View source for Tracheostomy complications

==Background==
{{Tracheostomy background}}
*Critical distinction: Tracheostomy (tracheal stoma, upper airway intact) vs laryngectomy (stoma is ONLY airway — cannot be ventilated from above)<ref>Mitchell RB, et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013 Jan;148(1):6-20. PMID 22990518</ref>
*Complications may be early (<7 days, ''immature'' tract) or late (>7 days, ''mature'' tract)
*Immature tracts are at high risk for false passage if tube is dislodged

==Clinical Features==
===Obstruction (Most Common Emergency)===
*Respiratory distress, increased work of breathing, inability to pass suction catheter
*Causes: mucus plugging, blood clot, granulation tissue, tube displacement

===Decannulation/Dislodgement===
*Tube falls out or is pulled out
*Immature tract (<7 days): High-risk — tract may close rapidly, reinsertion can create false passage
*Mature tract (>7 days): Usually can be replaced at bedside

===Hemorrhage===
*Minor: granulation tissue bleeding (common, usually self-limited)
*'''Tracheo-innominate fistula:''' Sentinel bleed followed by massive hemorrhage — life-threatening emergency
**Occurs days to weeks post-placement; innominate artery erosion
**Temporize with hyperinflation of tracheostomy cuff or digital compression through stoma

===Other===
*Tracheoesophageal fistula, subcutaneous emphysema, pneumothorax, stomal infection

==Differential Diagnosis==
{{Tracheostomy DDX}}

==Evaluation==
*Determine if tracheostomy vs laryngectomy (if laryngectomy → stoma is the ONLY airway)
*Identify tracheostomy type, size, and whether cuffed or uncuffed
*Assess patency: can suction catheter pass? Can patient be ventilated through trach?
*SpO2, capnography if available

==Management==
===Stepwise Emergency Algorithm===
*Call for airway expert help early
*Sit patient up or position of comfort
*Apply high-flow O2 to trach stoma AND to face (unless confirmed laryngectomy)
*Remove speaking valve or cap if present
*Remove inner cannula and attempt suction
*If unable to pass suction catheter:
**Deflate cuff
**Consider removing the tracheostomy tube entirely
*If tube removed:
**Mature tract: Attempt reinsertion (same size or one size smaller); use suction catheter as bougie guide
**'''Immature tract:''' Do NOT blindly reinsert — risk of false passage; cover stoma, ventilate from above (oral intubation)
*If unable to ventilate from either route → emergency [[cricothyrotomy]] or surgical airway through stoma

===Tracheo-innominate Hemorrhage===
*Hyperinflate cuff to tamponade
*If unsuccessful: digital compression of innominate artery through stoma (finger anterior and downward)
*Emergent surgery consult — definitive management is operative

==Disposition==
*Admit all patients with significant tracheostomy emergencies
*Low threshold for admission of patients with immature tracts

==See Also==
*[[Medical device complications]]
*[[Surgical airways]]
*[[G-tube complications]]
*[[Ostomy complications]]

==References==
<references/>

[[Category:ENT]]
[[Category:Surgery]]
[[Category:Pulmonary]]
[[Category:Critical Care]]