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COMPLICATIONS OF TRACHEOSTOMY

Introduction: Tracheostomy, while often lifesaving, comes with a variety of complications that can occur at different stages: immediately post-operation, in the early post-operative period, and in the long term. Today, we’ll explore these potential complications, emphasizing both their causes and how we manage them. 1. General Complications: • Tube Obstruction: One of the most common issues, where mucus or blood clots block the tube. Routine suctioning and humidification can help reduce the risk, but healthcare teams must be vigilant, as obstructions can lead to respiratory distress. • Accidental Decannulation: This can happen if the tube becomes dislodged, especially early on when the tract isn’t mature. Replacing the tube immediately is crucial, as the opening may close or cause a false passage. • Surgical and Anesthetic Risks: General risks from surgery or anesthesia include bleeding, infection, and very rarely, death. These underline the importance of considering risks vs. benefits for each patient. 2. Early Post-Operative Complications (Within 1 Week): • Bleeding: Bleeding around the wound edges is common, and it can be controlled with pressure or suturing if necessary. • Pneumothorax: During the procedure, air can enter the pleural space, leading to a collapsed lung. This can be managed with chest tube insertion, if severe. • Subcutaneous Emphysema: Air can sometimes get trapped under the skin around the tracheostomy site, causing swelling. Though usually harmless, severe cases may indicate improper tube placement. • Infection: Given the open nature of the tracheostomy site, it’s at risk for infection. Strict hygiene and antibiotic coverage, when necessary, are crucial preventive steps. • Apnea: Temporary cessation of breathing may occur due to sedation effects. Continuous monitoring ensures rapid intervention if needed. 3. Late Post-Operative Complications (After 1 Week): • Granulation Tissue Formation: Granulation tissue can develop around the tracheostomy site due to the tube acting as a foreign body. This tissue can obstruct the airway or bleed. Dr. Sharma emphasizes using topical steroid/antibiotic preparations to control it, and in severe cases, bipolar diathermy to remove the tissue. • Bleeding and Suprastomal Collapse: Over time, some patients may experience collapse of the tissue above the stoma, especially if the tube is left in place for an extended period. This may require surgical intervention to correct. • Skin Complications: Constant contact with the tube can lead to pressure sores or infections. Regular inspection and repositioning help prevent these issues. • Speech and Psychological Effects: Tracheostomies can impact speech, leading to feelings of isolation or frustration, especially for long-term patients. Rehabilitation and counseling play key roles in addressing these challenges. 4. Rare but Severe Complications: Tracheo-Innominate Artery Fistula • High Risk, High Mortality: Although rare, tracheo-innominate artery fistula is a life-threatening complication where the tube erodes into the nearby innominate artery. Dr. Sharma highlights this risk, particularly in patients with abnormal anatomy where the artery lies higher than usual. Immediate surgical intervention is often required, but prevention involves ensuring the tube is neither too high nor too low in the neck. Conclusion: The risks associated with tracheostomy are diverse and can occur at any stage post-operation. Understanding these complications allows healthcare teams to take preventative measures and intervene quickly if issues arise. Dr. Sharma’s ENT lectures emphasize the importance of individualized patient monitoring, regular follow-ups, and using the latest techniques to reduce risks wherever possible.