Healthcare Beyond the Airway

Improvements in modern tracheostomy care have swiftly evolved beyond technical, patient-level concerns: securing the airway, managing the tube, and preventing the complication.In their 2020 study, Brenner et al. 1 identify a paradigm shift in tracheostomy care, matching overall healthcare trends in emphasizing systems-level improvements.The articles in this issue resonate with that message.The quality of tracheostomy care is defined by how well we integrate engineering, economics, human experience, and interprofessional systems into a coherent model of safety. [1][2]][3] The Global Tracheostomy Collaborative stands at the forefront of this movement towards systems-based improvements by seeking the best approaches across disciplines. 1 Our first feature article by Michael et al. 4 shows how optimizing tracheostomy tube design and personalized clinical protocols can improve communication and safety for patients with a tracheostomy.Communication is considered the most common problem faced by patients and their caregivers. 5The isolation arising from barriers to speech has a profound effect on mental and physical well-being, with persistent social isolation being a predictor for cardiovascular disease, mental health disorders, and mortality. 6,7e welcome research that rigorously explores voice restoration, a critical component of impaired communication.The next featured study by nal et al. 8 provides clear evidence that chronic colonization and the requirement for ongoing home ventilation significantly reduce the likelihood of successful decannulation.These findings underscore the importance of closely monitoring feeding and swallowing disorders and ensuring consistent multidisciplinary follow-up for medically complex children.Decannulation outcomes are shaped not only by underlying diagnoses but by longitudinal factors that can be identified and addressed through structured, coordinated care. 9The findings by Lenze et al. 10 in this issue are revealing of a different kind of threat to patients with a tracheostomy.Out-ofpocket costs and surprise billing in the US healthcare system are