A tracheostomy tube (trach) is a plastic tube that is inserted directly into the patient’s trachea through a small incision on the neck. The tube could be connected to a ventilator circuit (big arrow on the image above). The trach is considered a long term option and some patients have it for the rest of their lives. The indications for trach insertion are multiple. In the Intensive Care Unit, the inability to wean the patient off mechanical ventilation is the most common indication to insert a trach.