Tracheostomy
Advantages and Disadvantages
A tracheostomy is a surgical opening (a tubular passageway) into the trachea (the windpipe, located in the lower front part of the throat) into which a plastic or metal tracheostomy tube is placed. It is considered an invasive procedure.
A small suction tube can be inserted into the opening to remove secretions (suctioning), or a mechanical ventilator can be connected to the tube. Eating and speaking can continue with effort IF there is no pre-existing speech or swallowing problem. A tracheostomy does not restore the ability to swallow or speak. A tracheostomy speaking device, such as the Passy-Muir valve, may enable the ability to speak and swallow.
Advantages of a tracheostomy
- It provides a small, secure connection to your airway for suctioning and for mechanical ventilation.
- Nebulized medication (sprays or mists) and oxygen can be delivered through it.
- It is the method of choice for long term mechanical ventilation, when bulbar involvement makes noninvasive ventilation impossible and when life support mechanical ventilation is desired.
- It leaves the face free and avoids headgear, straps, and skin pressures problems.
- Doctors, nurses, and respiratory therapists are familiar with tracheostomy care.
Disadvantages of a tracheostomy
- Some people feel it is too invasive, increases their disability and dependence, makes them look less "normal," and might prevent them from wearing certain articles of clothing (collar or tie).
- Secretions require frequent suctioning, often at night as well as during the day.
- Coughing to clear the smaller airways is difficult.
- The tracheostomy site (stoma) can become infected, bleed, or develop inflammatory tissue (granulations) that need to be removed.
- It requires some skill and makes care more complicated.
- Some people have resulting difficulty with speech and swallowing.
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Oppenheimer, E.A. (1997). Living With ALS: Adapting to breathing changes. (pp. 34-35). California: The ALS Association.
