Tracheostomy placement can be a short term solution to a more comfortable and secure airway, but it can also be a life sentence for a patient to require this form of assistance, becoming dependent upon the trach or the quite common scenario of their not ever being able to acquire the medical assistance to see them through to decannulation even though they may become fully ready.
Trach usage on an ongoing basis can have many risks, including:
- Infections or irritations of the stoma and or inside the trachea known as stomitis or trachitis
- Loss of voice over time
- Psychological distress
- Speech and language complications, especially in youth development
- Higher risk of aspiration, along with impaired swallowing capabilities
- Loss of smell and taste
- Compromised nutritional health
- Secretion issues, the trach tube within the trachea will stimulate pulmonary secretion production
- Loss of physiological PEEP and poor oxygenation
Hospital patients will receive a tracheostomy during an acute episode that lasts more that several days, In many cases they stabilize, then are moved to another facility for vent weaning or rehab with their trach in place. The trach may ultimately be left in due to continued need to connect to the invasive vent. In other cases the patient may not have met criteria for deannulation by the time their insurance coverage requires their discharge so they will be sent home or to a nursing facility with the trach in place. In these instances, even though they may over time be fully ready for decannulation they could conceivably never be provided the proper situation to allow for safe decannulation and the trach becomes a permanent fixture for them. Trachs can and should be discontinued once the reason they were required is resolved. A care plan can be established with a goal of tracheal decannulation or trach removal. If the patient can be supported non-invasively, discontinuation of the trach can be considered.
Trach removal is usually a trial process in most cases. To be performed safely the patient should be monitored closely by healthcare professionals experienced in assessing the patient for intolerance of the process and facilitating success. The tube has been in place usually for a significant length of time and the swallowing and airway tone maintenance reflexes and muscles of the upper airway may not be ready to resume full function and need to be conditioned with gradually increasing lengths of time with the trach plugged or capped. This loss or atrophy of the functions of the upper airway almost always occur to some degree and must be redeveloped. At any point in the decannulation trial process the patient could loose the ability to maintain a patent airway and be in danger of suffocation.
During the trial process non-invasive support methods can assist toward safer and more expeditious success; however all of this trouble could in many cases have been completely avoided if the same non-invasive support tools would have been applied aggressively in an effort to avoid the trach altogether.
Once fully established that the patient can tolerate the trach being capped most of the time, trach removal may be considered.