Healthcare Beyond the Airway

Improvements in modern tracheostomy care have swiftly evolved beyond technical, patient-level concerns: securing the airway, managing the tube, and preventing the complication. In their 2020 study, Brenner et al.¹ identify a paradigm shift in tracheostomy care, matching overall healthcare trends in emphasizing systems-level improvements. The articles in this issue resonate with that message. The quality of tracheostomy care is defined by how well we integrate engineering, economics, human experience, and interprofessional systems into a coherent model of safety.^1–3 The Global Tracheostomy Collaborative stands at the forefront of this movement towards systems-based improvements by seeking the best approaches across disciplines.¹

Our first feature article by Michael et al.⁴ shows how optimizing tracheostomy tube design and personalized clinical protocols can improve communication and safety for patients with a tracheostomy. Communication is considered the most common problem faced by patients and their caregivers.⁵ The isolation arising from barriers to speech has a profound effect on mental and physical well-being, with persistent social isolation being a predictor for cardiovascular disease, mental health disorders, and mortality.^6,7 We welcome research that rigorously explores voice restoration, a critical component of impaired communication.

The next featured study by Ünal et al.⁸ provides clear evidence that chronic colonization and the requirement for ongoing home ventilation significantly reduce the likelihood of successful decannulation. These findings underscore the importance of closely monitoring feeding and swallowing disorders and ensuring consistent multidisciplinary follow-up for medically complex children. Decannulation outcomes are shaped not only by underlying diagnoses but by longitudinal factors that can be identified and addressed through structured, coordinated care.⁹

The findings by Lenze et al.¹⁰ in this issue are revealing of a different kind of threat to patients with a tracheostomy. Out-of-pocket costs and surprise billing in the US healthcare system are not peripheral policy concerns; they are threats to survival.¹¹ A family forced into medical debt will ration supplies, delay follow-up, or decline essential care. These behaviors directly influence declines in physical and mental health.¹² Financial vulnerability must be viewed as a clinical risk factor, and one that directly influences treatment “nonadherence.¹³”

Equally important are the lived experiences highlighted in this issue by Brenner et al.¹⁴ Patients and caregivers consistently report fear, stigma, isolation, and disrupted access to supplies. These signals are echoed throughout the literature¹⁵ and in our clinical spaces, and represent a persistent and resilient threat to well-being. Patients with tracheostomy face, as the authors describe, an underexplored “compounded vulnerability” in their psychosocial wellness.¹⁶ Their work explores the struggles that hum in the background for those with chronic illness, such as those reliant on a tracheostomy.

Finally, the commentary by Pandian and Brenner¹⁷ on the International Council of Nurses’ framework provides a needed reminder that tracheostomy care is fundamentally a team endeavor, and our current variability in training, communication, and role clarity remains a barrier to safe practice and staff retention.^18,19 The authors highlight how the ICN framework aligns with the goals of the Global Tracheostomy Collaborative, particularly in strengthening interprofessional teamwork and supporting patient and family engagement. By clarifying nursing roles and reinforcing shared accountability across disciplines, the updated definitions provide a common language to guide care coordination, education, and transitions from hospital to home for individuals with a tracheostomy.

This issue advances the conversation on improving the overlapping health systems that represent the future of tracheostomy care. This issue demonstrates the value of integrating diverse perspectives, from engineering and health services research to qualitative insights and professional frameworks, to understand better the needs of individuals living with a tracheostomy. We hope you find that this issue offers the evidence and the imperative for strengthening communication, coordination, and safety across settings.

Disclaimer

The information or content and conclusions do not necessarily represent the official position or policy of, nor should any official endorsement be inferred by the Department of the Army, Department of Defense, or U.S. Government.