Proper Management of Tracheotomy: Tracheotomy Complications from the Point of View of the Morphological Characteristics of Tracheal Cannulas in Adults

Abstract

We conducted a comparison of 7 typical tracheotomy cannulas 8 mm ID single tube cannula with a cuff used in adult patients in Japan and attempted to identify the risk factors in patients with tracheotomy cannula related complications. The important issues in tracheotomy management are discussed. Comparison of the morphologies of the cannulas revealed that that among the cannulas, the outer diameter differed by a maximum of 0.9 mm, the bending angle differed by a maximum of 20°and the stationary cuff diameter by a maximum of 10 mm. The difference in the curvature radii was 28.8 mm at the maximum, and the difference in the depth from the wing was 29.9 mm at the maximum. To avoid tracheotomy cannula related complications, we analyzed cases of tracheo innominate artery fistula, cannula misinsertion in the mediastinum, and tracheoesophageal fistula, which can be fatal. From the viewpoint of the morphology of the cannula, it is desirable to select the a tracheal cannula with an appropriate radius of curvature that would prevent the development of a trachea innominate artery fistula, with an appropriate depth to prevent its straying into the mediastinum, and with an appropriate outer diameter of the stationary cuff to avoid the development of a tracheoesophageal fistula. Otolaryngologists are the specialists in tracheotomy and are in a position to educate doctors about safe tracheotomy management. It is necessary to understand the characteristics of these cannulas and to avoid complications by proper cannula selection.