The tracheotomized patient faces many challenges in maintaining a semblance of normal airway function. Normal airway secretion management and reduction of excessive or tenacious secretions are important in the care of a patient with a chronic tracheotomy. Secretions are substances normally produced and released by cells, and in the respiratory tract are primarily represented by mucus. Therapies available to augment secretion removal can be divided into four different groups: expectorants; mucolytics; mucokinetic agents; and mucoregulators. Ventilation via a tracheotomy eliminates the necessary functions of the nose, including humidification of inspired air. The three broad classifications of humidifiers are: bubble humidifier; passover humidifier; and heat and moisture exchange (HME). The three main controversies in suctioning involve routine suctioning versus as needed, closed versus open suction systems, and instillation of normal saline when suctioning. Unlike many surgical wounds, a tracheotomy involves the creation of the wound with planned healing by secondary intention.