Monday Back to Basics

Tracheostomy Complications with Dr. Sean Coulson

Key Questions

How long ago was is placed? Is it a tracheostomy vs a laryngectomy?


Mediastinitis, tracheitis, pneumonia, lung abscess/aspiration, sternal septic arthritis, cellulitis, fungal infections

Consider a tracheal aspirate culture, suction, hypertonic saline, humidified oxygen

Mechanical Complications

Decannulation or Dislodgement

Tracheostomies < 7 days old require replacement with direct visualization (fiber optic visualization)

Tracheostomies > 7 days old may be re-inserted blindly (but should confirm with fiber optic visualization)

Tracheal Stenosis

Can occur at any point along trachea -> look for stridor

Location of stenotic lesions may make mechanical ventilation or criccothyrotomy difficult, or may require a much smaller airway (consider pediatric sizing). This is a surgical emergency! Consider Heliox to improve laminar flow for oxygenation.


Tracheoinnominate artery fistula & hemorrhage

Majority within 4 weeks of trach placement

Even if small amount of bleeding, take seriously as these are often sentinel bleeds and can lead to massive hemorrhage in 24-48 hours

Treat with external compression to sternal notch, over inflated tracheostomy cuff, consider intubation from above. Consult your surgical/ENT colleagues for evaluation and assistance


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