Tracheotomy Complications
*Early
Complications
Hemorrhage
Minor
bleeding (oozing) :
5% cases, Venous ( ant.jug.
System, thyroid isthmus ).
Semi recumbent pos. +
hemostatic gauze
Major
bleeding.:
Less common, sup. thyroid
artery,
imm.local expl.+ ligation.
Massive
arterial hemorrhage :
rare, usually, innominate
artery,
erosion by the distal
end of the canula in the presence of mediastinal infection or by
intraoperative disruption when the artery is high lying, obscured by a
tumor, excessive use of electrocautery.
Airway should be secured,
digital pressure, arterial repair by median sternotomy approach.
Tube displacement
2-5%
dangerous during the
first 3-5 post-op days
failure to secure the
tube adequately / excessive traction
the tube should be replaced
under direct vision, a smaller caliber tube may be more easily inserted,/
or using a guide.
Pneumothorax
0-5%
Aggressive dissection
of the midline, in children and chronic lung disease when pleural apices
can extend into the neck
Forceful ventilation.
Subcutaneous
emphysema
Soft tissue swelling
and crepitus in the neck
Results when air that
normally escapes around the canula is forced into loose fascial planes:
closing the wound too tightly, Tube obstruction/displacement
Allow further contamination
Mediastinitis
Stomal contamination
/ intraop esophageal perf.
Fever,chills,dyspnea,
dull pleuretic chest pain.... Septic shock
Widening of the mediastinal
shadow.
Massive doses of broad-spectrum
antibiotics+surgical drainage.
Aerophagia
More common in children.
Mechanical irritation
from the cuff stimulates the sensation of food bolus, resulting in reflex
swallowing. NG tube is the treatment in case of gastric distention.
Cardiopulmonary
dysfunction
Delay in obtaining an
adequate airway : hypoxia, acidosis: myocardial irritability.
Relieving airway obstruction
itself:
sudden loss of hypoxic
stimulation, + sudden relief of upper airway obstruction: sudden onset
of pulmonary edema. These patients should me maintained on continuous +
airway Press.
*Late complications
Tube obstruction
Common cause of respiratory
distress.
Due to mucus plugging
Trt: increased humidification,
irrigation (5%NaHCo3).
In acute total obstruction:removal
of the inner canula, should be taught to the patients.
Infection
Local cellulitis and
purulent stomal exsudate require aggressive local therapy.
Systemic antibiotics
may be required.
Uncontrolled: can lead
to: mediastinitis, innominate artery rupture, osteomylitis, necrotizing
infections, stomal erosion, granulation tissue….
Innominate
artery erosion
Is the most common delayed
fatal complication of tracheotomy!
Incidence : 1-2%.
Survival rate: 10-25%
Once massive bleeding
occurs: Introduction of a longer endotracheal tube through the stoma can
be life saving.
Digital pressure should
be applied between the anterior trachea and the manubrium to compress
the artery.
Simultaneously massive
fluid resuscitation should be started and the patient immediately taken
to the operating room for median sternotomy and vessel ligation.
Tracheoesophageal
fistula
Pressure necrosis and
malposition of the canula, an over inflated cuff, or a malpositionned nasogastric
tube.
< 1 %.
Sudden increase in tracheal
secretions, air leak around the cuff, aspiration and abdominal distention.
Diagnosis: barium swallow
or tracheoscopy.
Treatment: conservative,
NG, if fails: surgical: tract debrided+viable soft tissue interposition.
Aspiration
2-4% ? Probably unrecognized!
Pneumonia, & lung
abscesses
Upright position and
inflating the balloon : temporary protection.
Complication
associated with decanulation.
Obstruction by a granuloma
Physiologic obstruction
( uncoordinated midline position of vocal cord)
Laryngeal stenosis
Subglottic stenosis
Tracheal stenosis
Tracheo-cutaneous fistula.
