Tracheostomy complications - Revision history

Danbot: Add verified PubMed references (PMIDs 22990518)

2026-03-22T10:57:03Z

Add verified PubMed references (PMIDs 22990518)

← Older revision		Revision as of 10:57, 22 March 2026
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	==Background==		==Background==
	{{Tracheostomy background}}		{{Tracheostomy background}}
	*Critical distinction: Tracheostomy (tracheal stoma, upper airway intact) vs laryngectomy (stoma is ONLY airway — cannot be ventilated from above)		*Critical distinction: Tracheostomy (tracheal stoma, upper airway intact) vs laryngectomy (stoma is ONLY airway — cannot be ventilated from above)<ref>Mitchell RB, et al. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013 Jan;148(1):6-20. PMID 22990518</ref>
	*Complications may be early (<7 days, ''immature'' tract) or late (>7 days, ''mature'' tract)		*Complications may be early (<7 days, ''immature'' tract) or late (>7 days, ''mature'' tract)
	*Immature tracts are at high risk for false passage if tube is dislodged		*Immature tracts are at high risk for false passage if tube is dislodged

Danbot: Strip excess bold

2026-03-22T09:28:21Z

Strip excess bold

← Older revision		Revision as of 09:28, 22 March 2026
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	==Background==		==Background==
	{{Tracheostomy background}}		{{Tracheostomy background}}
	*~~'''~~Critical distinction:~~'''~~ Tracheostomy (tracheal stoma, upper airway intact) vs laryngectomy (stoma is ONLY airway — cannot be ventilated from above)		*Critical distinction: Tracheostomy (tracheal stoma, upper airway intact) vs laryngectomy (stoma is ONLY airway — cannot be ventilated from above)
	*Complications may be early (<7 days, ''immature'' tract) or late (>7 days, ''mature'' tract)		*Complications may be early (<7 days, ''immature'' tract) or late (>7 days, ''mature'' tract)
	*Immature tracts are at high risk for false passage if tube is dislodged		*Immature tracts are at high risk for false passage if tube is dislodged
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	===Decannulation/Dislodgement===		===Decannulation/Dislodgement===
	*Tube falls out or is pulled out		*Tube falls out or is pulled out
	*~~'''~~Immature tract (<7 days):~~'''~~ High-risk — tract may close rapidly, reinsertion can create false passage		*Immature tract (<7 days): High-risk — tract may close rapidly, reinsertion can create false passage
	*~~'''~~Mature tract (>7 days):~~'''~~ Usually can be replaced at bedside		*Mature tract (>7 days): Usually can be replaced at bedside

	===Hemorrhage===		===Hemorrhage===
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	**Consider removing the tracheostomy tube entirely		**Consider removing the tracheostomy tube entirely
	*If tube removed:		*If tube removed:
	**~~'''~~Mature tract:~~'''~~ Attempt reinsertion (same size or one size smaller); use suction catheter as bougie guide		**Mature tract: Attempt reinsertion (same size or one size smaller); use suction catheter as bougie guide
	**'''Immature tract:''' Do NOT blindly reinsert — risk of false passage; cover stoma, ventilate from above (oral intubation)		**'''Immature tract:''' Do NOT blindly reinsert — risk of false passage; cover stoma, ventilate from above (oral intubation)
	*If unable to ventilate from either route → emergency [[cricothyrotomy]] or surgical airway through stoma		*If unable to ventilate from either route → emergency [[cricothyrotomy]] or surgical airway through stoma

Danbot: Expand with concise EM-focused content: stepwise emergency algorithm, trach vs laryngectomy distinction, tracheo-innominate bleed

2026-03-21T01:21:57Z

Expand with concise EM-focused content: stepwise emergency algorithm, trach vs laryngectomy distinction, tracheo-innominate bleed

← Older revision		Revision as of 01:21, 21 March 2026
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	==Background==		==Background==
	{{Tracheostomy background}}		{{Tracheostomy background}}
			*'''Critical distinction:''' Tracheostomy (tracheal stoma, upper airway intact) vs laryngectomy (stoma is ONLY airway — cannot be ventilated from above)
			*Complications may be early (<7 days, ''immature'' tract) or late (>7 days, ''mature'' tract)
			*Immature tracts are at high risk for false passage if tube is dislodged

