What to Know About Getting a Tracheostomy for COVID-19

A tracheostomy is a procedure where a surgeon places a breathing tube directly into your trachea (windpipe) through an incision made in the front of your neck. The tracheostomy tube can be left open to the air or connected to a ventilator.

Tracheostomy can be used to:

• provide oxygen for people who are having trouble breathing on their own
• bypass a blockage in the throat
• decrease the risk of aspiration pneumonia in individuals who need a breathing tube

There are two types of tracheostomy. A surgical tracheostomy is done in an operating room as an open surgery. A percutaneous tracheostomy can be done at your bedside in the hospital as a minimally invasive procedure.

Severe COVID-19 can lead to serious lung complications that can hamper your ability to breathe on your own. These are:

• pneumonia
• acute respiratory distress syndrome
• respiratory failure

Because of this, some individuals who are seriously ill with COVID-19 need help breathing using a ventilator. Tracheostomy is often used when people need to use a ventilator over a prolonged period of time.

A 2021 study notes that previous research has shown that tracheostomy has the following medical benefits for people on a ventilator:

• earlier weaning, which is the process by which you gradually stop depending on a ventilator
• a decreased need for sedation
• lower levels of ventilator-associated pneumonia

Earlier weaning can free up the ventilator and also help to move a person out of the intensive care unit (ICU). This was especially beneficial earlier in the pandemic when many ICUs were overwhelmed.

A tracheostomy is often done under general anesthesia. That means that you’ll be asleep during the procedure and won’t feel pain.

In emergency situations, tracheostomy may be done using a local anesthetic. In this scenario, you’ll be awake during the procedure but still won’t feel pain.

During the procedure, the surgeon will make an incision in the front of your neck through your skin and the cartilage of your trachea. The tracheostomy tube is then carefully inserted and secured into this incision.

If you need a tracheostomy due to COVID-19, hospital staff will help you to do the following:

• clean the site of your tracheostomy as well as your tracheostomy tube
• suction away mucus that has built up in your tracheostomy tube
• change your tracheostomy tube, if necessary

Because most of the air you’re breathing will now pass through your tracheostomy tube, it can be challenging to speak. Some tracheotomy tubes have a “speaking valve” that helps with this.

It’s also likely you’ll have a feeding tube right after your tracheostomy. If you’re awake and alert, you may be able to start eating on your own. The specific types of food you can have generally depend on how well you can swallow.

When you’re able to breathe on your own, your tracheostomy tube may be removed. This is called decannulation.

After the tube is removed, the hole (stoma) will be covered with a bandage and left to heal. One 2022 study found that the median healing time was 6.5 days. Having a tracheostomy tube for longer was associated with increased healing times.

There are several potential side effects of having a tracheostomy. These include:

• bleeding
• bacterial infection
• blockage of the tracheostomy tube by mucus or blood
• collapsed lung or windpipe
• injury to surrounding nerves and tissues
• narrowing of the windpipe, called stenosis

A 2022 report of 136 tracheostomies in people with COVID-19 noted bleeding as the most common complication. Collapsed lung was also reported.

Performing a tracheostomy generates aerosol particles. Because of this, there were also concerns that healthcare workers doing the procedure could be at risk of contracting SARS-CoV-2, the virus that causes COVID-19.

But, research has found that the risk to healthcare workers is low, provided that precautions, such as wearing appropriate personal protective equipment, are taken.

Some research has found that the timing of tracheostomy may be important. A 2020 study of people with COVID-19 on a ventilator found that the length of stay was shorter for those who had a tracheotomy earlier.

A 2022 review of 14 studies found that compared with later tracheostomy, early tracheostomy of people with severe COVID-19 was associated with a shorter time on a ventilator and a shorter ICU stay.

But, mortality was the same, regardless of when the tracheostomy was done.

A 2021 study found that, compared with surgical tracheostomy, people who had an early tracheostomy done through the skin (percutaneously) at the bedside and not during surgery had improved outcomes. These included:

• earlier ventilator weaning
• lower levels of ventilator-associated pneumonia
• shorter ICU stay
• decreased total hospital stay

Will I have a scar after my tracheostomy?

Yes. Once your tracheostomy tube is removed and the area heals, you’ll have a small scar.

How do I prevent having a tracheostomy due to COVID-19?

The best way to prevent having a tracheostomy due to COVID-19 is to take steps to prevent becoming ill. These include:

• staying up-to-date on your COVID-19 vaccines
• avoiding others who are currently sick with COVID-19
• washing your hands frequently
• improving the ventilation and airflow in your home
• moving activities outdoors, if possible
• practicing physical distancing and wearing a mask, if necessary

Some people needing prolonged ventilation for COVID-19 may have a tracheostomy. This is a procedure that allows you to receive oxygen through a breathing tube placed into your neck.

A tracheostomy can help people with serious COVID-19 by reducing the amount of time they depend on a ventilator. People receiving a tracheostomy may also have shorter stays in the ICU.