The surgical procedure of tracheotomy, involving an incision into the trachea of the airway, is now seen as a relatively straightforward procedure but is still associated with a risk of some complications. Recent studies have shown that approximately 10-15% of patients may experience complications to varying degrees of severity.

Some particular patient groups are more likely to experience complications following tracheotomy. This includes young children and infants, as well as people with certain health conditions such as diabetes and respiratory conditions, and people taking certain medications.

In most cases, tracheotomies that are planned have a higher success rate than those performed in an emergency.

All complications can be categorized as immediate, later and delayed, according to when they occur with respect to the surgical procedure.

Immediate Complications

Immediate complications may occur during or shortly following the surgical procedure. They may include:

• Bleeding of the trachea or the tracheostomy. In most cases, this is minor and heals within a few days, although some patients require a blood transfusion to manage the loss of large volumes of blood.

• Pneumothorax refers to the trapping of air around the lungs that cause the lungs to collapse inwards. Whilst this can correct itself autonomously, many more serious cases require the surgical implant of a tube into the chest to drain the air.

• Collection of air in the deep layers of the chest or underneath the skin of the tracheostomy can cause pneumomediastinum or subcutaneous emphysema respectively.

• Damage to esophagus or larynx may occur due to accidental injury, which can result in speaking and swallowing difficulties.

• Blockage of tracheostomy tube can be caused by blood clots, mucus or pressure from surrounding airway walls.

Later Complications

Later complications occur after surgery while the tube of the tracheostomy is still in place. They may include:

• Accidental decannulation or removal of the tracheostomy tube.

• Infection of the trachea with bacteria that require antibiotic treatment.

• Damage to the esophagus due to pressure, infection or friction from movement.

Delayed Complications

Delayed complications may occur days, weeks or months after the surgical procedure and may include:

• Tracheomalacia or erosion of the trachea due to the tube rubbing against it.

• Tracheo-esophageal fistula development leading to the connection of the two tubes.

• Granulation development that require surgical removal prior to decannulation.

• Narrowed or collapsed esophagus may lead to difficulty breathing and often requires corrective surgery.

• Failure to heal following decannulation, or removal of the tube, which may result in extended bleeding from the area.

Reducing Risk of Complications

The surgical technique employed in the tracheotomy procedure is important in lessening the risk of complications. Until recently, the risk of complications associated with tracheotomy was high and resulted in high mortality.

Surgeons can reduce the risk by following the current standard guidelines recommended for tracheotomy. This includes making the incision as high in the trachea as possible and practicing adequate post-operative care. Regular examination of the tracheostomy tube and airway should be conducted by an otolaryngologist, which will help reduce the risk of these complications.

References

• http://www.hopkinsmedicine.org/tracheostomy/about/complications.html
• http://www.nhs.uk/Conditions/Tracheostomy/Pages/Complications.aspx
• https://www.nhlbi.nih.gov/health/health-topics/topics/trach/risks
• http://link.springer.com/referenceworkentry/10.1007%2F978-3-642-23499-6_15