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Tracheostomy

  • A procedure that makes an opening in the neck in order to place a tube into the windpipe
  • A temporary or permanent solution for people with damaged tracheas, which can block air flow
  • This procedure is relatively simple and safe, and easy to reverse
  • Involves otolaryngology, surgery

Overview

You might not think about your throat as often as you do other parts of your body, but it’s important for many daily functions, including speaking and breathing. Central to a lot of these function is the trachea, a large membranous tube reinforced by rings of cartilage, that connects the voice box to the lungs. If the trachea is damaged or blocked, it could block airflow from your mouth to your lungs. One solution to this problem is a tracheostomy. A tracheostomy is a temporary or permanent opening surgically created through the neck into the trachea (or windpipe) where a tube is then placed so that the patient can breathe. The procedure is also called a tracheotomy, but both terms are often used interchangeably. 

“A tracheotomy may seem scary to some patients, but they’re relatively simple and safe to insert and even easier to remove when no longer needed,” says Saral Mehra, MD, an otolaryngologist (ear, nose and throat specialist) at Yale Medicine.

Who needs a tracheostomy?

There are three major reasons why someone may need a tracheostomy, says Dr. Mehra. They include: 

  • To help patients loosen and remove mucus or phlegm from the bronchioles to the upper airways to prevent lung infections. A tracheostomy allows doctors to insert a suction catheter into the lungs to remove mucus. 
  • If a patient has been on prolonged ventilation through a tube in the mouth, a tracheostomy tube in the neck may allow the patient to be wide awake and more comfortable as they work towards becoming unhooked from the ventilation equipment and breathe on their own.
  • If a patient has an obstructed upper airway because of a tumor, inflammation, infection, or other blockage, a tracheotomy can easily and safely deliver oxygen directly to the lungs, bypassing the obstruction.

What should I expect during a tracheostomy?

There are two types of tracheostomies—surgical tracheostomies and percutaneous tracheostomies. To create a surgical tracheostomy, a surgeon makes a cut through the lower front part of your neck and then another into your trachea, or windpipe. A tube is then placed through the hole and into the windpipe. Held in place with stitches, surgical tape or a Velcro band, the tube will help keep the hole open. The procedure to make a tracheostomy usually takes between 20 and 45 minutes.

During a percutaneous tracheostomy, the doctor will insert a needle through the lower front part of your neck and into your trachea followed by a small incision. Then, a catheter is threaded through the needle into the windpipe, and the opening is successively dilated until a tracheotomy tube can be inserted over the catheter. Percutaneous tracheostomies are generally considered less invasive than surgical tracheostomies, but can only be done safely in the properly chosen patient. 

What are potential complications from a tracheostomy?

Complications from tracheostomies are rare, especially because our doctors have so much experience performing them. However, the two complications doctors see most often are profuse bleeding or a dislodged tracheotomy tube. Yale Medicine doctors address severe bleeding immediately with anti-hemorrhagic dressing to stem the blood. Our doctors also take extra precautions to prevent the tube from falling out typically by suturing the tube in four quadrants and tying it in place.

What is it like to live with a tracheostomy?

Most patients who receive tracheotomies are being treated for severe illnesses in the intensive care unit. As patients continue to be treated and become healthier, the tracheotomy tube is removed as soon as possible. Removing the tube usually requires changing the tube to a smaller tube. The patient then starts capping trials where the tracheotomy tube is capped and the patient observed. Once the patient successfully passes capping trials, the tracheotomy tube is removed at the bedside and a small bandage is placed over the hole in the neck and it closes on its own.  In some cases, patients leave the hospital with a tracheotomy tube and are educated on keeping it clean and managing the tube. 

You also won’t be able to speak right after the procedure because the trach tube prevents air from the lungs from flowing over the voice box. Over time, once a smaller tube is placed, it is possible to eat speak with a tracheotomy tube.

How does Yale Medicine approach tracheotomies differently from others

At Yale Medicine, our doctors are both experienced and invested in making patients feel comfortable. We care a lot about our patients’ well-being and quality of life. Our surgeons and otolaryngologists perform hundreds of tracheostomies a year and work both quickly and safely. “We have in-house residents and doctors on-call to help troubleshoot,” says Dr. Mehra. “We do so many of these that for us it’s like doing an IV.”

At the same time, Yale Medicine doctors care deeply about their patients. They work with each person to determine the treatment plan and type of tube that will suit them the best. “In cases where the tracheotomy tube is temporary, our doctors try to create a plan to remove the tracheostomy tube as quickly as possible to restore quality of life,” says Dr. Mehra.