Pathophysiology

Patients with a tracheostomy may present to the emergency department with these complications.

• Tube displacement
  • Accidental dislodgement
  • Migration due to cuff deflation/poorly secured tube
  • Erosion into tissues
  • False passage creation – the tube can become lodged in between soft tissue planes around the neck
• Tube obstruction
  • Secretions
  • Blood
  • Lodged foreign body
  • Old or faulty humidification device
• Bleeding
  • Erosion into major vessel including tracheo-innominate fistula
  • Granuloma formation
  • Trauma secondary to suctioning

In a 2004 study, 60% of critical incidents directly affecting patients with tracheostomies involved tube obstruction or displacement, with a significant proportion of these contributing to patient harm.⁴

In 2014 an NCEPOD review identified 1.2% of tracheostomy patients experiencing major bleeding after tracheostomy.⁵ A potential cause of life-threatening bleeding is tracheo-innominate artery erosion, which has an incidence of around 0.1-1% in tracheostomy patients.^6,7 Tracheostomy bleeding and management is explained in more detail later.

Learning bite

Tube obstruction or displacement are the most common complications seen in patients with tracheostomies.