What is a Tracheostomy? Why is it Performed?

A tracheostomy is a medical procedure in which a small opening is made in the windpipe (trachea) through the neck to facilitate breathing.

Why is a tracheostomy performed?

A tracheostomy is applied in the following situations:

• In cases where the upper airway is blocked or narrowed.
• When there is a need for long-term mechanical ventilation (e.g., in intensive care).
• When respiratory muscles are insufficient due to neuromuscular diseases, strokes, or brain damage.
• In airway risks such as head and neck tumors, severe trauma, or congenital anomalies.
• To clean secretions (phlegm) more effectively and reduce the risk of aspiration.

What is the purpose of a tracheostomy?

The aim is to relieve breathing, make the connection to a ventilator secure, and facilitate secretion management. A tracheostomy:

• Makes breathing easier and reduces the respiratory workload.
• Provides a more comfortable and secure connection to a mechanical ventilator.
• Offers a more comfortable long-term airway compared to tubes in the mouth and throat.
• Facilitates the cleaning of secretions and ventilation of the lungs.
• Supports speech and nutrition rehabilitation with speaking valves in suitable patients.

What are the types of tracheostomy cannulas?

Cannula selection is personalized based on the patient’s age, anatomy, ventilator needs, and speech goals.

• By material: Plastic (PVC, silicone), metal.
• Cuffed and uncuffed: Cuffed cannulas reduce aspiration and leaks by inflating a small balloon; uncuffed cannulas may be preferred in speech/rehabilitation.
• With or without an inner cannula: The inner cannula can be removed and cleaned when secretions accumulate.
• Fenestrated (windowed) and non-fenestrated: Fenestrated cannulas can facilitate voice production with a speaking valve.
• Pediatric and adult sizes: Diameter and length vary according to age, anatomy, and indication.

How is a tracheostomy performed?

The procedure involves creating a secure opening in the trachea and placing the appropriate cannula using surgical or percutaneous methods.

• Surgical method: Performed in the operating room under sterile conditions through a small incision in the neck to enter the trachea directly.
• Percutaneous (bedside) method: Can be applied in intensive care with a smaller incision using a needle-wire-dilator system under ultrasound or bronchoscopy guidance.

During the procedure, oxygenation, heart rhythm, and blood pressure are closely monitored; the appropriate cannula is placed, secured, and the first dressing is applied.

Who cannot have a tracheostomy?

The procedure may be postponed or alternative methods chosen for patients with significant distortion of neck anatomy, uncontrolled bleeding disorders, inability to visualize the airway, or lack of appropriate emergency equipment. The decision is made through an individual risk-benefit assessment.

What is pediatric tracheostomy?

It can be applied in infants and children due to congenital airway narrowing, long-term ventilation requirements, neuromuscular diseases, or trauma. The diameter and length are carefully selected according to the child’s weight and tracheal measurements. Family training on aspiration, cannula care, and emergency management is taught in detail.

How is a tracheostomy tube selected and maintained?

When selecting a tube, the indication, amount of secretion, speech goals, ventilator needs, anatomy, and age are considered.

• Daily care: Cleaning and keeping the area around the stoma dry, adjusting cannula fixation tapes, and aspirating secretions at appropriate intervals.
• Humidification: Using heat-moisture exchangers or nebulization to reduce airway dryness and plug formation.
• Accessories: Speaking valves, caps, and inner cannulas are used according to physician recommendations.

What happens if a tracheostomy is not performed?

If a tracheostomy is delayed while the airway is blocked or respiratory support is needed, risks of laryngeal/tracheal damage, infection, and ventilation difficulties increase due to long-term oral intubation. In some emergency airway situations, failure to perform a tracheostomy or alternative surgical airway results in severe oxygen deficiency and life-threatening risk.

When and how is a tracheostomy removed?

The tube can be removed if the patient can breathe sufficiently on their own, manage their secretions, the airway is secure, and the underlying cause has improved. The cannula diameter may be gradually reduced, “capping” trials are performed, and tolerance is evaluated with a speaking valve. After removal, the stoma usually closes spontaneously; a small surgical correction can be made if necessary.

Risks and potential complications of tracheostomy

In the early period: Bleeding, infection, misplacement, air leak (subcutaneous emphysema), or pneumothorax. In the late period: Granulation tissue, tracheomalacia, tracheal stenosis (narrowing), fistula formation, or skin irritation may develop. Risks can be minimized with proper technique, regular care, and close follow-up.