Tracheostomy Emergencies in Adults

Authors: Jonathan Cooper / Editor: Frances Balmer / Codes: Published: 26/11/2021

Description:

Tracheostomy emergencies are rare in the emergency department (ED) but are associated with high mortality and morbidity. It is therefore essential that emergency department practitioners are competent in assessing and stabilising patients with complications arising from tracheostomies.

Learning objectives:

  • Understand the basic anatomy surrounding tracheostomies and laryngectomies.
  • Describe the types of tracheostomy tube and adjuncts.
  • Describe common tracheostomy-related complications.
  • Follow a structured approach to assess a patient with a tracheostomy or laryngectomy
  • Use national guidelines and algorithms to assess and stabilise an airway emergency in a patient with a tracheostomy or laryngectomy

References

  1. McGrath B, (ed.). Comprehensive tracheostomy care: the national tracheostomy safety project manual. John Wiley & Sons Ltd, 2014.
  2. Laura J. Bontempo, Sara L. Manning. Tracheostomy Emergencies. Emergency Medicine Clinics of North America, Volume 37. Issue 1. 2019. Pages 109-119. ISSN 0733-8627. ISBN 9780323654531.
  3. McGrath BA, Bates L, Atkinson D, Moore JA; National Tracheostomy Safety Project. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia. 2012 Sep;67(9):1025-41.
  4. McGrath BA, Thomas AN. Patient safety incidents associated with tracheostomies occurring in hospital wards: a review of reports to the UK National Patient Safety Agency. Postgrad Med J. 2010 Sep;86(1019):522-5.
  5. Mcgrath B, Wilkinson K. The NCEPOD study: on the right trach? lessons for the anaesthetist. British Journal of Anaesthesia. 2015 Aug;115(2):155-8. https://doi.org/10.1093/bja/aev147
  6. Allan JS, Wright CD Tracheoinnominate fistula: diagnosis and management. Chest Surg Clin N Am. 2003; 13: 331-341
  7. Dyer RK, Fisher SR Tracheal-innominate and tracheal-esophageal fistula. in: Wolfe WG Complications in Thoracic Surgery: Recognition & Management. Mosby Year Book, St Louis 1992: 288-306
  8. Cook TM, Woodall N, Harper J, