Physiological implications of tracheostomy in critical care—a narrative review
6 affiliations
- 1Department of Critical Care Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
- 2School of Medicine, University College Dublin, Dublin, Ireland
- 3Speech and Language Therapy Department, Mater Misericordiae University Hospital, Dublin, Ireland
- 4Department of Anesthesia and Intensive Care, Presidio Ospedaliero di Ciriè-Lanzo, Ciriè, Italy
- 5Department of Oncology, University of Turin, Turin, Italy
- 6Department of Anesthesia and Intensive Care, University Hospital San Luigi Gonzaga, Turin, Italy
Abstract
Background and Objective: Tracheostomy is a core component of critical care medicine. Although its use is traditionally justified by anticipated improvements in respiratory mechanics and patient comfort, the exact pathophysiological mechanisms are complex. The objective of this narrative review is to examine the physiological changes associated with tracheostomy, focusing on alterations on respiratory mechanics, patient-ventilator interactions, and the implications for speech and swallowing.
Methods: A comprehensive literature search of the PubMed (MEDLINE) database was conducted for articles published up to May 2026. The review synthesized data from randomized controlled trials (RCTs), prospective and retrospective observational studies, and relevant systematic reviews involving critically ill adult populations.
Key Content and Findings: Contrary to common clinical belief, transitioning from an endotracheal tube (ETT) to a tracheostomy leads to a marginal reduction in dead space (Vd). The primary respiratory benefit is a reduction in the resistive work of breathing (WOB). Post-tracheostomy dysphagia and dysphonia are highly prevalent and multifactorial, driven by pre-existing laryngeal trauma from intubation and the loss of trans-laryngeal airflow. Evidence demonstrates that early cuff deflation significantly reduces silent aspiration and enhances laryngeal rehabilitation.
Conclusions: The clinical benefits of tracheostomy can be appreciated through an understanding of the physiological effects of tracheostomy. Management of patients with tracheostomy in critical care requires early, multidisciplinary intervention.
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BibTeX
@article{mcmahon2026physiological,
title = {{Physiological implications of tracheostomy in critical care—a narrative review}},
author = {Aisling McMahon and Massimo Muraccini and Aoife Walsh and Eibhlín Cleary and Chiara Sansovini and Vincenzo Russotto},
journal = {Annals of Translational Medicine},
year = {2026},
month = oct,
doi = {10.21037/atm-2026-0148},
url = {https://doi.org/10.21037/atm-2026-0148},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Physiological implications of tracheostomy in critical care—a narrative review
AU - Aisling McMahon
AU - Massimo Muraccini
AU - Aoife Walsh
AU - Eibhlín Cleary
AU - Chiara Sansovini
AU - Vincenzo Russotto
PY - 2026
DA - 2026/10/23
JO - Annals of Translational Medicine
DO - 10.21037/atm-2026-0148
UR - https://doi.org/10.21037/atm-2026-0148
AB - Background and Objective: Tracheostomy is a core component of critical care medicine. Although its use is traditionally justified by anticipated improvements in respiratory mechanics and patient comfort, the exact pathophysiological mechanisms are complex. The objective of this narrative review is to examine the physiological changes associated with tracheostomy, focusing on alterations on respiratory mechanics, patient-ventilator interactions, and the implications for speech and swallowing. Methods: A comprehensive literature search of the PubMed (MEDLINE) database was conducted for articles published up to May 2026. The review synthesized data from randomized controlled trials (RCTs), prospective and retrospective observational studies, and relevant systematic reviews involving critically ill adult populations. Key Content and Findings: Contrary to common clinical belief, transitioning from an endotracheal tube (ETT) to a tracheostomy leads to a marginal reduction in dead space (Vd). The primary respiratory benefit is a reduction in the resistive work of breathing (WOB). Post-tracheostomy dysphagia and dysphonia are highly prevalent and multifactorial, driven by pre-existing laryngeal trauma from intubation and the loss of trans-laryngeal airflow. Evidence demonstrates that early cuff deflation significantly reduces silent aspiration and enhances laryngeal rehabilitation. Conclusions: The clinical benefits of tracheostomy can be appreciated through an understanding of the physiological effects of tracheostomy. Management of patients with tracheostomy in critical care requires early, multidisciplinary intervention.
SN - 2305-5839
SN - 2305-5847
ER -