Dispelling Tracheostomy Myths

Tracheotomies are life-saving procedures that can significantly improve a person’s ability to breathe and manage respiratory conditions. However, many myths and misconceptions surrounding tracheostomies can lead to confusion, delayed intervention and can negatively impact a patient’s quality of life.

These misunderstandings should be clarified so healthcare providers can appreciate the facts about tracheostomies and provide early and appropriate intervention to maximize patient outcomes. Additionally, dispelling these myths highlights the strength and resilience of the trach community, showing that with proper care and support, individuals with tracheostomies can lead active and fulfilling lives.

Myth: Patients with tracheostomies cannot live independently.

Fact: Many patients with tracheostomies can achieve complete independence, provided they receive comprehensive education on tracheostomy management, airway clearance techniques, and emergency protocols. With proper training, individuals can return to work, travel, and care for their families, demonstrating autonomy in activities of daily living.

Myth: Pediatric patients with tracheostomies are unable to engage in physical activities or attend school.

Fact: Children with tracheostomies can play with their friends and siblings, go to school, and participate in extracurricular activities with individualized planning and medical oversight. Measures such as providing emergency response protocols, infection prevention strategies, and continuous monitoring during physical exertion can facilitate safe participation in these activities. Additionally, caregiver support and education are crucial. Programs like simulation-based discharge education significantly improve caregivers' comfort and confidence in managing tracheostomy care.

Myth: Patients with tracheostomy tubes who require cuff inflation are unable to speak.

Fact: Above Cuff Vocalization (ACV) is a voicing technique typically used with patients who are alert, cooperative, and require cuff inflation during mechanical ventilation. To use ACV, a tracheostomy tube with a subglottic suction channel, such as the Tracoe Twist Plus Extract, is needed. The subglottic channel can be used to introduce air into the subglottic lumen which travels into the upper airway restoring audible voice, even with an inflated cuff. Use of ACV has been shown to be safe, restore earlier communication, and improve quality of life (Petosic et al. 2021; Gajic et al. 2024). To learn more, check out this patient video on ACV: Tracheostomy: Using Above Cuff Vocalization (ACV) for Patient Communication

Myth: Tracheostomies are permanent.

Fact: Tracheostomies are usually temporary interventions, and most patients can have their tracheostomy tube removed once they meet the decannulation criteria and the underlying condition, such as chronic respiratory failure or upper airway obstruction, has resolved or improved. Decannulation is a multidisciplinary team decision based on comprehensive pulmonary evaluation, including weaning from mechanical ventilation, sufficient airway patency, effective secretion management and adequate swallowing ability. Healthcare providers should actively support patients in achieving these criteria to facilitate successful decannulation.

Myth: Patients with tracheostomy tubes always experience dysphagia.

Fact: Although dysphagia is common in this patient population, many patients with tracheostomy tubes (even during mechanical ventilation) can resume at least partial oral intake of food and liquids. Thorough assessment by a speech-language pathologist with tools such as Videofluoroscopic Swallow Studies (VFSS) and Flexible Endoscopic Evaluation of Swallowing (FEES) are useful and often necessary to determine the appropriate modifications or techniques to minimize the risk of aspiration and maximize nutritional intake. Early swallowing intervention can lead to faster return of PO intake. (Mah et al. 2017; Welton et al. 2016).

Myth: Patients with tracheostomy tubes do not need artificial humidification.

Fact: Patients with tracheostomy tubes require artificial humidification because the natural humidification process is bypassed when air is delivered through the tube, increasing the risk of airway dryness and thickened secretions. Typical options for restoring heat and moisture to the upper airway include conventional external humidification systems and Heat and Moisture Exchangers (HMEs). Due to the numerous advantages, HMEs are becoming an increasingly popular choice for patients and healthcare providers. Advantages include improved patient compliance and mobility, decreased noise, ease of set up and discharge planning, reduced pulmonary complaints, and reduced cost when compared to conventional external humidification systems. (Wong et al. 2016; Kearney et al. 2023). To learn more about artificial humidification and the benefits of HMEs, check out this article: HME Evidence and Benefits - Atos Medical

Myth: Patients with tracheostomies cannot achieve a good quality of life.

Fact: One of the primary causes of poor quality of life following a tracheostomy is the inability to effectively communicate (Newman et al. 2022). By restoring voice with techniques such as ACV and devices such as speaking valves, quality of life is significantly improved (Freeman Sanderson et al. 2016; Newman et al. 2022; Pandian et al. 2020). Therefore, early communication intervention is paramount. Newman et al. 2022 recommends that voice restoration take high priority in tracheostomy management decisions such as tracheostomy tube size selection, cuff deflation, and use of speaking valves. Ultimately, making communication effectiveness a priority for patients with tracheostomy tubes can greatly enhance their overall well-being and quality of life.

References
1. Freeman-Sanderson AL, Togher L, Elkins MR, Phipps PR. Quality of life improves with return of voice in tracheostomy patients in intensive care: An observational study. J Crit Care. 2016;33:186-191. doi: 10.1016/j.jcrc.2016.01.012.
2. Gajic S, Jacobs L, Gellentien C, Dubin RM, Ma K. Implementation of Above-Cuff Vocalization After Tracheostomy Is Feasible and Associated With Earlier Speech. Am J Speech Lang Pathol. 2024;33(1):51-56.
3. Kearney A, Norris K, Bertelsen C, Samad I, Cambridge M, Croft G, et al. Adoption and Utilization of Heat and Moisture Exchangers (HMEs) in the Tracheostomy Patient. Otolaryngol Head Neck Surg. 2023.
4. Mah JW, Staff II, Fisher SR, Butler KL. Improving decannulation and swallowing function: A comprehensive, multidisciplinary approach to post-tracheostomy care. Respir Care. 2016;62(2):137-143. doi:10.4187/respcare.04878.
5. Newman H, Clunie G, Wallace S, Smith C, Martin D, Pattison N. What matters most to adults with a tracheostomy in ICU and the implications for clinical practice: a qualitative systematic review and metasynthesis. J Crit Care. 2022 Dec 1;72. doi: 10.1016/j.jcrc.2022.154145. PMID: 36174431.
6. Pandian V, Cole T, Kilonsky D, Holden K, Feller-Kopman DJ, Brower R, Mirski M. Voice-related quality of life increases with a talking tracheostomy tube: A randomized controlled trial. Laryngoscope. 2020;130(5):1249-1255. doi: 10.1002/lary.28211081.
7. Petosic, A., Viravong, M. F., Martin, A. M., Nilsen, C. B., Olafsen, K., & Berntzen, H. Above cuff vocalisation (ACV): A scoping review. Acta Anaesthesiologica Scandinavica. 2021; 65(1):15-25.
8. Welton C, Morrison M, Catalig M, Chris J, Pataki J. Can an interprofessional tracheostomy team improve weaning to decannulation times? A quality improvement evaluation. Can J Respir Ther. 2016;52(1):7-11.
9. Wong CY, Shakir AA, Farboud A, Whittet HB. Active versus passive humidification for self-ventilating tracheostomy and laryngectomy patients: a systematic review of the literature. Clin Otolaryngol. 2016;41(6):646-651.