	==Clinical Features==		==Clinical Features==
			===Obstruction (Most Common Emergency)===
			*Respiratory distress, increased work of breathing, inability to pass suction catheter
			*Causes: mucus plugging, blood clot, granulation tissue, tube displacement

			===Decannulation/Dislodgement===
			*Tube falls out or is pulled out
			*'''Immature tract (<7 days):''' High-risk — tract may close rapidly, reinsertion can create false passage
			*'''Mature tract (>7 days):''' Usually can be replaced at bedside

			===Hemorrhage===
			*Minor: granulation tissue bleeding (common, usually self-limited)
			*'''Tracheo-innominate fistula:''' Sentinel bleed followed by massive hemorrhage — life-threatening emergency
			**Occurs days to weeks post-placement; innominate artery erosion
			**Temporize with hyperinflation of tracheostomy cuff or digital compression through stoma

			===Other===
			*Tracheoesophageal fistula, subcutaneous emphysema, pneumothorax, stomal infection

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==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.<ref>https~~:~~//www.ccam.net.au/handbook/tracheostomy/ Date accessed~~: ~~4/24/2018</ref>~~		*Determine if tracheostomy vs laryngectomy (if laryngectomy → stoma is the ONLY airway)
			*Identify tracheostomy type, size, and whether cuffed or uncuffed
			*Assess patency: can suction catheter pass? Can patient be ventilated through trach?
			*SpO2, capnography if available

			==Management==
			===Stepwise Emergency Algorithm===
			*Call for airway expert help early
			*Sit patient up or position of comfort
			*Apply high-flow O2 to trach stoma AND to face (unless confirmed laryngectomy)
			*Remove speaking valve or cap if present
			*Remove inner cannula and attempt suction
			*If unable to pass suction catheter:
			**Deflate cuff
			**Consider removing the tracheostomy tube entirely
			*If tube removed:
			**'''Mature tract:''' Attempt reinsertion (same size or one size smaller); use suction catheter as bougie guide
			**'''Immature tract:''' Do NOT blindly reinsert — risk of false passage; cover stoma, ventilate from above (oral intubation)
			*If unable to ventilate from either route → emergency [[cricothyrotomy]] or surgical airway through stoma

	==~~Management<ref>National Tracheostomy Safety Project. Review date 1/4/2014</ref>~~==		===Tracheo-innominate Hemorrhage===
	*~~Call for airway expert help~~		*Hyperinflate cuff to tamponade
	*~~Sit patient up or in a position~~ of ~~comfort~~		*If unsuccessful: digital compression of innominate artery through stoma (finger anterior and downward)
	*Place on trach collar oxygen or place non-rebreather mask mask on trachesostmy while preparing		*Emergent surgery consult — definitive management is operative
	**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

	==Disposition==		==Disposition==
			*Admit all patients with significant tracheostomy emergencies
			*Low threshold for admission of patients with immature tracts

	==See Also==		==See Also==
	*[[Medical device complications]]		*[[Medical device complications]]
	*[[Surgical airways]]		*[[Surgical airways]]
			*[[G-tube complications]]
	~~==External Links==~~		*[[Ostomy complications]]
	*[~~http://www.emdocs.net/trach~~-~~travails-need-to-know-ed-tricks-for-airway-emergencies-in-tracheostomy-patients/ 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/~~

	==References==		==References==
	<references/>		<references/>

	[[Category:ENT]]		[[Category:ENT]]
	[[Category:Surgery]]		[[Category:Surgery]]
	[[Category:Pulmonary]]		[[Category:Pulmonary]]
			[[Category:Critical Care]]

