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When is a tracheostomy required in ventilated patients?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

I am curious about the tracheostomy procedure. When is a tracheostomy required? Can a tracheostomy be performed in a patient on a ventilator in PSV mode with 21% FiO₂ and PEEP of 6 cm H₂O?

Kindly help.
Answered by Dr. Amandeep Singh Arneja

Education:

MD RESPIRATORY MEDICINE

Professional Bio:

I am Dr. Amandeep Singh Arneja, a dedicated Chest Physician and Senior Resident in Pulmonary Medicine at Jawaharlal Nehru Medical College (JNMC), Wardha, with extensive training in the management of complex respiratory and critical care conditions. I completed my M.B.B.S. from Universal College of Medical Sciences, Tribhuvan University (2016) and M.D. in Respiratory Medicine from Shri Shankaracharya Institute of Medical Sciences, Bhilai (2025), where I gained hands-on expertise in managing ICU patients, performing advanced diagnostic and therapeutic procedures, and conducting research in pulmonary diseases. My areas of expertise include: Management of asthma, COPD, tuberculosis, and interstitial lung disease Critical care management (ICU care, mechanical ventilation) Pulmonary function testing (spirometry, DLCO) Interventional procedures (thoracentesis, ICD insertion, bronchoscopy) Sleep medicine and polysomnography Research, academic writing, and clinical presentations I hold certifications in Good Clinical Practice and Biomedical Research. I am a proud member of the National College of Chest Physicians (NCCP). Alongside my pulmonary expertise, I have also completed a CPCDM Fellowship in Diabetes from RSSDI, enabling me to provide holistic care for patients with respiratory diseases complicated by diabetes. Currently, I am also pursuing a Fellowship in Critical Care Medicine, which further enhances my ability to manage critically ill patients with respiratory and systemic illnesses. With multiple research publications, conference presentations (NAPCON, SSIMSCON), and a strong academic background, I strive to combine evidence-based medicine with compassionate patient care. My mission is to provide comprehensive, high-quality care to patients suffering from respiratory and lifestyle-related diseases.

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Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

A tracheostomy is a small surgical opening made in the front of the neck to help a person breathe through a tube placed directly into the trachea, which is the windpipe.

It is usually necessary when a patient is expected to require ventilator support for an extended period or when it becomes challenging to maintain the breathing tube safely in place.

It may also be required if the patient has weak breathing muscles or repeated difficulty coming off the ventilator.

PSV mode, which stands for pressure support ventilation. In this mode, the patient is already breathing on their own, and the ventilator provides minimal assistance with each breath to make it easier.

This mode is commonly used when the patient is improving and preparing to be weaned off the ventilator completely.

If a patient is on PSV mode with an oxygen level (FiO₂) of 21% and a PEEP (positive end-expiratory pressure) of 6 (attachment removed to protect the patient's identity), it means they are already receiving very minimal ventilator support, almost equivalent to breathing room air.

These values indicate that the lungs are functioning well, and the patient is likely nearing the point of being taken off the ventilator.

In such cases, tracheostomy is generally not required unless the patient has other issues like a weak cough, poor airway protection, severe weakness, or is expected to stay in the ICU (intensive care unit) for a long time.

I hope I have addressed all your queries. You may reach out anytime. Best wishes.

Thank you and take care.

Medically reviewed by iCliniq medical review team
Published At January 3, 2026
Reviewed At January 5, 2026

Education:

MD RESPIRATORY MEDICINE

Professional Bio:

I am Dr. Amandeep Singh Arneja, a dedicated Chest Physician and Senior Resident in Pulmonary Medicine at Jawaharlal Nehru Medical College (JNMC), Wardha, with extensive training in the management of complex respiratory and critical care conditions. I completed my M.B.B.S. from Universal College of Medical Sciences, Tribhuvan University (2016) and M.D. in Respiratory Medicine from Shri Shankaracharya Institute of Medical Sciences, Bhilai (2025), where I gained hands-on expertise in managing ICU patients, performing advanced diagnostic and therapeutic procedures, and conducting research in pulmonary diseases. My areas of expertise include: Management of asthma, COPD, tuberculosis, and interstitial lung disease Critical care management (ICU care, mechanical ventilation) Pulmonary function testing (spirometry, DLCO) Interventional procedures (thoracentesis, ICD insertion, bronchoscopy) Sleep medicine and polysomnography Research, academic writing, and clinical presentations I hold certifications in Good Clinical Practice and Biomedical Research. I am a proud member of the National College of Chest Physicians (NCCP). Alongside my pulmonary expertise, I have also completed a CPCDM Fellowship in Diabetes from RSSDI, enabling me to provide holistic care for patients with respiratory diseases complicated by diabetes. Currently, I am also pursuing a Fellowship in Critical Care Medicine, which further enhances my ability to manage critically ill patients with respiratory and systemic illnesses. With multiple research publications, conference presentations (NAPCON, SSIMSCON), and a strong academic background, I strive to combine evidence-based medicine with compassionate patient care. My mission is to provide comprehensive, high-quality care to patients suffering from respiratory and lifestyle-related diseases.

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality

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Decision Helper
Tracheostomy for Ventilated Patients Decision Helper

Considering a tracheostomy for ventilator support?

Answer a few quick questions to understand if a tracheostomy might be a relevant option for you or a loved one on a ventilator.

This tool provides general information and is not a substitute for professional medical advice.
Dr. Amandeep Singh Arneja
Dr. Amandeep Singh Arneja

Pulmonology (Asthma Doctors)

Education:

MD RESPIRATORY MEDICINE

Professional Bio:

I am Dr. Amandeep Singh Arneja, a dedicated Chest Physician and Senior Resident in Pulmonary Medicine at Jawaharlal Nehru Medical College (JNMC), Wardha, with extensive training in the management of complex respiratory and critical care conditions. I completed my M.B.B.S. from Universal College of Medical Sciences, Tribhuvan University (2016) and M.D. in Respiratory Medicine from Shri Shankaracharya Institute of Medical Sciences, Bhilai (2025), where I gained hands-on expertise in managing ICU patients, performing advanced diagnostic and therapeutic procedures, and conducting research in pulmonary diseases. My areas of expertise include: Management of asthma, COPD, tuberculosis, and interstitial lung disease Critical care management (ICU care, mechanical ventilation) Pulmonary function testing (spirometry, DLCO) Interventional procedures (thoracentesis, ICD insertion, bronchoscopy) Sleep medicine and polysomnography Research, academic writing, and clinical presentations I hold certifications in Good Clinical Practice and Biomedical Research. I am a proud member of the National College of Chest Physicians (NCCP). Alongside my pulmonary expertise, I have also completed a CPCDM Fellowship in Diabetes from RSSDI, enabling me to provide holistic care for patients with respiratory diseases complicated by diabetes. Currently, I am also pursuing a Fellowship in Critical Care Medicine, which further enhances my ability to manage critically ill patients with respiratory and systemic illnesses. With multiple research publications, conference presentations (NAPCON, SSIMSCON), and a strong academic background, I strive to combine evidence-based medicine with compassionate patient care. My mission is to provide comprehensive, high-quality care to patients suffering from respiratory and lifestyle-related diseases.

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality
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