Key takeaways:
A tracheostomy is a small hole in the front of the neck that bypasses the upper airway to allow someone to breathe.
It’s used when there is damage or a blockage to the upper airway that prevents air from reaching the lungs.
Even though the procedure is considered safe, the rate of complications and death can be high.
If you’ve ever wondered why some people have a hole in their neck to breathe, you’re not alone. Chances are, they’ve had an injury or blockage to their airway above the chest. This prevents air from reaching the lungs. When this happens, a person needs a tracheostomy to breathe.
Let’s take a closer look at situations when a tracheostomy may be used and how it works to help you breathe.
A tracheostomy (trach) is a small hole in the front of the neck. It allows air to move into the lower part of the windpipe and lungs without passing through the nose or mouth. A surgeon creates a tracheostomy by cutting through the skin of the neck into the front part of the windpipe. They will then place a “trach tube” in the hole to keep it open so that air can flow through.
The procedure is usually done while someone is asleep under general anesthesia, unless it’s an emergency. When someone needs airway access urgently, local anesthesia may be used to quickly numb the area before the procedure.
There are many reasons a tracheostomy might be necessary. They can include emergency and elective (planned) reasons.
A person’s airway might suddenly become blocked, preventing air from getting into the lungs. In these cases, a tracheostomy may be a lifesaving measure. Medical emergencies that might require a tracheostomy include:
A sudden swelling of the airway that prevents a breathing tube from being placed in the throat by intubation, like from severe cases of allergic reaction (anaphylaxis) or swelling under the skin (angioedema)
Severe head or neck trauma
Choking on something stuck in your windpipe (foreign body aspiration)
Sometimes a person or their family might plan a tracheostomy to improve their quality of life or make caring for the person easier. Some of the reasons for an elective tracheostomy include:
Needing to be on a ventilator for a long time
Expecting upper airway damage to happen (after radiation for certain types of head and neck cancer)
Severe sleep apnea, when routine treatments aren’t working
Chronic aspiration, which is when someone regularly inhales food, drink, or saliva into their windpipe
A narrowing of the windpipe (subglottic stenosis)
Neuromuscular disease, like amyotrophic lateral sclerosis (ALS)
In a tracheostomy, a tube is placed through the tracheostomy incision, directly into the windpipe. It is held in place inside the windpipe, or trachea, with an inflated balloon. The tube outside the body is taped in place.
A tracheostomy allows air to move into the lungs without going through the mouth or nose. If needed, the tracheostomy tube can be connected to a ventilator to help with breathing. If the person can breathe on their own, air will be pulled into the lungs every time they take a breath, bypassing the upper airway.
Tracheotomy is considered a safe and effective procedure with a low rate of serious complications. And in emergency situations, a tracheostomy can mean the difference between life and death.
With trained providers performing the procedure, tracheostomy is almost always successful. The risk of death is as high as 2% in adults, but it can be higher in small children and critically ill people.
Complications of tracheostomies can happen immediately during the procedure. Or they can happen anytime after the tube is placed. They can be minor or life-threatening.
Immediate complications of a tracheostomy may involve:
Bleeding
Lung collapse (pneumothorax)
Air underneath the skin (subcutaneous emphysema)
Nerve damage
The tracheostomy tube becoming blocked or accidentally displaced
Complications of a tracheostomy that may develop later include:
Infection (skin infection, pneumonia)
Scarring of the windpipe
Excess mucus production
Changes in voice, taste, or smell
Difficulty swallowing
There is also a risk of a breakdown of the tissues around the tracheostomy tube, causing a fistula to form. This can cause an abnormal connection between the tracheostomy and nearby structures like the esophagus.
In general, people who need to have a tracheostomy have very serious medical conditions. But the life expectancy of someone with a tracheostomy will depend on the underlying reason it was needed. For example, if a tracheostomy was placed because of a severe allergic reaction or choking, they can make a full recovery quickly. And the tracheostomy can be removed as soon as the airway is clear.
The outcome is less certain, though, if someone needs a tracheostomy for long-term conditions. Some people can live many years with a tracheostomy. But one large study found the risk of death 1 year after a tracheostomy was about 35% for people under 65 years old. For people over 65, the risk was greater than 50%. Most people over age 65 lived 6 months after the procedure.
After having a tracheostomy placed, most people will need to stay in the hospital for at least a few days. If there are no complications from the tracheostomy placement, it will take about a week for the incision to heal.
It can take a couple of weeks to get used to living with a tracheostomy. Speech and occupational therapists may be able to help with feeling more comfortable with speech, swallowing, and breathing.
For some people, a tracheostomy is permanent. For others, once the reason for the tracheostomy resolves, the tube can be removed. The tracheostomy site will need to be covered with sterile dressings until it closes and is airtight.
Depending on how long the tube was in place, it can take up to 3 weeks for the site to close. Pressure will need to be applied to the bandage to cough and speak until the wound is completely healed.
A tracheostomy can be a life-saving procedure. It allows someone to breathe when they have a condition affecting the upper airway that prevents air from reaching the lungs. It is considered safe and has a high success rate, especially in an emergency. Some people have to learn how to live with a tracheostomy long term, while others can eventually have it removed. If someone you know has had a tracheostomy, speak with their healthcare team about recovery options.
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