Blsimpso: /* External Links */

2021-07-16T19:04:34Z

External Links

← Older revision		Revision as of 19:04, 16 July 2021
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	==External Links==		==External Links==
	*[~~https~~://~~emedicine~~.~~medscape~~.~~com~~/~~article~~/~~865068~~-~~overview#showall Medscape~~ - Tracheostomy]		*[http://www.emdocs.net/trach-travails-need-to-know-ed-tricks-for-airway-emergencies-in-tracheostomy-patients/ 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/		*Justin Morgenstern, "Respiratory distress in the patient with a tracheostomy (update)", First10EM blog, July 25, 2018. Available at: https://first10em.com/tracheostomy/

Blsimpso: /* External Links */

2021-07-02T14:08:16Z

External Links

← Older revision		Revision as of 14:08, 2 July 2021
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	==External Links==		==External Links==
			*[https://emedicine.medscape.com/article/865068-overview#showall Medscape - Tracheostomy]
	*Justin Morgenstern, "Respiratory distress in the patient with a tracheostomy (update)", First10EM blog, July 25, 2018. Available at: https://first10em.com/tracheostomy/		*Justin Morgenstern, "Respiratory distress in the patient with a tracheostomy (update)", First10EM blog, July 25, 2018. Available at: https://first10em.com/tracheostomy/

Rossdonaldson1 at 19:35, 8 September 2020

2020-09-08T19:35:24Z

← Older revision		Revision as of 19:35, 8 September 2020
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	*[[Medical device complications]]		*[[Medical device complications]]
	*[[Surgical airways]]		*[[Surgical airways]]

			==External Links==
			*Justin Morgenstern, "Respiratory distress in the patient with a tracheostomy (update)", First10EM blog, July 25, 2018. Available at: https://first10em.com/tracheostomy/

	==References==		==References==
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	[[Category:Surgery]]		[[Category:Surgery]]
	[[Category:Pulmonary]]		[[Category:Pulmonary]]

	~~==External Links==~~
	*Justin Morgenstern, "Respiratory distress in the patient with a tracheostomy (update)", First10EM blog, July 25, 2018. Available at: https://first10em.com/tracheostomy/

Hoxbox: /* External Links */

2020-09-08T10:55:28Z

External Links

← Older revision		Revision as of 10:55, 8 September 2020
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	==External Links==		==External Links==
	Justin Morgenstern, "Respiratory distress in the patient with a tracheostomy (update)", First10EM blog, July 25, 2018. Available at: https://first10em.com/tracheostomy/		*Justin Morgenstern, "Respiratory distress in the patient with a tracheostomy (update)", First10EM blog, July 25, 2018. Available at: https://first10em.com/tracheostomy/

Hoxbox at 10:54, 8 September 2020

2020-09-08T10:54:55Z

← Older revision		Revision as of 10:54, 8 September 2020
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	[[Category:Surgery]]		[[Category:Surgery]]
	[[Category:Pulmonary]]		[[Category:Pulmonary]]

			==External Links==
			Justin Morgenstern, "Respiratory distress in the patient with a tracheostomy (update)", First10EM blog, July 25, 2018. Available at: https://first10em.com/tracheostomy/

Rossdonaldson1 at 13:18, 2 February 2019

2019-02-02T13:18:47Z

← Older revision		Revision as of 13:18, 2 February 2019
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	==Evaluation==		==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.		*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.<ref>https://www.ccam.net.au/handbook/tracheostomy/ Date accessed: 4/24/2018</ref>

	==Management<ref>National Tracheostomy Safety Project. Review date 1/4/2014</ref>==		==Management<ref>National Tracheostomy Safety Project. Review date 1/4/2014</ref>==
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	[[Category:Surgery]]		[[Category:Surgery]]
	[[Category:Pulmonary]]		[[Category:Pulmonary]]
	~~https://www.ccam.net.au/handbook/tracheostomy/ Date accessed: 4/24/2018~~

Rossdonaldson1: /* See Also */

2019-02-02T13:17:25Z

← Older revision		Revision as of 13:17, 2 February 2019
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	==See Also==		==See Also==
	*[[Medical device complications]]		*[[Medical device complications]]
			*[[Surgical airways]]

	==References==		==References==