Complications of Tracheostomy

⚠️ Tracheostomy Complications

Complications of tracheostomy are classified into:

1️⃣ Immediate complications → During surgery
2️⃣ Intermediate complications → Hours to days after surgery
3️⃣ Late complications → Weeks to months later

🚨 Immediate Complications of Tracheostomy (Intraoperative)

🩸 1- Hemorrhage (Most Common & Most Fatal)

Prevention

• Strict midline dissection
• Good anatomical knowledge
• Proper ligation / retraction of thyroid isthmus

Management

• Explore wound
• Identify bleeding vessel
• Ligate vessel

What are the vessels at risk of injury in Tracheostomy?

💨 2- Air Embolism (Rare but Life-Threatening)

What is the mechanism of formation of Air embolism during Tracheostomy?

Management

• Head-low position
• Supportive management

🧠 3- Damage to Local Structures

What is the management of injury to oesophagus during Tracheostomy?

What is the management of Pneumothorax during Tracheostomy?

What is the management of injury to Cricoid / Tracheal Wall during Tracheostomy?

😴 4- Apnea (Central Respiratory Failure)

Mechanism

Chronic obstruction → respiratory drive due to:

• Hypercapnia
• Hypoxia

After tracheostomy:

• CO₂ ↓
• O₂ ↑ → Respiratory drive lost

What is the management of Apnea during Tracheostomy?

What is Carbogen?

🩸 5- Aspiration of Blood / Secretions

• May cause airway obstruction

❗ 6- False Passage Formation

Features suggestive of False Passage Formation in Tracheostomy

• Falling SpO₂
• Tachypnea
• Tachycardia
• Cyanosis (late)
• Bradycardia (terminal)

❤️ 7- Cardiac Failure

What are the causes of cardiac failure during Tracheostomy?

⏳ Intermediate Complications of Tracheostomy (Hours → Days)

🔄 1- Tracheostomy Tube Dislodgement / Accidental Decannulation

What are the causes of Accidental decannulation in a Tracheostomy case?

When to suspect Tracheostomy Tube Dislodgement?

• Sudden airway obstruction
• Unable to pass suction catheter
• Patient unable to speak

How to prevent Accidental decannulation in a Tracheostomy case?

🚫 2- Tracheostomy Tube Block

Causes

• Crusts
• Granulation tissue
• Poor positioning

Prevention

• Regular suction
• Periodic tube change

💥 3- Subcutaneous Emphysema

What is the mechanism of formation of Subcutaneous Emphysema in Tracheostomy?

Signs

• Crepitus on palpation
• Swelling up to eyelids / chest

How would you treat subcutaneous emphysema in a post Tracheostomy patient?

🔗 4- Tracheoesophageal Fistula

Causes

• Posterior tracheal wall injury
• Constant tube pressure

What signs and symptoms would be suspicious of Tracheoesophageal fistula in a Tracheostomy patient?

How would you manage a case of Tracheoesophageal Fistula?

🩸 5- Tracheoarterial Fistula (⚠️ MCQ Important)

What is the most common artery involved in Tracheoarterial Fistula?

Presentation

• Sudden massive hemorrhage

Management

• Immediate cuff inflation
• Compression
• Surgical exploration

🔥 6- Tracheitis / Tracheobronchitis

• Due to infection / crusting

Management

• Antibiotics
• Regular dressing

🫁 7- Atelectasis

• Partial → blood / secretion aspiration
• Complete → tube in one bronchus

Management

• Tube repositioning
• Shorter tube if required

🩸 8- Reactionary & Secondary Hemorrhage

Treatment

• Antibiotics
• Hemostasis

🧱 9- Crust Formation

Cause

• Loss of nasal humidification

Prevention

• Wet gauze
• HME device
• Nebulization

🕰️ Late Complications of Tracheostomy (Weeks → Months)

🔽 1- Laryngeal Stenosis

Causes

• High tracheostomy
• Improper tube curvature
• Overinflated cuff
• Mucosal injury
• Chemical irritation

What is the ideal cuff pressure to be maintained in a cuffed tracheostomy tube?

Treatment

• Steroids
• Antibiotics
• Surgery

🔻 2- Tracheal Stenosis

Causes

• Infection
• Scar contracture
• Repeated tracheal incision

Treatment

• Tracheal dilatation
• Excision & primary closure

🚫 3- Difficult Decannulation

• More common in children

What is Difficult Decannulation?

What are the causes of Difficult Decannulation?

🔗 4- Persistent Tracheocutaneous Fistula

Seen In long term tracheostomy

Features

• Skin irritation
• Poor phonation

Treatment

• Excision of tract
• Layered closure

🧬 5- Scar Complications

• Depressed scar
• Keloid formation

⭐ Exam Pearls

• Most fatal complication → Hemorrhage
• Most common artery in tracheo-arterial fistula → Innominate artery
• Apnea treated with → Carbogen
• Ideal cuff pressure → 15–25 mm H₂O
• Most common intermediate complication → Tube displacement