Tracheostomy complications

Background

Tracheostomy Sizes

(1) Thyroid cartilage (2) Cricothyroid ligament (3) Cricoid cartilage (4) Trachea (A) Cricothyrotomy site (B) Tracheotomy site

Tracheotomy in situ
1 – Vocal folds
2 – Thyroid cartilage
3 – Cricoid cartilage
4 – Tracheal rings
5 – Balloon cuff

Shiley™ trach tube

• Average size:
  • Adult: 5-10mm
  • Peds: 2.5-6.5mm

Tracheostomy vs laryngectomy

It is important to differentiate between tracheostomy vs laryngectomy

• If laryngectomy:
  • The stoma is the only way to ventilate the patient.
  • Patient cannot be orally intubated

Differential Diagnosis

Tracheostomy complications

• Tracheostomy obstruction
• Tracheostomy dislodgement
• Tracheostomy infection
• Tracheostomy bleeding

Evaluation

• Attempt to find out if patient has a tracheostomy vs laryngectomy from history. If the latter is present, the stoma is the only way to ventilate the patient.

Management

• Call for airway expert help
• Sit patient up or in a position of comfort
• Place on trach collar oxygen or place non-rebreather mask mask on trachesostmy while preparing
  • If any doubt about tracheosomy vs. laryngectomy, be sure to oxygenate nasal/oral airway in addition to stoma
• Don faceshield, have suction, oxygen, flushes (possibly surgical airway supplies)
• Remove speaking valve or cap (if present)
• Remove inner cannula
• If unable to pass suction catheter at this point, deflate cuff and consider removing tracheostomy tube

See Also

• Medical device complications
• Surgical airways

External Links

• emDocs - Need-to-Know ED Tricks for Airway Emergencies in Tracheostomy Patients
• Justin Morgenstern, "Respiratory distress in the patient with a tracheostomy (update)", First10EM blog, July 25, 2018. Available at: https://first10em.com/tracheostomy/