Quick Tip for Families in Intensive Care: Can a Tracheostomy Prevent Aspiration?

“Can a tracheostomy prevent aspiration?” That is one of the many questions we’re getting quite frequently from families in intensive care, and I’m going to answer this question today.

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

So, can a tracheostomy prevent aspiration? The answer is that a tracheostomy does not inherently prevent aspiration. In fact, many patients with tracheostomies are still at risk for aspiration, especially if they have issues with swallowing, dysphagia, or impaired neurological function.

What is aspiration? Aspiration occurs when food, liquid, saliva, or gastric contents enter the airway, instead of going down the esophagus to the stomach. This can lead to aspiration pneumonia, which is particularly dangerous in medically fragile patients.

So, how a tracheostomy affects aspiration risk? The tracheostomy tube creates a direct airway through the neck into the trachea, bypassing the upper airway structures like the larynx and vocal cords. This can sometimes reduce the sensation in the upper airway, affecting the swallow reflex, making it harder to cough or clear secretions effectively, especially if the patient is weak or neurologically impaired. Aspiration may worsen in patients with poor swallowing function, neurological injury like stroke or hypoxic brain injury, weak cough reflex, significant secretions that they cannot clear.

Exceptions or modifications. Some tracheostomy tubes are fitted with cuffs inflated with balloons around the tube. A cuffed tracheostomy tube and properly inflated can reduce but not fully eliminate the risk of aspiration, especially of large volume secretions. However, it does not stop micro aspiration, which basically means its minimal aspiration, of secretions from the above cuff. Long-term cuff inflation can damage the trachea and does not eliminate the risk.

Swallowing therapy, diet modifications, and sometimes speaking valves, like a Passy Muir valve, may be used in tracheostomy patients to help reduce aspiration risk as part of a broader care plan.

In summary, a tracheostomy is not a guaranteed way to prevent aspiration. It might help in some specific cases, i.e. to manage secretions, to reduce large volume aspiration temporarily with a cuffed tube, but managing aspiration risk requires a multidisciplinary approach, including speech therapy, nutrition, and respiratory care.

So, there you have it, whether a tracheostomy can prevent aspiration or not.

I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse unit manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients in intensive care. You can verify that by looking at our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.