Abstract
Background: Patients who breathe “through the neck only” following tracheostomy or total laryngectomy cannot be ventilated through the mouth or nose. Misunderstanding or misuse of airway terminology can lead to catastrophic management errors, including hypoxia, brain injury, or death. Despite growing awareness, no standardized, patient-centered nomenclature exists for describing airway anatomy in these populations.
Purpose: To clarify and standardize terminology describing tracheostomy and laryngectomy airway anatomy by conducting a global mixed methods survey of healthcare professionals (HCPs), patients, families, and caregivers (PFCs), promoting accuracy, safety, and patient-centeredness in communication.
Methods: A multidisciplinary team developed and iteratively refined a survey instrument for assessing airway knowledge and terminology preferences, incorporating fixed-response and free-response elements. The survey was distributed internationally through professional and advocacy networks. Quantitative data were analyzed using descriptive and inferential statistics, and qualitative data underwent thematic analysis.
Results: Respondents included 1,004 participants from six continents, representing diverse professional, patient, and care roles. Knowledge gaps included respondents indicating that individuals with a total laryngectomy could breathe through their mouth, more common among PFCs (p=0.003). Safety was rated the highest priority in selecting terminology. HCPs emphasized universal terminology whereas PFCs favored patient-centered and humanistic language (p=0.001). Preferred terms varied by airway status, with "neck-only breather" (25.4%) and "person with tracheostomy who is not intubatable" (43.2%) emerging as key terms for individuals with blocked or absent upper airway. Thematic analysis reinforced that clear terminology supports emergency preparedness, communication, and individualized care.
Conclusion: Developing a consistent, patient-centered airway terminology can reduce preventable harm and improve communication across global healthcare systems. Future work should establish implementation frameworks and evaluate outcomes of standardized nomenclature on safety and care quality.
Notes
Presenter notes available in attached slide deck. To see the notes in Adobe Acrobat, go to Tools > Comment or look at your Layers Panel. If the notes were saved as comments or layers, you can toggle them visible.
References:
1. Ng FK, McGrath BA. 'Neck-only breather' is a better term than 'neck breather' in algorithms and bedhead signs for the management of tracheostomy emergencies. A reply. Anaesthesia. Nov 2019;74(11):1475. doi:10.1111/anae.14798
2. Paulich S, Kelly FE, Cook TM. 'Neck breather' or 'neck-only breather': terminology in tracheostomy emergencies algorithms. Anaesthesia. Jul 2019;74(7):947. doi:10.1111/anae.14709
3. Brenner MJ, Cramer JD, McGrath BA, et al. Oral Intubation Attempts in Patients With a Laryngectomy: A Significant Safety Threat. Otolaryngol Head Neck Surg. May 2021;164(5):1040-1043. doi:10.1177/0194599820960728
4. Cook TM, Woodall N, Harper J, Benger J, Fourth National Audit P. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth. May 2011;106(5):632-42. doi:10.1093/bja/aer059
5. El-Sayed IH, Ryan S, Schell H, Rappazini R, Wang SJ. Identifying and improving knowledge deficits of emergency airway management of tracheotomy and laryngectomy patients: a pilot patient safety initiative. Int J Otolaryngol. 2010;2010:638742. doi:10.1155/2010/638742
6. McGrath BA, Bates L, Atkinson D, Moore JA, National Tracheostomy Safety P. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia. Sep 2012;67(9):1025-41. doi:10.1111/j.1365-2044.2012.07217.x
7. Brenner MJ, Pandian V, Milliren CE, et al. Global Tracheostomy Collaborative: data-driven improvements in patient safety through multidisciplinary teamwork, standardisation, education, and patient partnership. Br J Anaesth. Jul 2020;125(1):e104-e118. doi:10.1016/j.bja.2020.04.054
Sigma Membership
Omega Epsilon at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Implementation Science, Acute Care, Advancing Clinical Practice, Tracheotomy, Laryngectomy, Medical Terminology, Patient Safety
Recommended Citation
Walter, Naomi Nancy Simon; Brenner, Michael J.; and Pandian, Vinciya, "Standardizing Tracheostomy and Laryngectomy Terminology for Patient Safety: Global Outlook" (2026). International Nursing Research Congress (INRC). 277.
https://www.sigmarepository.org/inrc/2026/presentations_2026/277
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-09-16
Standardizing Tracheostomy and Laryngectomy Terminology for Patient Safety: Global Outlook
Toronto, Ontario, Canada
Background: Patients who breathe “through the neck only” following tracheostomy or total laryngectomy cannot be ventilated through the mouth or nose. Misunderstanding or misuse of airway terminology can lead to catastrophic management errors, including hypoxia, brain injury, or death. Despite growing awareness, no standardized, patient-centered nomenclature exists for describing airway anatomy in these populations.
Purpose: To clarify and standardize terminology describing tracheostomy and laryngectomy airway anatomy by conducting a global mixed methods survey of healthcare professionals (HCPs), patients, families, and caregivers (PFCs), promoting accuracy, safety, and patient-centeredness in communication.
Methods: A multidisciplinary team developed and iteratively refined a survey instrument for assessing airway knowledge and terminology preferences, incorporating fixed-response and free-response elements. The survey was distributed internationally through professional and advocacy networks. Quantitative data were analyzed using descriptive and inferential statistics, and qualitative data underwent thematic analysis.
Results: Respondents included 1,004 participants from six continents, representing diverse professional, patient, and care roles. Knowledge gaps included respondents indicating that individuals with a total laryngectomy could breathe through their mouth, more common among PFCs (p=0.003). Safety was rated the highest priority in selecting terminology. HCPs emphasized universal terminology whereas PFCs favored patient-centered and humanistic language (p=0.001). Preferred terms varied by airway status, with "neck-only breather" (25.4%) and "person with tracheostomy who is not intubatable" (43.2%) emerging as key terms for individuals with blocked or absent upper airway. Thematic analysis reinforced that clear terminology supports emergency preparedness, communication, and individualized care.
Conclusion: Developing a consistent, patient-centered airway terminology can reduce preventable harm and improve communication across global healthcare systems. Future work should establish implementation frameworks and evaluate outcomes of standardized nomenclature on safety and care quality.
Description
Purpose: To refine airway anatomy terminology using a mixed methods survey among healthcare care professionals and patient family caregivers.
Methods: A survey instrument incorporating fixed response and free response elements to assess knowledge and terminology preferences was distributed internationally to professional and advocacy groups.
Findings: Developing a consistent, patient-centered airway terminology can reduce preventable harm and improve communication across global healthcare systems.