A doctor may replace a person’s ventilator with a tracheostomy if they require ventilation for an extended time. They may also use a tracheostomy to wean a person off respiratory support.

A mechanical ventilator helps a person breathe when they are unable to without assistance. A tracheostomy is a hole cut by a surgeon that allows them to insert a breathing tube into a person’s trachea, or windpipe.

A person may require ventilation due to an accident or a health issue. Ventilators push air into a person’s lungs, allowing them to breathe if they are having difficulties breathing.

Research from 2019 states that weaning from respiratory support is one of the most common uses of tracheostomies.

Read on to learn more about the process of going from a ventilator to a tracheostomy, as well as the risks involved and the differences between the two treatments.

A person is lying in a hospital bed.Share on Pinterest
Edwin Tan/Getty Images

The main difference between a ventilator and a tracheostomy is that a ventilator is a machine, and a tracheostomy is a hole that a surgeon creates.

A doctor may use a ventilator when a person has difficulty breathing or getting enough oxygen.

Ventilators supply a person with air via a mask or a breathing tube. Ventilation with a mask is known as noninvasive ventilation. When a person uses a breathing tube, it is known as invasive ventilation.

A tracheotomy is a surgical procedure where a doctor inserts a breathing tube into a person’s trachea. It involves a surgeon cutting a hole through a person’s trachea and inserting a breathing tube into their airways. This hole is the tracheostomy.

If a person is using a ventilator, the machine will push air into their lungs. In contrast, a person with a tracheostomy may be able to breathe by themselves. If a person cannot breathe unassisted with a tracheostomy, the tracheostomy can attach to a ventilator.

Learn more about tracheostomies.

If a doctor decides that a tracheostomy is the right choice for a person using a ventilator, they will require a tracheotomy procedure.

Tracheostomy surgery involves the following steps:

  1. A person receives a general anesthetic from an anesthesiologist. They will be asleep for the procedure.
  2. A surgeon cuts a hole into the lower part of a person’s neck and then into their trachea.
  3. The surgeon inserts the tracheostomy tube into the hole in a person’s trachea.
  4. The surgeon uses surgical tape, stitches, or a Velcro band to hold the tube in place.
  5. If a person requires additional help to breathe, the surgeon attaches the breathing tube to a ventilator.

Medical professionals will help a person get used to living with the tracheostomy tube. A speech therapist can help a person learn to breathe and speak comfortably after the procedure.

It is possible to remove the tracheostomy tube if a person no longer requires it. This can depend on the reason a person requires the tube. The doctor or surgeon will be able to advise whether the tracheostomy is likely to be permanent or not.

Learn more about tracheotomies.

The time it takes for a person to go from a ventilator to a tracheostomy can vary. The time between a person starting on a ventilator to having a tracheostomy may be 5–14 days.

However, a person with severe closed head injuries or requiring prolonged ventilation may move from ventilation to a tracheostomy after 3–7 days.

A study from 2021 stated that the time range between a person moving from ventilation to a tracheostomy was 7.4–25.7 days in the United States.

There are certain risks involved in tracheostomy surgery, such as:

  • air becoming trapped beneath a person’s skin
  • bleeding
  • tube obstruction due to blood or mucus following surgery
  • collapsed lung
  • windpipe scarring
  • impaired swallowing
  • difficulty speaking
  • accidentally dislodging the breathing tube
  • a hole forming between the trachea and esophagus

Infection and tissue death (necrosis) from a tracheostomy occurs in rare cases.

A person’s doctor can discuss the possible risks of going from a ventilator to a tracheostomy beforehand and provide advice on steps that may help to reduce these risks.

Here are some frequently asked questions about ventilators and tracheostomies.

Why would you go from ventilator to tracheostomy?

A doctor may move a person from a ventilator to a tracheostomy if they require long-term ventilation. A tracheostomy has certain benefits over ventilation, including:

  • reducing trauma to the throat and vocal cords
  • reducing work of the airways by increasing the airway space and reducing airway resistance
  • increasing lung secretion clearance
  • reducing the need for sedation
  • reducing the length of intensive care unit (ICU) and hospital stays
  • increasing a person’s comfort

How many days can you be on a ventilator before needing a trach?

The amount of time a person is on a ventilator before switching to a tracheostomy can depend on various factors, such as the person’s condition and the reason for being on a ventilator.

Research indicates that a person usually transfers from ventilation to a tracheostomy in 5–14 days.

Research from 2017 also notes that switching a person from a ventilator to a tracheostomy in a shorter amount of time may help to reduce their chances of developing hospital-acquired pneumonia (HAP).

Is it easier to wean off a ventilator with a tracheostomy?

Doctors may use tracheostomies to help wean a person off ventilation. This may be due to tracheostomies helping to increase the amount of airway space and reducing airway resistance.

Is a tracheostomy considered life support?

Ventilation may be a necessary life support when a person cannot breathe by themselves. A tracheostomy can attach to a ventilator if a person is unable to breathe without assistance.

A doctor may move a person from a ventilator to a tracheostomy if they require long-term respiratory assistance. Tracheostomies can help a person wean off ventilation.

A person will undergo a tracheotomy procedure, during which the surgeon will create the tracheostomy and insert the breathing tube. Medical professionals will then work with the individual to help them get used to breathing and speaking with the tracheostomy tube.