Cervical breathing tube in the elderly causes types and how to deal with it

In the lives of elderly individuals, certain medical conditions may necessitate the use of a tracheostomy tube as an essential solution to support breathing and improve quality of life. A tracheostomy tube is a medical device used to facilitate the passage of air to the lungs, especially in cases where the airway faces difficulty or obstruction. With aging, choosing the appropriate type of tracheostomy tube and providing meticulous care becomes critically important to avoid complications and achieve the best health outcomes. we review the types of tracheostomy tubes suitable for the elderly, their benefits, risks, and essential care tips to ensure their safety and comfort.

What is a Tracheostomy Tube for the Elderly?

A tracheostomy tube is a small tube surgically inserted by a doctor into the trachea through a small opening in the neck. Its main function is to help the patient breathe directly, especially in cases where breathing through the nose or mouth is difficult due to chronic illness or airway obstruction. Elderly people may need it in certain situations such as strokes, neurological diseases, or after major surgeries.

Types of Tracheostomy Tubes Suitable for the Elderly

1. Standard Tracheostomy Tube

The most commonly used type in hospitals.
Made of plastic or silicone.
Equipped with an inflatable cuff to prevent air leakage.
Suitable for elderly patients who need mechanical ventilation for a long time.
Easy to insert and clean.

2. Cuffless Tube

Does not have an inflatable cuff.
Suitable for elderly who mostly breathe naturally and can control their secretions.
Helps reduce pressure on the tracheal wall, decreasing ulcers and complications.

3. Fenestrated Tube

Has side openings that allow air to pass to the vocal cords.
Useful for patients starting to improve who want to speak again or breathe on their own.
Requires close monitoring because it can allow mucus to leak into the lungs.

4. Metallic Tube

Made of stainless steel or rust-resistant metal.
Rarely used today because it is uncomfortable and lacks flexibility.
May be used for short periods or in special cases.

5. Soft Cuffed Tube

The cuff is made of soft silicone instead of plastic.
Reduces inflammation and friction inside the trachea.
Ideal for elderly patients with skin problems or allergies.

6. High Ventilation Tube

Designed to deliver larger volumes of air.
Used for elderly patients suffering from respiratory failure or who need long-term mechanical ventilation.
Helps improve breathing efficiency and overall comfort.

Why Might Elderly People Need a Tracheostomy Tube?

1. Chronic Respiratory Failure
Some elderly patients suffer from chronic lung diseases that significantly affect breathing, such as:

Chronic Obstructive Pulmonary Disease (COPD)
Pulmonary fibrosis
Severe asthma

Over time, breathing becomes difficult and exhausting, and the patient may require mechanical ventilation for extended periods. When the oral tube becomes uncomfortable or insufficient, a tracheostomy tube is used to facilitate breathing and reduce inflammation.

2. Need for Long-Term Mechanical Ventilation
If the patient experiences a serious health crisis such as:

Severe pneumonia
Stroke

And needs to stay on a ventilator for more than 10 to 14 days, doctors often prefer to insert a tracheostomy tube to:

Reduce the risk of throat and mouth ulcers
Facilitate airway cleaning from mucus
Help the patient regain swallowing and speech over time

3. Weakness in Respiratory Muscles
Some neurological diseases affecting the elderly can weaken the muscles involved in breathing, such as:

Parkinson’s Disease
Amyotrophic Lateral Sclerosis (ALS)
Strokes

In these cases, the patient may require a permanent means to assist breathing, and a tracheostomy tube is often the best solution.

4. Upper Airway Obstruction

There can be narrowing or blockage of the airway from the mouth, nose, or larynx caused by:

Tumors in the neck or larynx
Swelling due to severe allergies
Enlarged thyroid gland
Facial or neck injuries

In such cases, placing a tracheostomy tube is urgent and necessary to help the patient breathe.

5. Severe Lung Infections or Inflammation

Examples include:

Acute pneumonia
COVID-19 complications (especially in patients with chronic illnesses)

If the infection severely weakens lung function and oxygen exchange becomes insufficient, requiring long-term ventilation, doctors often insert a tracheostomy tube to protect the patient and improve recovery chances.

6. After Major Surgeries

Some surgeries temporarily affect breathing or swallowing, especially:

Head or neck surgeries
Tumor removals near the larynx or trachea
Open-heart or chest surgeries that require long anesthesia and intensive care

In these cases, the tube is placed temporarily until the patient regains normal breathing ability.

7. Dysphagia and Aspiration (Food Entering the Lungs)

Elderly patients may have difficulty swallowing due to muscle weakness or neurological diseases, which can cause food or liquid to enter the lungs instead of the stomach, leading to:

Repeated lung infections
Choking during meals
Respiratory failure over time

The tracheostomy tube helps protect the airway and reduces the risk of aspiration.

