Tracheostomy care in intensive care
A plain-English guide for patients and families explaining a tracheostomy — a tube placed through the front of the neck into the windpipe — why it is used in intensive care, how people communicate with one, and how it is weaned and removed.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- A tracheostomy is a tube placed through the neck into the windpipe, often used when breathing support is needed for longer than a short while.
- It is usually more comfortable than a tube in the mouth, often needs less sedation, and can make weaning off the ventilator easier.
- Speaking is usually affected at first because air bypasses the voice box, but communication aids help, and a speaking valve often restores the voice in time.
- Most tracheostomies in intensive care are temporary; the tube is removed when it is no longer needed and the opening usually heals, leaving a small mark.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Usually more comfortable than a breathing tube in the mouth
A tracheostomy may not be appropriate if a person is expected to come off the ventilator very soon.
There are often more secretions and some coughing, needing suctioning. The cuff on the tube is usually inflated to protect the lungs, and speaking is not...
Trained staff and emergency equipment available wherever a tracheostomy patient is cared for.
There are often more secretions and some coughing, needing suctioning. The cuff on the tube is usually inflated to...
As the person improves, the cuff is deflated for longer periods so air can pass up to the voice box. A speaking...
A speech and language therapist often helps assess swallowing and speaking. The person may move from a smaller...
When the person can breathe, cough and protect their airway safely, the tube is removed. A dressing covers the...
What is a tracheostomy and how is it cared for?
A tracheostomy is a small opening made in the front of the neck, through which a short tube is placed directly into the windpipe (trachea). Air then passes in and out through this tube rather than through the nose and mouth.
In intensive care, a tracheostomy is often used when someone has needed a breathing machine (ventilator) for a longer time. Moving from a tube in the mouth to a tube in the neck is usually more comfortable, often needs less sedation, makes it easier to clear secretions, and can help the person be weaned off the ventilator step by step.
Most tracheostomies in intensive care are temporary. Once the person can breathe and protect their airway on their own, the tube is removed and the opening usually heals over within a week or two, leaving a small mark. Sometimes a tracheostomy is needed for longer, for example after a severe brain or spinal injury, and the team will explain if this is likely.
At first a person with a tracheostomy may not be able to make their voice heard, which can be frightening for them and for you. This is usually temporary, and there are several ways to help them communicate while the tube is in place.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Percutaneous tracheostomy
Made at the bedside in intensive care through a small puncture, widened gently to take the tube. This is the common method for critically ill adults.
Surgical tracheostomy
Made in an operating theatre through a small cut, sometimes preferred if the neck anatomy is difficult or it is done at the same time as other surgery.
Cuffed tube
Has a small balloon that seals the windpipe, used early on to protect the lungs and allow the ventilator to work effectively.
Uncuffed or fenestrated tube
Used later in weaning; lets more air pass up to the voice box, helping with speaking and breathing through the nose and mouth.
Preparing for your treatment
- A tracheostomy is usually planned within intensive care once it is clear breathing support is needed for longer, so there is rarely much to prepare.
- Ask the team why a tracheostomy is being suggested and whether it is likely to be temporary.
- Tell staff about any neck problems, previous neck surgery or bleeding problems.
- Ask how your relative will be able to communicate once the tube is in place.
- Find out who will care for the tube and how suctioning of secretions works.
- If a longer-term tracheostomy is likely, ask what support and training the family will be given.
What happens
Inserting a tracheostomy is done with the person sedated and comfortable, either at the bedside in intensive care or in an operating theatre. A small opening is made in the front of the neck and the tube is placed into the windpipe and secured with tapes or stitches. The procedure usually takes around 30 to 45 minutes.
Once in place, the tube connects to the ventilator if breathing support is still needed, or to humidified oxygen as the person improves. Because the airway makes more secretions at first, a thin suction tube is used from time to time to clear them; this can make the person cough briefly.
The tube is checked and cleaned regularly, and the area around it kept clean to prevent infection. As the person recovers, the team adjusts the type of tube, lets more air reach the voice box, and works towards speaking, eating and, in time, removing the tube.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A tracheostomy may not be appropriate if a person is expected to come off the ventilator very soon.
- It may be avoided or delayed where serious bleeding problems or difficult neck anatomy make it unsafe at the bedside.
- Where the underlying illness cannot be overcome, a tracheostomy may not be in the person's best interests, and the team will discuss this.
- Decisions take account of the person's wishes and the whole clinical picture, not a fixed rule.
Delay or rearrange if…
- If the person is improving quickly and may be extubated soon, the team may wait rather than place a tracheostomy.
- Serious clotting or bleeding problems may need correcting first.
- Active infection at the neck site may mean choosing a different approach or timing.
