Tracheostomy in intensive care: what it is, how it works and recovery

The windpipe carries air from the nose and mouth to the lungs. A tracheostomy creates a new opening to it through the front of the neck. The NHS explains that the surgeon makes a cut in the skin at the front of the neck and creates a small hole in the windpipe, a tracheostomy tube is inserted through the hole, and it is held in place by a piece of tape around the neck. You breathe through the tube rather than through your nose and mouth.

In intensive care units (ICUs), which the NHS describes as specialist hospital wards providing treatment and monitoring for people who are very ill, most patients have problems with one or more organs, for example being unable to breathe on their own. A ventilator is a machine that helps with breathing, and the NHS says the tube may be placed in the mouth, in the nose, or through a small cut in the throat, which is a tracheostomy.

The NHS lists three reasons for a tracheostomy: to help you breathe if your throat is blocked, to remove excess fluid and mucus from your lungs, and to deliver oxygen from a ventilator to your lungs.

The NHS says a tracheostomy is usually done under general anaesthetic, so you are asleep and feel no pain, but if it needs to be done in an emergency you will have a local anaesthetic, where you are awake but your neck is numb. If you need a tracheostomy but cannot give your consent, it will be discussed with your family; the NHS adds that ICU staff will usually decide on what they feel is in the person’s best interests and talk things over with the family whenever possible.

The NHS says it may take a while to get used to having a tracheostomy. The tube often has an air-filled cuff around it, and you will not be able to speak when the cuff is inflated, so at first you may need to communicate using writing and gestures. As you recover, air is gradually removed from the cuff and you can start to speak, and a speaking valve is sometimes fitted to make the voice stronger.

For eating and drinking, the NHS says you may be able to eat and drink with a tracheostomy, but if you cannot swallow you may need a thin feeding tube passed through your nose down to your stomach to give liquid food and fluids. It adds that the tube may need to be changed if it has been in for 28 days or you need a different tube to help with breathing and talking, and that changing it is a quick and simple procedure usually done in hospital.

The NHS says the tracheostomy tube is removed when you no longer need help breathing, which might be a few days or weeks but for some people longer. A dressing is put over the hole after the tube is removed, the hole usually takes about 7 to 10 days to heal, and you may have some pain or discomfort where the tube was that improves as the hole heals. There will be a small scar on the neck, which fades over time.

The NHS says that once a person no longer needs intensive care they can be transferred to another ward to continue their recovery before going home, and that many people who leave an ICU make a good recovery.

The NHS says a tracheostomy is a common procedure but, as with any surgery, there are risks and possible complications that your doctor will discuss with you before you agree to a planned tracheostomy.

• Bleeding in or around the tracheostomy.

• Damage to the windpipe or the area around it.

• The tube becoming blocked or moving out of place.

• Problems with the hole healing after the tube is removed, such as infection.

• A build-up of air between the lungs and chest wall, which can cause pain, breathing difficulty or, in severe cases, a collapsed lung.

The NHS says to call NHS 111 or get an urgent GP appointment if you are at home after a tracheostomy and have problems swallowing, cough or are sick after eating or drinking, have noisy breathing during the day or night including snoring, have a raised or uncomfortable scar, have pain or discomfort around the tracheostomy particularly when swallowing, or have a hoarse or weak voice for more than a week. You may be referred to a specialist.

It says to call 999 if you have had a tracheostomy and have difficulty breathing. The NHS also notes that after intensive care some people have lingering problems such as weakness and stiffness, extreme tiredness, sleep problems, depression, anxiety or post-traumatic stress, and problems with memory or thinking that can last several months; it advises seeking medical advice if they persist and says some people need ongoing rehabilitation.

The NHS notes that an ICU can be overwhelming. Patients may be connected to tubes, wires and cables and may be drowsy, appear swollen or have injuries, but staff ensure they are as comfortable as possible. You will normally be free to touch, comfort and talk to the person, and it may help them to hear familiar voices even if they do not appear to respond.

It signposts the ICUsteps charity and the Intensive Care Society for information and support for patients and relatives. Intensive care is provided through the NHS, with private hospitals offering critical care in general terms for their own patients, but the principles and equipment described here are the same.