8. Severe Sleep Apnea

If the patient suffers from sleep apnea and conventional treatments like CPAP or BiPAP devices are ineffective, especially with:

Relaxation of laryngeal muscles
Recurrent airway obstruction

A permanent or temporary tracheostomy tube may be inserted to improve breathing during sleep and prevent complications.

9. Quadriplegia or Spinal Cord Injuries

Accidents or fractures in the cervical vertebrae can damage nerves controlling breathing, causing the patient to:

Be unable to breathe normally
Require permanent respiratory support

The tracheostomy tube is vital to sustaining life in these cases.

10. Continuous Need for Suctioning Mucus and Secretions

Elderly patients who have difficulty clearing lung secretions, especially if:

Bedridden
Suffering from neurological diseases like Alzheimer’s or stroke

Insertion of a tracheostomy tube facilitates suctioning, protecting the lungs from blockage and infection.

11. Advanced Head and Neck Cancers

In cases where cancer affects the airway, such as:

Laryngeal cancer
Pharyngeal cancer
Large neck tumors

Doctors use a tracheostomy tube to assist breathing or as part of treatment before or after surgery or radiation therapy.

12. Coma or Prolonged Loss of Consciousness

Patients who enter coma due to stroke, brain hemorrhage, or severe hypoglycemia often require a tracheostomy tube to keep the airway open and prevent food or secretions from entering the lungs, reducing the risk of aspiration pneumonia.

13. Enlarged Tonsils or Adenoids (Even in Adults)

Though more common in children, elderly patients can also have enlarged tonsils or adenoids due to chronic infections or tumors. This enlargement can press on the airway causing severe breathing difficulties, sometimes requiring urgent medical intervention including tracheostomy.

14. Facial or Oral Injuries

In accidents like traffic collisions or falls, if there is severe damage to the mouth, jaw, or larynx preventing normal breathing through the mouth or nose, a tracheostomy tube is necessary to maintain the airway and save the patient’s life.

15. Severe Burns or Smoke Inhalation

Exposure to fire or toxic smoke can cause rapid and severe swelling of the larynx and trachea, directly affecting breathing. In such emergencies, doctors must insert a tracheostomy tube immediately to prevent suffocation.

16. Post-Anesthesia or Post-Surgical Complications

After lengthy or complicated surgeries, patients may not regain normal breathing quickly or may have breathing difficulties after awakening. In these cases, doctors insert a temporary tracheostomy tube until the patient stabilizes.

17. Paralysis or Relaxation of the Vocal Cords

If the vocal cords become relaxed or paralyzed, this can cause narrowing or even complete blockage of the airway. This may result from:

Stroke
Certain tumors
Thyroid surgeries

In these cases, a breathing tube is necessary to help the patient breathe properly.

18. Tracheal Stenosis

This happens due to chronic inflammation or prolonged use of an endotracheal tube (breathing tube through the mouth). The narrowing prevents air from passing easily, so doctors create a new opening in the trachea to bypass the blocked part.

19. Diseases Affecting the Respiratory Muscles

Some rare diseases affect body muscles including respiratory muscles, such as:

Myasthenia Gravis
Muscular Dystrophy

These diseases cause difficulty breathing naturally, requiring long-term mechanical ventilation support.

20. When the Patient Refuses Oral or Nasal Breathing Tube

In some cases, especially elderly patients with dementia or psychiatric disorders, the patient may refuse to keep the tube in mouth or nose and try to pull it out. This is very dangerous because it cuts off oxygen supply. Therefore, doctors prefer to insert a tracheostomy tube (through a small neck opening) since it is safer, harder for the patient to remove, and helps them breathe better for longer periods.

How is a Tracheostomy Tube Inserted?

The tracheostomy tube can be inserted either as a planned procedure or as an emergency, depending on the patient's condition.

Planned Cases

If the procedure is scheduled in advance, the doctor will usually ask the patient to fast for several hours to empty the stomach and reduce the risk of complications.

Emergency Cases

If the patient is in critical condition and cannot breathe, doctors may have to perform the procedure immediately without prior preparation to save the patient's life.

