Tracheostomy care Instructed patient caregiver Signs and symptoms of difficulty breathing are: Retractions Pulling of the skin between the ribs, under the breastbone or around the trach itself. Also symptoms of difficulty breathing are: Sweaty and pale skin, a person is sweaty and pale and seems to be working hard to breathe while at rest, dusky lips or nail beds. The lips or nail beds look dark, dusky or blue.