About Tracheostomies

A tracheostomy
A tracheostomy

Most patients on the ICU have difficulty breathing for themselves and, therefore, need help at some point from artificial breathing machines (called ventilators). These machines are connected to the patient's lungs using a plastic tube that is inserted through the mouth (but sometimes through the nose).

Some patients will need their breathing to be supported for several days or more. These patients can benefit from having the tube in their mouth or nose changed to a shorter tube that is placed directly into the windpipe through the front of the neck. This is known as a tracheostomy and has several advantages:

  • A tracheostomy makes it easier to keep a patient's lungs clean, which is important for their health;

  • Tracheostomies are more comfortable for patients than having a tube in the mouth or nose. Therefore, patients can need less of the drugs that make them sleepy, which is better for their health in the medium to long term;

  • Tracheostomies can make it easier to 'wean' some patients from the ventilator.

Occasionally, a tracheostomy is needed for other reasons, which will be explained to you by the ICU staff.

Because a patient is in ICU does not mean they will have to have a tracheostomy.

 

What's involved

A tracheostomy requires a short operation, which is done either in the operating theatre by the ear, nose and throat surgeons (called a surgical tracheostomy) or on the John Farman ICU by the ICU consultants (called a percutaneous tracheostomy).

 

Which type is best?

A percutaneous tracheostomy has the advantage that the patient does not need to be moved to the operating theatre, but a surgical tracheostomy is safer in patients with shorter or fatter necks, or in those who have blood clotting problems.

 

What is a percutaneous tracheostomy?

A percutaneous tracheostomy is the type performed by ICU consultants on patients staying in the ICU.

 

Are there any risks associated with a tracheostomy?

As with any technique undertaken on patients staying in intensive care, there are always some associated risks. The main serious risks associated with a tracheostomy occur during or soon after the operation and are:

  • A decrease in the amount of oxygen in the blood;

  • Bleeding in the neck area;

  • The development of an air leak from the lungs;

  • Damage to the windpipe;

  • Displacement of the tube;

  • Infection

We can monitor patients for these complications and take steps to treat them if they occur. These complications are not common but they can have serious implications and the ICU consultants take the risks into account before a tracheostomy is sited. The decision to perform a tracheostomy is only taken if the benefits to the patient are greater than the potential risks.

 

What are the long-term effects of a tracheostomy?

When the patient no longer needs their tracheostomy, it is simply removed and the hole is covered with an air-tight dressing. Within a short space of time (one to two weeks) the hole closes and heals over, leaving a tiny scar. Very occasionally, a small dimple remains at the old tracheostomy site. This can easily be removed, if necessary, by a plastic surgeon.

Last updated: 2 April 2007
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