Complications following Tracheostomy Insertion in Critically Ill Patients -Experience from a Large Teaching Hospital

Abstract

Quoted rates of complications following tracheostomy insertion vary greatly, with little information available on complications occurring in patients with tracheostomies in situ or following their removal. A series of 200 consecutive tracheostomies in critical care patients were reviewed for complications occurring at insertion, in patients while cannulated, and following decannulation. A questionnaire was completed at insertion and patients then received weekly follow-up where any complications were recorded. High rates of follow-up were achieved. Insertion complications included: major bleeding (5%), tracheal wall injury (0.5%), pneumothorax (0.5%). Complications in cannulated patients included: prolonged bleeding (5%), pneumothorax (2%), accidental decannulation (4%) and tube blockage (6%). Of the blockages and displacements, 40% resulted in severe hypoxia and in two patients, cardiac arrest. Post-decannulation one patient (0.8%) required immediate recannulation. Initial problems relating to swallowing difficulties post-decannulation were seen to resolve with time. This work demonstrates that tracheostomy can be safely performed in critical care patients although serious adverse events may occur due to tube blockage or displacement.

Fine Governance of Difficult Tracheostomy in Difficult Airway with Stridor and Respiratory Distress

“…The rate of major or serious insertion complications like major bleeding, posterior tracheal wall injury, pneumothorax, and death is approximately 6% [8]. Pneumothorax and subcutaneous emphysema following tracheostomy has been reported to occur in 2 to 5% of cases [9]. In upper tracheal stenosis, the lower limit of tracheal narrowing cannot be made without imaging and evenif there is no anatomical stenosis, the functional stenosis due to collapse of trachea with Bernoulli's effect, have to be anticipated.…”

Traqueostomía percutánea por dilatación sin fibrobroncoscopio en la Unidad de Cuidados Intensivos del Hospital Carlos Alberto Seguín Escobedo, Arequipa 2011-2014

“…Sólo hubo un caso de complicación fatal debido a sangrado. Estos hallazgos son similares a otros estudios [1,12,17] .…”

Quick Response Tracheotomy

“…Inherent in all PDT procedures and to some extent formal surgical tracheotomies are the following problems: tissue crushing, hemorrhage, tracheal ring fracture, posterior tracheal wall laceration, and misplacement of guidewire, 39 all of which makes the search for technically simplified and safer approaches very desirable.…”