What Is a Tracheostomy?

A tracheostomy is a surgical procedure that creates an opening — called a stoma — in the front of the neck, allowing a breathing tube (tracheostomy tube, or "trach tube") to be placed directly into the trachea (windpipe). This bypasses the upper airway entirely and gives patients a reliable, direct path for breathing.

Tracheostomies are performed for a number of reasons, including:

Prolonged mechanical ventilation — when a patient needs a ventilator long-term and an endotracheal tube is no longer appropriate
Airway obstruction — due to tumors, severe swelling, or trauma
Neuromuscular disease — such as ALS, muscular dystrophy, or spinal muscular atrophy, where weakened respiratory muscles make unassisted breathing unsafe
Chronic secretion management — for patients who cannot clear secretions effectively on their own

According to the American Thoracic Society (https://www.thoracic.org/), tracheostomy is one of the most commonly performed procedures in critically ill patients, and a growing number of people now live successfully at home with a long-term tracheostomy.

Coming home after a tracheostomy can feel overwhelming at first — but with the right preparation, the right team, and the right equipment, most patients adjust well and maintain a high quality of life.

Getting Ready to Come Home

The transition from hospital to home is the most critical phase. A successful discharge depends on thorough training for both the patient and their primary caregivers. Before leaving the hospital or skilled nursing facility, you and your care team should feel confident in the following:

Recognizing signs of respiratory distress
Performing tracheostomy suctioning safely
Cleaning and changing the inner cannula
Changing the trach ties or holder
Knowing when and how to change the outer trach tube (in coordination with your care team)
Emergency protocols — including what to do if the tube is accidentally dislodged

At Integrated Respiratory Solutions, our respiratory therapists conduct individualized training sessions with patients and families before and after discharge. We follow each patient from the facility to the front door — and beyond. Learn more about our Invasive Respiratory Care program and how we support complex patients through every step of the transition.

Daily Tracheostomy Care: What to Expect

Living with a trach requires consistent daily routines. Once those routines become second nature, most patients report that managing their trach becomes just another part of their day.

Suctioning

Suctioning removes secretions from the airway that the patient cannot clear on their own. The frequency varies by individual — some patients may need suctioning multiple times per hour; others only a few times per day. Signs that suctioning is needed include:

Visible secretions in or near the trach tube
Gurgling or rattling sounds during breathing
Increased work of breathing
Oxygen saturation dropping

Always use clean technique, limit suction passes to 10–15 seconds, and allow the patient to rest between passes.

Humidification

When air bypasses the nose and mouth, it no longer gets naturally warmed and moistened before reaching the lungs. This makes humidification critical for trach patients. Without it, secretions can thicken and become difficult to clear, increasing the risk of mucus plugs and respiratory infections.

Options include:

Heat and Moisture Exchangers (HMEs) — small devices that attach to the trach hub and trap moisture from exhaled air
Active humidification systems — built into home ventilators for patients on mechanical ventilation

Inner Cannula Care

Most modern trach tubes have a removable inner cannula. This inner cannula should be removed and cleaned (or replaced with a disposable cannula) at least once per day, or more frequently if secretions are heavy.

Stoma Site Care

The skin around the stoma opening requires daily cleaning with saline-moistened gauze. Keep the area dry between cleanings and inspect for redness, swelling, or signs of infection at every dressing change.

Breathing Support at Home: Ventilators and Cough Assist

Home Mechanical Ventilation

If you've been discharged with a ventilator, the equipment will deliver breaths at set intervals, maintaining your breathing safely through the trach tube. Modern home ventilators — like the ResMed Astral 150 or the Philips Trilogy Evo — are designed to be compact, portable, and intelligent.

Cough Assist Therapy

Mechanical insufflation-exsufflation (MI-E) devices simulate the action of a cough by applying positive pressure to fill the lungs, then rapidly shifting to negative pressure to expel secretions.

According to the National Institutes of Health (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528995/), cough assist therapy significantly reduces the risk of respiratory infections and hospitalizations in patients with neuromuscular conditions who cannot cough independently.

Learn more about our Invasive Respiratory Care program: https://www.integratedhsc.com/invasive-respiratory

Communication: Finding Your Voice

Options for trach patients to communicate:

Speaking Valves (e.g., Passy-Muir Valve) — A one-way valve that redirects exhaled air past the vocal cords, enabling natural speech. Best for patients weaned or partially weaned from the ventilator.
Cuffless or Deflated Cuff Trach Tubes — When the cuff is deflated, air can pass around the tube and reach the vocal cords.
Augmentative and Alternative Communication (AAC) Devices — Tablets, eye-tracking technology, and voice-output devices for patients with significant motor involvement.
Low-Tech Options — Writing boards, alphabet boards, and eye blink systems remain simple, reliable backups.

The American Speech-Language-Hearing Association (ASHA) maintains a directory of certified speech-language pathologists who specialize in tracheostomy communication: https://www.asha.org/

Nutrition, Swallowing, and Quality of Life

A tracheostomy can affect the ability to swallow safely. Key steps to protect swallowing safety:

Request a formal swallowing evaluation from a speech-language pathologist before eating or drinking by mouth
Ask your physician about the possibility of cuff deflation trials during meals, if appropriate
Work with a registered dietitian if your nutritional needs are being met through a feeding tube

Warning Signs: When to Call for Help

Accidental decannulation (trach tube comes out) — Emergency. Call 911 immediately.
Mucus plug — Sudden inability to breathe or pass a suction catheter; attempt suctioning immediately, call 911 if unresolved.
Signs of infection — Fever, increased secretion color or odor, redness spreading from the stoma
Significant bleeding from or around the trach site
Ventilator alarms that do not resolve — contact Integrated Respiratory Solutions immediately

Integrated Respiratory Solutions provides a 24/7 on-call clinical hotline for our patients.

Frequently Asked Questions

Yes, with precautions. Use a shower guard or cover the stoma to prevent water from entering the airway.
Not necessarily. In some cases, decannulation (removal of the tube) is possible through a gradual, supervised process.
Most patients do sleep normally. If you are on a ventilator, your settings will be adjusted for sleep.
Integrated Respiratory Solutions provides patients with ventilators and backup battery systems to ensure uninterrupted support. We also help you register with your local utility company as a life-sustaining equipment user.

Living with a tracheostomy takes preparation, patience, and the right team behind you. At Integrated Respiratory Solutions, we specialize in supporting patients and families through every phase of invasive respiratory care — from hospital discharge training to long-term home management. If you or someone you love has a tracheostomy and needs expert respiratory support in Illinois, Northwest Indiana, or Missouri, we're here to help.

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Life After a Tracheostomy: How to Thrive at Home