Before the Procedure: Preparation

Before inserting the tube, the medical team conducts a full assessment including:

Blood tests
Chest or neck X-rays
Respiratory and airway evaluation

The type of anesthesia is determined based on the case:

General anesthesia: for planned surgeries or major operations
Local anesthesia: for emergencies or when full anesthesia is not suitable

Steps of Tracheostomy Procedure

The operation is relatively simple and usually done as follows:

Patient positioning: The patient lies on their back with the neck extended backward to allow easy access to the trachea.
Sterilization: The neck area is cleaned thoroughly with antiseptic to reduce infection risk.
Incision: The surgeon makes a small horizontal or vertical cut in the middle of the neck, usually between the 2nd and 4th tracheal rings.
Accessing the trachea: A small part of the tracheal wall is cut to open an airway passage.
Tube insertion: A small tube is inserted into the opening and connected to a ventilator or left for direct air passage to the lungs.
Tube fixation: The tube is secured in place with medical tape around the neck to prevent movement.

After the Procedure: Follow-Up and Care

The patient is monitored in the intensive care unit or according to their condition.
The tube is cleaned regularly to prevent infection or blockage.
Some patients need the tube temporarily; others may have it for long periods depending on the respiratory problem.

How to Live Normally After Tracheostomy?

1. Will the patient be able to speak?
Initially, speaking is difficult because air bypasses the vocal cords, but there are solutions:

Special speaking devices, like valves, that redirect air upward toward the vocal cords to produce sound.
Speech therapists help patients learn how to use these devices and retrain speech.

With time and practice, many regain their ability to speak even with the tube.

2. Eating and swallowing after the procedure
Swallowing can be difficult at first, especially in the initial days or weeks, so:

Patients may receive nutrition and fluids via feeding tubes (nasogastric or gastrostomy tubes).
Speech and swallowing therapists assist the patient in relearning safe swallowing.

Continuous training helps strengthen swallowing muscles, allowing gradual return to normal eating.

3. Coughing and lung dryness
The air from the tracheostomy tube is dry, which can cause:

Frequent coughing
Lung irritation
Thick mucus that's hard to expel

Solutions:

Use saline sprays to moisturize the tube and loosen mucus.
Use humidifiers or natural humidity to moisten the environment.

Daily hydration is crucial to prevent blockages and ensure patient comfort.

Immediate Complications After Tracheostomy

Bleeding
Bleeding may occur due to:

Cutting or injuring blood vessels during surgery
Blood-thinning medications

When is bleeding dangerous?

If bleeding is heavy and rapid
If blood blocks the tube and prevents air from reaching lungs

Both require immediate medical intervention.

Infection at the wound site
Since there is an open hole in the neck, bacteria can enter especially if:

The site is not cleaned regularly
Dressings are not changed properly

Signs of infection:

Redness and swelling around the opening
Pus or foul-smelling discharge
Fever
Severe pain or neck swelling

Early detection and treatment with antibiotics and wound care are essential.

Subcutaneous emphysema (air under the skin)
This happens when air leaks from the trachea into the surrounding tissues, possibly due to:

Incorrect tube placement
Air leakage around the tracheal opening

Signs:

Swelling around the neck or face
A crackling sensation under the skin when pressed

If swelling worsens, it can cause difficulty swallowing or breathing. Quick follow-up and repositioning the tube reduce the problem; sometimes it resolves on its own.

Tube blockage immediately after insertion
Blockage can be caused by:

Clotted blood inside the tube
Thick mucus or sticky secretions
Incorrect initial tube placement

Why is this dangerous?
If the tube blocks, air can't reach the lungs, threatening life unless cleaned or replaced immediately.

Injury to the trachea or surrounding tissues
If the surgery is difficult or there is a technical error, injury may occur to:

The tracheal wall itself
Soft tissues and nerves around the trachea

This may cause:

Severe neck pain
Difficulty swallowing or speaking
Abnormal swelling around the opening

The patient requires close monitoring to prevent further complications.

Pneumothorax (collapsed lung)
In rare cases, if the lung is injured or large air leaks occur during the procedure, air can enter the chest cavity and compress the lung.

Symptoms:

Sudden severe shortness of breath
Sharp chest pain
Rapid drop in blood oxygen levels

Emergency chest X-rays and treatment (such as chest tube insertion) are necessary.

Allergic reactions
Some patients may have skin allergies around the opening due to:

Types of dressings or sutures
Antiseptics or topical medications

Signs:

Severe redness or itching
Mild swelling or skin ulcers

Doctors will switch to suitable dressings or antiseptics and may prescribe soothing creams.

Tube displacement
Right after surgery or if the patient moves suddenly, the tube may move or come out:

Partial dislodgement causes breathing difficulty and air leakage.
Complete displacement is life-threatening because air cannot reach the lungs.

