Transtracheal Oxygen Therapy for COPD

A treatment option when oxygen therapy isn't working

Indian doctor talking with patient
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Transtracheal oxygen therapy (TTOT) is sometimes used in people with severe chronic obstructive pulmonary disease (COPD) who need a more direct method of supplemental oxygen than the standard delivery method via nasal cannula and oxygen tank. In transtracheal oxygen therapy, a narrow tube called a catheter is inserted through a hole in the neck to feed oxygen directly to the lungs.

While not commonly used, it may be a useful option for some patients.

Indications and Contraindications

TTOT was first used in 1982 and was initially largely dismissed by those who considered it to be impractical other than in cases of extreme oxygen deprivation (hypoxia). Since then, a number of doctors have endorsed its use in people whom they believe can benefit greatly from the procedure.

This includes individuals who are achieving less-than-optimal results with a cannula, oftentimes because they are not using it enough and/or properly. The simple fact is that the prolonged use of a cannula can lead to chronic irritation around the nose and ears, as well as the development of contact dermatitis, chondritis, and skin ulcers. This alone can discourage use, leading to a deterioration of physical activity and exercise tolerance.

Others who may benefit from TTOT include:

  • Those with severe COPD
  • Those with interstitial lung disease (ILD)
  • Those with obstructive sleep apnea (OSA)
  • Those with overlap syndrome (having both COPD and OSA)
  • Those with pulmonary fibrosis
  • Others who may be reliant on long-term oxygen therapy

TTOT should not be used (is contraindicated) in the following conditions:

  • Clotting disorders
  • Terminal illnesses
  • Upper airway obstruction


Transtracheal oxygen therapy can actually improve a person's quality of life. TTOT requires far less oxygen than an oxygen tank, meaning that a portable oxygen concentrator can be smaller, lighter, and longer-lasting, allowing a person to be out and about for longer periods of time.

It's also considered less cosmetically visible than a cannula/tank, which may relieve some feelings of self-consciousness.

TTOT also allows for lower flow rates, as it requires 55% less oxygen during rest and 35% less oxygen during exercise compared to a cannula/tank. These numbers can translate to improved physiological function and an increase in exercise tolerance.

While these facts don't entirely overcome the obstacles to transtracheal oxygen therapy, they do advocate for its use in persons who are not responding to standard oxygen therapy as well as they should.


The procedure needed to initiate TTOT is generally safe, but not without its limitations. The insertion of a catheter into the neck can be distressing and/or aesthetically unappealing to some, though it is generally not considered uncomfortable. Moreover, the tube is prone to mucus clogging and may sometimes require unwieldy adjustments.

Other complications may include developing bumps in the trachea (tract granulation), narrowing of the windpipe (stenosis), ulcerations on the trachea, or the coughing up of blood (hemoptysis).

Collapsed lung (pneumothorax) is also a potential complication of TTOT, but it is rare, as is subcutaneous emphysema (trapped air left under the skin).


There are two common procedures that are used by surgeons to deliver transtracheal oxygen therapy:

Modified Seldinger Technique

The modified Seldinger technique is the best-known form of TTOT. The procedure itself is performed under anesthesia on an outpatient basis and involves the following steps:

  1. A small incision is made into the neck into which a needle is inserted.
  2. A wire guide is then passed over the needle, and the needle is extracted.
  3. A smooth tube called a dilator is then passed over the wire and begins the process of gently stretching the neck tissue.
  4. Once the opening is large enough, the dilator is removed and a stent is passed over the wire into the opening. This will keep the incision from closing.
  5. After the wire guide is removed, the stent is sutured into place.
  6. After a week, the patient returns to have the stent removed. The catheter is then inserted into the trachea to complete the procedure.

The Fast Tract Technique

A newer method, called the Fast Tract technique, was developed to streamline the TTOT process. The procedure is performed in the operating room under light sedation and usually involves an overnight stay.

To create the transtracheal opening, the surgeon creates tiny skin flaps on the neck, exposing the inside of the trachea. The skin flaps are then tacked to the underlying muscle on the inside of the neck, creating a permanent pathway.

With the Fast Tract procedure, TTOT can begin the following day rather than a week later.

Connecting a Portable Oxygen Concentrator

Following surgical insertion of the catheter, your doctor will help you connect your portable oxygen concentrator for the first time and should teach you how to properly use it.

For the first few weeks after surgery, you'll need to meet with your care provider regularly to check and adjust any settings on your oxygen concentrator as necessary and to make sure oxygen delivery is adequate for your needs. Regular check-ups can also be helpful to spot any potential complications early.

Just make sure that you never self-adjust your oxygen concentrator; changes to your oxygen flow should only be performed by a medical professional.

A Word From Verywell

Transtracheal oxygen therapy requires a minimally invasive procedure that generally has few complications, and the treatment itself may lead to an improved quality of life for those with serious lung conditions. It's highly worth discussing with your physician to determine if you're a good candidate for it.

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