- Families should have time to ask questions before a planned tracheostomy.
Alternatives to discuss
- Continuing with a breathing tube in the mouth for a short period if the person is likely to wake and breathe soon.
- Non-invasive ventilation (a tight mask) in suitable people, avoiding a tube altogether.
- Earlier weaning attempts off the ventilator where the person is improving.
- Comfort-focused care if invasive treatment can no longer help.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Usually more comfortable than a breathing tube in the mouth
- Often allows less sedation, so the person can be more awake and take part in their care
- Makes it easier to clear secretions from the chest
- Can make weaning off the ventilator more gradual and successful
- Allows speaking again, often with a speaking valve, once the person improves
- Can usually be removed when no longer needed, with the opening healing over
Risks & complications
- Coughing and more secretions, especially in the first days, needing suctioning
- Not being able to make the voice heard at first, which can be distressing
- Soreness or irritation around the opening in the neck
- Needing time and aids to swallow safely again
- Infection around the opening or in the chest
- Bleeding from the site, usually minor
- The tube becoming blocked with secretions and needing clearing or changing
- The tube being accidentally dislodged, needing prompt attention
- Heavier bleeding, which can be serious and needs urgent treatment
- Narrowing of the windpipe (stenosis) developing later
- A lasting change to the voice, or rarely a small connection forming between the windpipe and food pipe
- A collapsed lung (pneumothorax) around the time of insertion
Two things matter most day to day: keeping the tube clear and in place, and helping the person communicate so they do not feel trapped or frightened. The serious risks, such as heavy bleeding or windpipe narrowing, are uncommon but important, which is why tracheostomy patients are cared for by trained staff with emergency equipment to hand. Ask the team how communication will be supported and what the plan is for weaning and removal.
Published figures to discuss
How likely complications are depends on how the tracheostomy is placed, the person's anatomy and how ill they are. Serious problems such as heavy bleeding or windpipe narrowing are uncommon, but reliable single percentages do not fit every patient, so the team will explain the risks for your relative rather than quote a fixed figure.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Blocked or displaced tracheostomy tube | Uncommon but immediately life-threatening | Bedside emergency equipment, staff training and clear algorithms are essential. | Guide sourcesClinical context |
| Bleeding from a tracheostomy | Minor bleeding is not unusual; major bleeding is rare but critical | Any large bleed or sentinel bleed needs urgent senior airway and surgical review. | NHS — Intensive carenhs.ukSource-linked context |
| Swallowing difficulty or aspiration | Common during recovery from critical illness and airway support | Speech-and-language therapy assessment helps guide cuff deflation, oral intake and communication. | Guide sourcesClinical context |
| Failure to decannulate quickly | Common when weakness, secretion burden, airway swelling or neurological impairment persists | Progress should be reviewed against a documented weaning and rehabilitation plan. | NHS — Intensive carenhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Recovery with a tracheostomy follows the wider recovery from critical illness, which is usually slow. Getting off the tube is a gradual, step-by-step process called weaning, not a single event, and the team moves at a pace the person can manage.
- More coughing and secretions early on that settle as the chest improves
- Not being able to speak at first, with the voice returning as weaning progresses
- Needing a speaking valve or capping trials before the tube comes out
- A dressing over the opening after removal, which closes within a week or two
- A small scar on the neck once the opening has healed
Aftercare
- Keep the area around the tube or healed opening clean as advised.
- Use the suction and humidification equipment as shown if the tube is still in place.
- Work with the speech and language therapist on speaking and safe swallowing.
- Follow the team's plan for cuff deflation, speaking valve and capping during weaning.
- After removal, keep the small dressing in place until the opening closes.
- Watch for and report signs of infection, bleeding or breathing difficulty.
- If a tracheostomy is going home with the person, make sure carers are trained and have emergency advice.
- Know whether the tracheostomy is expected to be temporary or longer-term
- Understand how communication will be supported day to day
- Know the plan for weaning and removing the tube
- If going home with a tube, have carer training and emergency equipment arranged
- Know the signs of a blocked tube, infection or bleeding
- Have contact details for the team and, if relevant, community support
Scars and how they heal
After the tracheostomy tube is removed, the small opening in the neck usually closes on its own within one to two weeks, leaving a small scar at the front of the neck. The scar typically fades over months. A long-standing tracheostomy may leave a slightly larger mark. This is a healing opening rather than a planned cosmetic cut, and your team can advise on its care.
