why is going from a ventilator to tracheotomy better is the ventilator still has to be used on the trach?
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I think you’re referring to the transition from ventilating through a endotracheal tube (in the mouth through the vocal cords) to ventilating through a tracheostomy tube (in the neck).
We do this all the time when a patient is anticipated to need continued ventilation for a while longer, and yes, it doesn’t change the way we ventilate them, at least to begin with.
By far the biggest reason is that you need a lot of sedation and pain relief drugs to tolerate a tube going through the vocal cords. Essentially, the patient has to be kept in a coma, or at least in a bit of a stupor.
Once you insert a tracheostomy and remove the endotracheal tube, you can stop all those drugs, wake the patient up, and once they’re awake, they are in a much better place to be rehabilitated and eventually weaned off the ventilator. They can eat, they can communicate, they can exercise, and once ready, a special device called a speaking valve allows them to start talking with the tracheostomy in. Eventually the ventilator can go and the tracheostomy can stay in for a little longer, keeping their airway open and safe.
Occasionally tracheostomy tubes are inserted to bypass big problems in the throat (like large tumours or abscesses) but these patients tend not to need to be ventilated for very long; it’s mainly to provide an alternative route to breathe through.
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