Tracheostomy - Why a tracheostomy is necessary

A tracheostomy is often required when a person is unable to breathe normally because of an underlying health condition or a blockage in one of their airways.

For example, a tracheostomy may be used:

• to deliver oxygen to the lungs when a person is unable to breathe normally – the loss of normal lung function is called respiratory failure
• to bypass an airway that has become blocked
• to remove fluid that has built up in the upper airway, particularly in the throat and windpipe (trachea)

These are discussed in more detail below.

Respiratory failure

There are many conditions that can lead to respiratory failure and the need for a tracheostomy. Examples are:

• being unconscious or in a coma as a result of a severe head injury or stroke
• paralysis (an inability to move one or more muscles) after a serious neck and spinal cord injury
• a condition that causes extensive damage to the lungs, such as pneumonia or cystic fibrosis
• a condition that causes progressive damage to the nervous system, such as motor neurone disease or Guillain-Barré syndrome (both conditions can lead to paralysis and breathing difficulties)

Blockage

The airways can become blocked as a result of:

• accidentally swallowing something that gets stuck in the windpipe, such as a piece of bone
• an injury, infection, burns or a severe allergic reaction (anaphylaxis) that causes the throat to become swollen and narrowed
• a cancerous tumour that blocks one or more airways – this can sometimes happen with mouth cancer, laryngeal cancer or thyroid gland cancer

In addition, some children are born with birth defects that cause one or more of their airways to be abnormally narrow.

Fluid

There are several factors that can cause fluid to build up inside the airways and lungs, resulting in breathing difficulties. There is also a danger that the fluid could become infected.

In some circumstances, it may be necessary to carry out a tracheostomy so the fluid can be sucked out through the tracheostomy tube. This may be necessary when the person:

• is unable to cough properly because of chronic pain, muscle weakness or paralysis
• has a serious lung infection, such as pneumonia, that has caused their lungs to become clogged with fluid
• has an injury that has resulted in their airways or lungs becoming filled with blood