What to Know About Going from Ventilator Alone to Ventilator with a Tracheostomy

You may have a tracheostomy placed if you’ve been using a ventilator for an extended period. You may also have a tracheostomy to help support ventilator therapy.

Ventilators are machines that move air in and out of your lungs for you. You may need a ventilator if you’re unable to breathe on your own or unable to breathe well enough to supply your tissues with adequate oxygen.

A tracheostomy is an opening in the front of your neck that allows a tube to be inserted into your windpipe to aid your breathing. You can breathe through a tracheostomy yourself, or it can be combined with a ventilator.

Here’s what to expect when going from a ventilator to a ventilator with a tracheostomy.

Why would you go from a ventilator to a tracheostomy?

A surgeon usually performs a tracheostomy when a medical professional thinks a patient won’t be very quickly weaned from the ventilator .

When it becomes apparent that it’s more likely to take weeks or months to wean from a ventilator, they’ll decide to perform a tracheostomy . This generally happens between days 5 and 14 , depending on the underlying reason for the mechanical ventilation.

In a 2022 review , researchers found strong evidence that getting a tracheostomy early is associated with better outcomes for people in the intensive care unit (ICU).

It’s thought that early tracheostomy is linked to:

• a lower risk of death
• a shorter ICU stay
• reduced rates of ventilator-associated pneumonia

The benefits of getting a tracheostomy while weaning from a ventilator include:

• improved comfort
• easier oral care and suctioning
• a reduced need for sedation or pain relief
• a reduced chance of accidental extubation (removal of the breathing tube)
• easier facilitation of rehabilitation
• earlier communication and oral nutrition
• easier transfer to a lower level of care.

Even after weaning from a ventilator, it’s not uncommon to keep a tracheostomy in place. This may be the case if you need further intubation or expect to have prolonged ventilator requirements in the future.

It’s easier to keep the tracheostomy in place than go through another intubation and another tracheostomy surgery.

What’s the difference between a ventilator and a tracheostomy?

A ventilator is a machine that helps move air in and out of your lungs. Ventilators can supply oxygen to you through a tube that goes down your throat or through a facemask.

People primarily use them to:

• protect the airways after trauma, infection, or surgery
• treat breathing problems due to causes like:
  • drug overdose
  • muscular dystrophy and other conditions that cause problems with respiratory muscles
  • nervous system conditions, such as Guillain-Barré syndrome
  • chest wall trauma , collapsed lung , or pulmonary effusion
  • pneumonia
  • acute respiratory distress syndrome
  • pulmonary fibrosis
• increase oxygen supply required for conditions like:
  • sepsis
  • shock
  • metabolic acidosis

A tracheostomy is a hole in your throat that you can use with a breathing tube alone or with a ventilator. About 10% to 15% of people admitted to the ICU receive a tracheostomy.

Its primary uses include:

• weaning off prolonged ventilator use
• preventing complications from head and neck cancer treatment
• treating:
  • traumatic injury to structures around your throat
  • upper airway obstruction
  • neuromuscular disease
  • sleep apnea that doesn’t respond to other treatments
  • chronic aspiration

What are the risks of a tracheostomy?

A tracheostomy is usually a safe procedure, but it does come with some risks , especially if you have an unplanned tracheostomy.

Risks include:

• collapsed lung
• bleeding
• nerve or voice box injury
• infection
• blocked tracheostomy tube
• collapsed or narrowed windpipe

What are the benefits of placing a tracheostomy while using a ventilator?

Some of the benefits of having a tracheostomy placed while using a ventilator may include:

• a reduced need for sedation
• improved safety
• improved comfort
• a reduced overall cost of care
• quicker weaning off ventilation

What happens during the placement of a tracheostomy when you’re using a ventilator?

Here’s what you can expect during surgery to create a tracheostomy:

1. You’ll receive a general anesthetic to put you to sleep so that you don’t feel pain. In an emergency where there isn’t time, you may be given a local anesthetic to numb your throat instead.
2. Your surgeon will cut a hole in your lower neck and into your windpipe using a needle or scalpel. They’ll then insert a tube into the opening.
3. They’ll insert surgical dressing around the edge of the hole in your neck, and they’ll use tape or stitches to hold the tube in place.
4. They’ll then connect your tube to a ventilator if you’re unable to breathe on your own.

What’s the outlook for people who have a tracheostomy placed while using a ventilator?

The outlook for people using a ventilator depends largely on the underlying cause that led to the need for a ventilator.

In a 2023 study, researchers found that the ICU death rate was 9.9% among 304 people who needed a tracheostomy and were admitted to one hospital in Ireland between 2017 and 2019.

Frequently asked questions

How long should you stay on a ventilator before a tracheostomy is placed?

The amount of time that passes before a surgeon places a tracheostomy when you’re using a ventilator depends on your condition. Usually, you’ll get a tracheostomy after 5 to 14 days . In some cases, it can be sooner than this.

What is the quality of life after a tracheostomy?

A tracheostomy can be temporary or permanent. Many people can maintain a high quality of life after receiving a tracheostomy. But some may need time to adapt to:

• eating
• exercising
• cleaning the tube

Can you eat with a tracheostomy?

Swallowing can be difficult at first, but most people are eventually able to eat normally with a tracheostomy.

Does getting a tracheostomy affect life expectancy?

A tracheostomy doesn’t directly affect your life expectancy. However, many conditions that require a tracheostomy may cause premature death.

Takeaway

You may have a tracheostomy placed while you’re using a ventilator if you’ve been using it for a long time or if your healthcare team is trying to wean you off it.

Some research suggests that getting a tracheostomy early may improve your chance of survival in the ICU and may lead to better outcomes.

Your healthcare team can best advise you or your loved one on when you should have a tracheostomy.