Tracheotomy

The surgical creation of an opening into the windpipe to bypass obstructions that are interfering with breathing. A tube is inserted into the opening to allow for normal breathing. The opening is called a stoma or tracheostomy, and depending on the situation, may be either temporary or permanent.

When an airway must be created immediately, a slightly different procedure called a cricothyroidotomy may be done. The resulting airway should only be used temporarily, until the emergency situation is under control. If the airway will be necessary for more than 48 hours, a standard tracheotomy will be performed. This factsheet describes the standard tracheotomy.

Parts of the Body Involved

Windpipe (trachea); muscles, blood vessels, and nerves in the neck

Reasons for Procedure

A tracheotomy is done to create an open airway in order to restore normal breathing in the following situations:
  • The airway is obstructed at or above the level of the larynx (voice box), due to:
    • Severe pneumonia
    • Insufficient clearing of fluid from the lungs
    • Trauma to the neck area with bleeding
  • Respiratory failure requiring long-term mechanical breathing assistance, as in these cases:
    • Spinal cord injury in the neck area
    • Hospitalized patients requiring a breathing tube for more than 21 days
  • Sleep apnea (frequent stoppage of breathing during sleep)
  • Difficulty swallowing, resulting in excess saliva and mucus that can't be cleared (this can be due to paralysis of muscles necessary for swallowing, other neurological conditions, or a tumor)
  • Injury to the respiratory tract due to breathing in smoke or steam, or inhaling corrosive substances
  • Birth defects of the trachea or larynx
  • Foreign body blocking the trachea or larynx

Risk Factors for Complications during the Procedure

  • Age: infants and adults over 75
  • Obesity
  • Smoking
  • Poor nutrition
  • Recent illness, especially an upper-respiratory infection
  • Alcoholism
  • Chronic illness
  • Diabetes
  • Use of certain prescription and nonprescription drugs

What to Expect

Prior to Procedure

Your doctor will likely do the following:
  • Chest x-rays
  • Blood and urine tests
  • Review of medications
During Procedure

Outcome

Allow about 2 weeks for recovery, and expect complete healing.

Once a tracheostomy tube is in place, you will experience breathing and vocal changes. It usually takes 3 days to adjust to breathing through the tube. Speaking is often a larger adjustment. Initially, you may not be able to speak and your doctor may recommend speech therapy.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough or shortness of breath that remain despite careful suctioning of the tracheostomy tube
  • Nausea or vomiting
  • Speech difficulties that persist after a temporary tracheostomy tube has been removed
  • New, unexplained symptoms develop
  • Call you local emergency number if your tracheostomy tube falls out and you can't replace it