Tracheostomy and Ventilator Dependence

The scope of this page includes communication and swallowing issues in patients with tracheostomy, both with and without ventilator dependence, across the lifespan.

See the Tracheostomy and Ventilator Dependence Evidence Map for summaries of the available research on this topic.

Individuals with artificial airways due to medical complications often experience compromised communication and swallowing function. Speech-language pathologists (SLPs) with appropriate training contribute to the communication and swallow assessment and management of patients with tracheostomies, both with and without ventilator dependence, in cooperation with an interprofessional team.

Definitions relevant to page content:

  • Artificial Airway: a device that is used to facilitate ventilation and secretion management (e.g., endotracheal tube, tracheostomy tube) and that may be used to access mechanical ventilation.
  • Endotracheal tube (ET): a tube placed into the trachea via the mouth or nose to establish and/or maintain the airway and ventilation.
  • Tracheotomy: a specific surgical procedure that involves an incision in the trachea and placement of a tube to create an artificial airway.
  • Tracheostomy: the opening (tracheostoma) into the trachea created by the tracheotomy through which the tracheostomy tube can be inserted.
  • Tracheostomy tube: a curved tube inserted into the tracheostoma to maintain an airway.
  • Decannulation: the removal of a tracheostomy tube.
  • Mechanical ventilator: a machine that assists or replaces the spontaneous breathing process.

Due to the wide variety of medical conditions that may necessitate a tracheostomy (both with and without mechanical ventilation), patients have diverse experiences in type and severity of communication and swallowing difficulties. Individualized assessment and management require interprofessional collaborative practice. A tracheostomy team may include an otolaryngologist, a pulmonologist, a respiratory therapist, nurses, and the SLP. Positive patient outcomes—including reductions in cannulation times, hospital length of stay, adverse events, and cost of care—have been realized when patients with tracheostomy are managed with a multidisciplinary team approach (Bonvento, Wallace, Lynch, Coe, & McGrath, 2017; de Mestral et al., 2011; Garrubba, Turner, & Grieveson, 2009). See ASHA’s page on Interprofessional Education/Interprofessional Practice (IPE/IPP).

Other ASHA Practice Portal pages that are applicable to this topic include Adult Dysphagia, Pediatric Dysphagia, Voice Disorders, and Augmentative and Alternative Communication.

Content Disclaimer: The Practice Portal, ASHA policy documents, and guidelines contain information for use in all settings; however, members must consider all applicable local, state and federal requirements when applying the information in their specific work setting.