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
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)
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