Tracheostomy Emergencies

Repositioning a displaced tracheostomy tube with an Aintree intubation catheter mounted on a fibre-optic bronchoscope

“…If oxygenation can be maintained and the patient is not compromised, the tracheostomy tube should be replaced as soon as possible to preserve the tract. 3 Prepare for oro-tracheal intubation if the tract is not well defined or the tracheostomy cannot be recannulated easily.…”

Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies

“…This allows the responder to know immediately whether or not the patient has any special considerations for managing the upper airway or the tracheostomy stoma [32]. Bedside information can also summarise key details of the nature and date of the tracheostomy, the method of forming the stoma and the function of any 'stay sutures' to inform the responder managing such an airway incident [32][33][34][35][36][37]. For example, if a 4-day old surgical tracheostomy tube became displaced, one could reasonably expect to be able to replace it (as the stoma tract is likely to remain initially patent), whereas replacement of a 4-day old percutaneous tracheostomy would be likely to prove much more difficult (as the dilated stoma tract tissues recoil) [33,[38][39][40][41] and this would therefore affect management of any attempts at replacement in certain circumstances [42,43].…”

“…This includes the provision of routine and emergency airway equipment. Most equipment should be at the bedside, usually in a dedicated emergency box [36,56]. Additional equipment should also be summoned (Table 1).…”

“…Continued attempts at 'rescue' ventilation will not be effective as the airway is obstructed and the tracheostomy tube should be removed. Although there may be concerns about the consequences of removing a tracheostomy tube at this stage (especially from a patient with a difficult or obstructed upper airway, or one whose tracheostomy is known to be difficult) [94,95], when faced with a deteriorating patient with an obstructed airway, a non-functioning tracheostomy offers no benefit, with considerable potential for harm [36,89,[96][97][98]. Following tracheostomy tube removal, reassessment at both airways (mouth and trachea) is required, ensuring oxygen is reapplied to face and stoma [36,98,99].…”

Effectiveness of a Video Teaching Programme Regarding Tracheostomy Care on Knowledge and Skills of Care Providers of Tracheostomized Patients at AIIMS, New Delhi

“…3 A tracheostomy is an incision into the trachea that forms a temporary or permanent opening to allow airflow and permit the removal of bronchotracheal secretions. 4 A tracheostomy may be performed as an emergency or planned procedure. The aim of tracheostomy is to bypass obstruction in the upper airway; to aid prolonged and assisted ventilation; and to facilitate the removal of respiratory secretions.…”