What Is a Tracheostomy?

A tracheostomy is an opening in the front of the neck that’s made during an emergency procedure or a planned surgery. It makes an airway for people who are not breathing on their own, cannot breathe well, or have a blockage that is affecting their breathing. Sometimes people who have a disease, such as cancer, may need a tracheostomy if their disease is expected to soon cause breathing problems.

During a tracheostomy procedure, an opening is made in the trachea (windpipe). A tube is then inserted into the trachea through the opening. The person then breathes through the tube.

A tracheostomy may only be needed for a short time (temporary), but sometimes a tracheostomy may be needed for the rest of a person's life (permanent):

• A temporary tracheostomy may be used when there is a blockage or injury to the windpipe. It can also be used when a person needs to be on a breathing machine (ventilator), such as for severe pneumonia, a major heart attack, or stroke.
• A permanent tracheostomy might be needed if part of the trachea needs to be removed because of a disease such as cancer.

A tracheostomy is often considered a "percutaneous" procedure, meaning it can be done without the need for open surgery. For patients who are the emergency room or a critical care unit where they can be watched closely, a tracheostomy is often done as a "bedside procedure" right in the room. It can also be done as part of a planned surgical procedure when other problems are being taken care of, such as during cancer surgery.

When you look at a tracheostomy opening (stoma), you may see part of the trachea lining (the mucosa), which looks a lot like the inside lining of your cheek. The stoma will look like a hole in the front of your neck, and may look pink or red. It’s warm and moist and secretes mucus.

What does a tracheostomy do?

It’s important to know a tracheostomy affects the trachea (windpipe). It's different from a laryngectomy, which affects the larynx (voice box). A tracheostomy is done to help someone breathe while a laryngectomy is done when the larynx needs to be removed and separated from the airway.

Usually, air needed for breathing is inhaled (enters) into the nose or mouth, goes through the trachea, and then into the lungs. Then it is exhaled (exits) from the lungs, back through the trachea, and out the nose or mouth.  

With a tracheostomy, if a person’s lungs still work well, they breathe through the tube that’s directly in the trachea instead of breathing through the nose or mouth. But if a person’s lungs are not working well, or if the muscles or nerves that help with breathing are affected by a disease, a breathing machine is used to help push air in and out of the tracheostomy tube.

Types of tracheostomies

Depending on the problem being treated, a tracheostomy can be either temporary or permanent.

If the plan is for a tracheostomy to be temporary, how long it is left in place depends on why it was done and how long that problem will take to get better. For example, if a tracheostomy is needed because radiation therapy is expected to damage the trachea, the trachea will need to heal before the tracheostomy can be removed. Or if a patient needs help from a breathing machine, the problem that caused the tracheostomy will need to heal or be fixed before the tracheostomy can be removed. If the tracheostomy was done due to a blockage, injury, or disease, the tube will probably be needed for an extended period of time.

A tracheostomy could possibly be in place for the rest of the patient’s life, if part of the trachea needed to be removed or if the problem doesn’t get better.

A tracheostomy tube is either cuffed or uncuffed. The cuff is a seal that inflates inside the trachea to block air from leaking around the tube. It forces all air going in and out of the lungs to go through the tube, and stops saliva and other liquids from accidentally reaching the lungs.

• A cuffed tube is often used when a patient is on a ventilator or needs help from a breathing machine. The cuff pressure is monitored by the health care team and adjustments are made to the breathing machine as needed.
• Uncuffed tubes are used for patients who do not need a ventilator or help from a breathing machine. With an uncuffed tube, some air can still flow around the tube and up through the trachea to the larynx.

A tracheostomy may or may not have an inner cannula, depending on the type you have and the reason it’s been done. An inner cannula is a liner that can be locked into place and then unlocked so it can be removed and cleaned.