Care and Management of a Tracheostomy Tube (Neck Breathing Tube)

Complications and How to Handle Them:

Securing the Tube
Fix the tube firmly with a medical tape tied snugly around the neck.
Continuously monitor the tube position, especially when moving or transferring the patient.
Injury to Nearby Nerves
The neck contains sensitive nerves that control voice, movement, and sensation.
During surgery, accidental injury may occur to:

Recurrent Laryngeal Nerve:
Can cause weakness or partial paralysis of the vocal cords, leading to hoarseness or difficulty speaking.
Other nerves controlling skin sensation or fine muscle movement around the neck.

Prevention and Follow-up:
Surgeons carefully identify nerve pathways to avoid injury.
If voice weakness or numbness in the neck appears, consult an ENT (Ear, Nose, and Throat) specialist immediately.

Change in Voice or Loss of Speech
Why does this happen?
The nerves around the trachea, especially the recurrent laryngeal nerve, may be affected during tube insertion.

Signs:

Hoarseness or unclear speech.
Partial or complete loss of voice.
Numbness or mild pain in the neck.

How to manage:

Follow-up with an ENT specialist to assess the severity.
Speech therapy sessions to gradually restore vocal cord strength.
In mild cases, voice may improve gradually over time.

Swelling of Surrounding Tissues
Cause:
Swelling is normal due to tissue irritation and blood congestion during the first 2-3 days post-operation.

When to worry?

Rapidly increasing swelling that presses on the neck wound.
Difficulty breathing or swallowing.

Management:

Raise the head of the bed to reduce fluid accumulation.
Apply light cold compresses around the neck, avoiding the stoma site.
Regular follow-up with medical staff; anti-inflammatory medications may be prescribed if needed.

Leakage of Fluids from the Stoma
Causes:

Clear watery secretions are normal as part of healing.
Yellow or greenish secretions may indicate infection.

Warning signs:

Foul smell.
Change in color to yellow or green.
Sudden increase in fluid amount.

Actions:

Clean the stoma regularly with sterile gauze.
If signs of infection appear, doctor will prescribe antibiotics and antiseptics.
Follow up for fluid cultures if necessary.

Breathing Difficulties or Low Oxygen Levels
Cause:
The body may temporarily struggle to adjust to the new tube, causing mild breathing difficulty or low blood oxygen.

Symptoms:

Slight shortness of breath, especially during movement.
Quick fatigue or dizziness.
Oxygen saturation below normal (< 92%) on pulse oximeter.

Management:

Continuous monitoring by nursing or respiratory therapy staff.
Adjust patient positioning (head elevation and neck stabilization).
Sometimes, ventilator settings are adjusted or saline nebulizers used to moisten airways.

Formation of a Hematoma (Blood Clot)
When does it occur?
Usually within hours after surgery, blood may collect under the skin around the stoma forming a hematoma.

Signs:

Hard swelling larger than usual.
Severe pain with a throbbing sensation.
Skin color changes to brownish or bluish.

Risks:
Large hematoma may compress the airway and cause breathing difficulty.

Action:

Notify medical staff immediately if pain worsens or swelling grows fast.
Surgery may be needed to drain the hematoma and relieve pressure.
After stabilization, re-secure the tube and monitor closely.

Best Practices for Caring for Elderly Patients with a Tracheostomy Tube:

Regular Cleaning of the Stoma and Tube
Use clean, sterile tools to clean the skin around the stoma daily.
Clean the tube inside and out as per doctor’s instructions to prevent mucus buildup and blockage.
Avoid irritants or allergens near the skin.
Monitor for Signs of Infection or Inflammation
Watch for redness, swelling, or pus discharge around the stoma.
Be alert to any foul smell or unusual secretions.
See a doctor immediately if any signs appear.
Manage Respiratory Secretions
Encourage the patient to cough to clear mucus.
Use suction devices if needed to prevent tube blockage.
Keep airways moist using steam or humidifiers.
Regularly Change Patient’s Position
Change sleeping or sitting position often to prevent pressure sores around the stoma.
Support the neck comfortably to reduce tension on the tube and protect the stoma.
Avoid Pollutants and Harmful Environments
Keep the patient’s surroundings clean.
Avoid exposure to smoke, dust, or other irritants to protect the lungs.
Monitor Breathing and Airflow Through the Tube
Watch for signs of breathing difficulty or tube blockage.
Ensure air passes freely through the tube.
Be prepared to act quickly if obstruction occurs (e.g., use emergency suction or call for medical help).
Proper Nutrition and Medical Follow-up
Provide a balanced diet to boost immunity and healing.
Regular medical visits to check the tube and stoma condition.
Educate the Patient and Family on Care
Teach how to clean the stoma and tube properly.
Train family members on basic first aid for emergencies such as tube blockage.