Tracheostomy

Overview

A tracheostomy (say tray-key-OS-tuh-mee) is a surgical opening made in the front of the neck into the windpipe (trachea). A tube called a tracheostomy tube is placed into the opening so air can flow in and out of the lungs, bypassing the nose and throat. It helps people breathe when the usual breathing route is blocked or when they need long-term support with breathing.

Tracheostomy is a relatively common procedure in hospitals, particularly for people in intensive care or with serious breathing problems. It is less common as a long-term solution for people at home, but it is a well-established treatment.

It can affect people of all ages — from premature babies to older adults. People who need it may have an injury, an infection, a blockage in the airway, or a condition that weakens breathing muscles.

Symptoms

Common symptoms

• Difficulty breathing or feeling short of breath
• A feeling that something is stuck in the throat
• Noisy breathing (also called stridor)

Symptoms in children

• A child who is working hard to breathe — for example, the chest moving in a seesaw motion
• Flaring nostrils or grunting while breathing
• Difficulty feeding or unusual sleepiness

Symptoms in older adults

• Increasing confusion or drowsiness due to low oxygen levels
• Fast or uneven breathing
• Using extra muscle effort to breathe

Causes

Main causes

• A blockage or injury to the upper airway, such as from trauma, swelling, or a foreign object
• A condition that requires a breathing machine (ventilator) for more than a week or two
• Severe lung disease, nerve or muscle conditions (for example, motor neurone disease) that weaken breathing
• Surgery to the throat or mouth that makes it hard to breathe normally

Risk factors

• Prolonged stay in intensive care
• Serious neck or chest injury
• Repeated respiratory infections
• Certain neurological conditions that affect the muscles used for breathing

When to see a doctor

See a doctor urgently if:

• Contact your care team or go to the nearest emergency department right away if you cannot breathe, bleeding is severe, or the tube dislodges.
• Seek same-day medical care if you have signs of infection or the tube seems partially blocked.

Book a routine appointment if:

• Attend all scheduled follow-up appointments with your tracheostomy care team.
• Have the tube checked and changed as often as your healthcare team advises.

Diagnosis

Tracheostomy is not a disease — it is a procedure. Doctors first diagnose the underlying condition that makes breathing difficult. They examine the person, review their symptoms and medical history, and run tests. Then a specialist team decides whether a tracheostomy is the right treatment.

Tests that may be done

• Chest X-ray
• CT scan
• Blood oxygen test
• Lung function tests
• Endoscopy to look at the airway

What to expect at your appointment

A specialist team will explain why you need a tracheostomy, how it is done, what the opening and tube will look like, and how to care for it. The procedure is done under general anaesthetic, so you will be asleep and feel no pain. Afterward, you may have a sore throat, a change in your voice, and some discomfort around the stoma.

Treatment

Tracheostomy is a treatment itself. After the opening is made, the main work is caring for the tube and the stoma, and learning to speak, swallow and breathe comfortably. Your healthcare team will teach you and your family how to clean the stoma, suction secretions, and manage the tube safely.

Self-care at home

• Clean the outer area of the stoma every day as your nurse shows you
• Keep a spare tracheostomy tube and a suction kit nearby
• Use a clean bib or cloth over the opening to filter the air and catch secretions
• Keep the air moist — a humidifier or a stoma cover can help

Medical treatments

There is no specific medication for a tracheostomy itself. Your healthcare team may give treatments for the underlying problem — for example, inhalers (puffers) for lung disease, antibiotics for infection, or oxygen to help oxygen levels. Always follow the advice of your doctors and do not change any prescribed treatment on your own.

When is surgery considered?

The tracheostomy is a surgical procedure. Some people need a follow-up operation to close the stoma once normal breathing has recovered, or to make the opening smaller. Your surgeon will discuss what you need if this applies to you.

Living with this condition

Learning to live with a tracheostomy takes time. You will learn to keep the tube clean, check for blockages, and talk with it. Speech and language therapists can help you speak by teaching you to cover the tube with your finger or use a speaking valve. Many people return to work, school, and hobbies once they settle into a routine.

Lifestyle tips

• Avoid swimming unless your doctor says it is safe
• Be careful when showering — keep water and soaps out of the opening
• Use a bib or filter cover to protect the stoma from dust and dirt
• Carry a medical alert card that says you have a tracheostomy

Diet and exercise

You may be able to eat and drink normally once your swallowing is assessed. Some people need softer food at first. Gentle exercise, with clearance from your healthcare team, is often fine and can improve strength and mood.

Mental health and emotional wellbeing

Living with a tracheostomy can feel overwhelming and affect self-esteem. Feeling frustrated, sad, or anxious is common. It is important to talk about your feelings — with a doctor, nurse, counsellor, or loved one. You are not alone.

Prevention

Most of the conditions that lead to a tracheostomy cannot be prevented. Good overall health, vaccinating your child against infections, and avoiding injuries can reduce the risk of needing one.

Vaccines

Keep vaccinations up to date — for example, flu, whooping cough, and pneumococcal vaccines — to reduce the risk of severe respiratory infections.

Screening programmes

No regular screening test is available. Some people need regular follow-up to check the airway and lungs.

Complications

If left untreated

• The tube can become blocked, cutting off airflow
• Low oxygen levels can damage the brain and other organs
• Lung infections can develop
• Bleeding or damage to the windpipe can occur

Long-term outlook

Most people adjust well to a tracheostomy and, once the underlying condition improves, the tube is often removed. With good care and support, people can return to an active, fulfilling life.

Find support

International organisations

• NHS Tracheostomy information ↗

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