, mouth, or spinal cord injury
  • Paralysis of the vocal cords
  • Obstructive sleep apnea
Tracheostomies are usually temporary but may be long-term or even permanent in some cases.

Sometimes, tracheotomies are performed in emergency situations if the airway is blocked and a breathing tube can’t be inserted through the mouth.

How Is a Tracheotomy Performed?

A tracheotomy is typically performed in an operating room. General anesthesia is usually used to put you to sleep, and the surgeon may also apply a local anesthetic (numbing agent) to the front of the neck.

Tracheotomies can be performed differently, depending on the type:

  • Open Tracheotomy A traditional surgical tracheotomy, which is performed by a surgeon, involves a horizontal incision in the lower part of the neck. Then, the neck muscles are pulled back and a small cut is made through the thyroid gland, exposing the trachea and allowing the surgeon to make the tracheostomy hole.
  • Percutaneous Dilatational Tracheotomy A percutaneous (minimally invasive) tracheotomy can be performed bedside by two physicians, which may include a surgeon and a critical care physician or pulmonologist. One physician will make a small incision. The other will insert a lens into the mouth to visualize the trachea, which helps them guide a needle into the windpipe to make the tracheostomy hole. This hole is dilated sequentially until it’s large enough to place a tracheostomy tube.

After the tracheostomy hole is created, the physician will insert a catheter called a tracheostomy tube, or "trach” tube. This provides an airway and helps remove secretions from the lungs.

If a patient cannot breathe on their own, the tracheostomy tube will be attached to a ventilator. In these cases, a cuff may be used. A cuff is a seal that prevents air from leaking out around the tube. It also helps ensure saliva or other liquids stay out of the tracheostomy tube.

How Do I Prepare for a Tracheotomy?

Surgical tracheotomies are performed with general anesthesia. In such cases, a doctor will ask that you not eat or drink anything for several hours beforehand.

Additionally, let your doctor know about any medications you take, as they may ask to stop taking certain ones.

You will also need to prepare for an extended stay at hospital, which can last for several days after surgical tracheotomies. Consider packing a bag with comfortable clothes, blankets, personal care items, and reading materials.

In cases of an emergency tracheotomy, there may not be any time to prepare.

What Should I Expect During a Tracheotomy?

A tracheotomy can last 20 to 45 minutes.

During a surgical or open tracheotomy, you’ll be sedated with general anesthesia in an operating room.

 After you’re asleep, your care team will clean the surgical area and put your neck into the proper position before making an incision.

A percutaneous tracheotomy may be performed at your bedside in the hospital

 with general anesthesia.

After the tracheostomy is done, a tube will be inserted, which may be secured with tape or stitches.

You’ll also receive nutrients through an intravenous (IV) line or a feeding tube.

If you can’t breathe on your own, your physician may attach the tracheostomy tube to a ventilator. A seal, or cuff, will be applied to prevent air leakage.

What Are the Potential Risks Associated With a Tracheotomy?

Outside of emergency care settings, risks from this procedure are more likely to develop during or after surgery.

Any surgery with anesthesia carries risks. For tracheotomies, these risks include:

  • Bleeding
  • Nerve injuries in the neck
  • Damage to your trachea, esophagus, or thyroid gland
  • Air trapped around your lungs (pneumothorax) or beneath your neck (subcutaneous emphysema)

  • Hematoma in the neck, which is a small collection of blood that can cause breathing problems due to pressure against your trachea

  • Accumulation of mucus or blood that becomes trapped in the tracheostomy tube

What Type of Care Is Needed Following a Tracheotomy?

Overall, it takes about two weeks to recover from a tracheotomy.

After receiving a tracheotomy, you will recover in the hospital for several days. During this time, your care team will show you how to:

  • Clean your tracheostomy tube to help prevent infections.
  • Redirect airflow to speak with your tube in place. In some cases, a speech therapist may help.
  • Use a saline solution into the tracheostomy tube to help cope with breathing in dry air.
  • Use suction machines to clear mucus from your airways.
  • Eat and swallow solid foods once your feeding tube is removed.
You will also need to change the tracheostomy tube within one week of your surgery. After this point, it may be changed every 7 to 14 days to help reduce buildup.

 A medical team will help you do this.

What Are the Possible Complications and Side Effects of a Tracheotomy?

Certain complications can occur during or after surgery. These include:

  • Tracheostomy tube obstruction or displacement from your trachea
  • Narrowing or scarring of the trachea from damage during tracheotomy
  • Development of abnormal passageways called fistulas, which are located between the trachea and your esophagus
  • Dried secretions and mucus that block the tracheostomy
  • Infection near the tracheostomy
  • Infection in the lungs (pneumonia) or trachea
While the procedure itself is generally considered safe, the chances for side effects and complications are greater in emergency situations.

After you’ve been discharged from the hospital, call your doctor immediately if you have:

  • Difficulty breathing
  • Increased pain
  • Redness or swelling near the tracheostomy tube
  • Bleeding near the tracheostomy tube
  • Noticed the tracheostomy tube changed position

What’s Next

When you have a tracheostomy tube, you might not be able to speak. In these cases, a speech therapist can help you use a special device to learn how to speak again. They can also teach you how to swallow and eat solid food once the feeding tube is removed.

Most tracheostomies are temporary, so you’ll need to follow up with your doctor to determine when the tracheostomy tube can be removed.

If a tracheostomy hole doesn’t heal on its own, you may need additional surgery to close it.

A tracheostomy itself doesn’t shorten your life span, and having this procedure may extend your life, depending on the reason for the tracheotomy.

The Takeaway

A tracheostomy is a small hole made through your trachea to help you breathe. This opening, which is performed in a procedure called a tracheotomy, may be needed if the airway is compromised or if you have a medical condition that prevents breathing. Talk to your doctor about the risks and benefits of this potentially life-saving procedure.

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Jessica Lee, MD

Medical Reviewer
Castle Connolly Top Doctor, Member of American College of Lifestyle Medicine
Jessica Lee, MD, practices general otolaryngology at Charleston ENT and Allergy in South Carolina. After several years in clinical and surgical practice, Dr. Lee wanted to learn more about the impact of nutrition, activity, and sleep on general health and ear, nose, and throat health, so she pursued additional training in integrative, lifestyle, and functional medicine topics and became board-certified in lifestyle medicine in 2021.

Her practice centers on first addressing the lifestyle causes of disease and chronic illness, with the understanding and ability to use medical and surgical care for more acute concerns. She is also the co-founder and director of the Keto Hope Foundation, a nonprofit dedicated to helping families use the ketogenic diet as medical treatment for epilepsy

Lee enjoys cooking, strength training, reading, and spending time with friends and family.
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Kristeen Cherney, PhD

Author
Kristeen Cherney, PhD, is a freelance writer, essayist, author, and poet with more than 15 years of health writing experience for digital platforms such as Healthline, The Mighty, and LiveStrong. She’s covered nutrition, women’s and children’s wellness issues, as well as specialized topics ranging from diabetes and thyroid disease to anxiety, depression, asthma, allergies, and skin conditions.

With a doctorate in English (rhetoric and composition), Dr. Cherney focuses her academic scholarship on the intersection between disability and literacy. She also holds a Master of Arts in English and a Bachelor of Arts in communication.

Cherney has contributed to the books The Wiley Handbook on Violence in Education: Forms, Factors, and Preventions, Composing in Four Acts: Readings for Writers, and Georgia State University's Guide to First-Year Writing, as well as to scholarly journals like Praxis, the Journal of Teaching Writing, and the Journal of Dracula Studies.

Cherney enjoys running, meditating, hiking, and paddleboarding.
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