The reason to perform a tracheostomy is individualised, as various health conditions and injuries can demand the consideration of tracheotomy. However, the purpose of tracheostomy can be classified in three groups:

1. To Aid Breathing of Blocked Airway (Bypass Airway Obstructions) A tracheostomy is performed when there is an obstruction/blockage in the upper airway such as tumors, trauma from RTA/Intubation, swelling from burns, stenosis, or foreign bodies. By creating a direct opening in the trachea, it bypasses the obstruction, allowing air to flow directly into the lungs.
2. To Remove Excess Fluid and Mucus from the Lungs (Secretion Management) A tracheostomy provides a direct route for suctioning and therapeutic devices to optimize secretion management that accumulate in the trachea and bronchi caused by upper airway trauma, cricoid muscle damage, spinal cord injuries, Cervical/C-spine injuries, chronic respiratory conditions (COPD), head injury neuromuscular and degenerative conditions.

Tracheostomy is important for patients with conditions involving muscle atrophy, which leads to breathing difficulties, poor coordination, weakness, and reduced alertness. These patients often struggle with swallowing and have an ineffective cough, making it hard for them to expectorate secretions on their own. This can result in a build-up of excessive secretions, increasing the risk of airway obstruction and chest infections.

However, if a patient cannot swallow effectively, some of the swallowed contents will enter the trachea rather than down the oesophagus, referred to as ASPIRATION.

Aspirations can lead to lung issues including chest infections (LRTI) characterised by excessive secretion. On the other hand, a cuffed tracheostomy gives a good but not full proof level of protection from aspiration.

1. To Ventilate Lungs with Oxygen and help to wean patients off long term ventilation A tracheostomy can serve as a stable airway for mechanical ventilation, whether for short-term critical care or long-term respiratory support. It allows for efficient delivery of oxygen directly to the lungs, reducing the risks associated with prolonged endotracheal intubation (ETT).