⚠ Get urgent help if…
- Difficulty breathing, or the tube seeming blocked despite suctioning
- The tube coming out or moving — get help immediately
- Heavy or bright-red bleeding from the tube or the opening — this is an emergency
- A high temperature, increasing redness, swelling or discharge around the opening
- New or worsening difficulty swallowing, or choking when eating or drinking
- After removal: the opening not closing, leaking air, or persistent breathing problems
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good outcome is that the tracheostomy makes breathing support safer and more comfortable, helps the person wean off the ventilator, lets them communicate and eat again, and is removed when no longer needed. The voice and swallowing usually recover, and the small opening heals over.
A tracheostomy does not, by itself, cure the illness that led to it, and it cannot guarantee a return to exactly the same voice or swallowing as before. For people who need a tracheostomy long-term, the focus is on safe, comfortable care and good support at home.
Most tracheostomies placed in intensive care are temporary and are removed once the person recovers enough to breathe and protect their airway. A minority are needed for months or permanently, for example after severe neurological injury. After removal, the opening heals and most people return to normal breathing, though some have lasting changes to the voice or, rarely, a narrowing of the windpipe that needs follow-up.
Related tests, treatments or support
A tracheostomy is usually part of wider intensive care, used alongside ventilator support, sedation that is gradually reduced, and treatment of the underlying illness. Speech and language therapy and physiotherapy are closely involved in weaning, communication and swallowing.
Follow-up & long-term care
While the tube is in, the team reviews the weaning plan regularly. After removal, the healing opening is checked, and the voice and swallowing are monitored. People with lasting voice, swallowing or breathing changes may be referred to an ear, nose and throat (ENT) or speech and language service. Anyone going home with a tracheostomy should have clear follow-up and community support.
- Regular cleaning and changing of the tube while it is in place
- Suction and humidification to keep the airway clear and moist
- Speech and language therapy input for communication and swallowing
- Ongoing carer training and emergency planning for a long-term tracheostomy
- Follow-up for any lasting voice, swallowing or breathing changes after removal
Repeat, follow-on and what comes next
- The type or size of tube is often changed during weaning, which is normal.
- Weaning may take several attempts, with steps forward and back; this is expected.
- If the person deteriorates after the tube is reduced, support may be increased again.
- Occasionally a tracheostomy needs to be re-sited or replaced, or stays in longer than first hoped.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Trained staff and emergency equipment available wherever a tracheostomy patient is cared for.
- Active support for communication, including speaking valves and aids.
- Involvement of speech and language therapy and physiotherapy in weaning and swallowing.
- A clear, shared plan for weaning, removal and follow-up.
- Thorough carer training and community support for anyone going home with a tracheostomy.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- A tracheostomy is part of NHS intensive care, so families do not usually face a separate bill.
- Where any private critical care exists, the cost is part of the overall intensive care stay.
- Whether the tracheostomy is placed at the bedside or in theatre affects the resources used.
- Ongoing tube care, suctioning, humidification and speech therapy form part of the care.
- How long the tracheostomy is needed, and whether it goes home, affects later support costs.
- Carer training and community support are needed for a long-term tracheostomy.
- Confirmation that tracheostomy care is part of the wider critical care, not a separate charge
- Who places and cares for the tracheostomy
- The plan for communication, weaning and removal
- What support is provided if the tracheostomy is needed long-term or at home
- What happens if there is a complication such as bleeding or a blocked tube
- How the family will be kept informed and trained where needed
On the NHS? A tracheostomy and its care are provided as part of NHS intensive care when a longer-term or more comfortable airway is needed, rather than as a private self-pay procedure.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Families not being told whether the tracheostomy is likely to be temporary or long-term.
- Not explaining that speaking will be affected at first and how communication will be supported.
- No clear plan for weaning, swallowing assessment and removal.
- Sending someone home with a tracheostomy without proper carer training and emergency advice.
- Big decisions being made without giving the family time and information.
Marketing red flags
- Any claim that a tracheostomy is without risks or 'just a small tube'.
- Downplaying how distressing the loss of voice can be at first.
- Private services implying faster weaning or better outcomes than urgent NHS care.
- No mention of the support needed for a long-term or home tracheostomy.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Why does my relative need a tracheostomy, and is it likely to be temporary?
- How will they be able to communicate while the tube is in?
- What is the plan for weaning and removing the tube?
- When might they be able to speak and eat again?
- What are the signs of a problem I should look out for?
- If the tracheostomy goes home with them, what training and support will we get?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Why has my relative been given a tracheostomy instead of the tube in the mouth?
Will they be able to talk?
Is a tracheostomy permanent?
Can they eat and drink with a tracheostomy?
What happens when the tube comes out?
Is having a tracheostomy a sign things are getting worse?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Intensive care St George's NHS — Tracheostomy weaning guidance Cambridge University Hospitals NHS — Adult tracheostomy communication advice ICUsteps — Intensive care: a guide for patients and relatives Faculty of Intensive Care Medicine — What is intensive care?
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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