What is a Tracheostomy?
A tracheostomy is a medical procedure that creates an opening in the neck below the vocal cords through which a tube is inserted into the windpipe (trachea). This allows air to enter the lungs directly, bypassing the nose, mouth and throat.
The tube can be temporary or permanent, depending on the patient's condition.
Why is a Tracheostomy Needed?
- Prolonged need for a ventilator — typically more than two to three weeks
- Airway obstruction or narrowing (e.g. vocal cord paralysis, throat cancer)
- Inability to clear secretions independently, requiring direct tracheal suctioning
- Preparation for major head or neck surgery
- Severe head or neck trauma compromising breathing
- Emergency situations where immediate intubation is not possible
Risks
Immediate Risks
- Bleeding
- Damage to the trachea, thyroid gland, or neck nerves
- Misplacement or displacement of the tube
- Air trapped under the skin (subcutaneous emphysema)
- Collapsed lung (pneumothorax)
- Blood collection (haematoma) in the neck
Long-Term Risks
- Tube obstruction or displacement
- Tracheal damage, scarring, or narrowing
- Tracheo-oesophageal fistula (abnormal passage)
- Tracheo-arterial fistula (potentially severe bleeding)
Eating and Speaking with a Tracheostomy
Eating: Swallowing is assessed once the patient is conscious. A temporary feeding tube may be needed if safe swallowing is not yet possible.
Removal and Recovery
The tracheostomy tube is removed when the patient regains full consciousness and can breathe independently and cough secretions on their own without suctioning.
The opening in the neck usually closes on its own within a week after removal, leaving only a small scar. No stitches are usually needed.
Most patients need the tube for a few weeks, though some may require it long-term. The respiratory care team will train families to care for the tube before the patient leaves hospital.
Contributed by: SN. Abeer Al-Harthy & Dr Maher Al-Bahrani, Critical Care Department, Royal Hospital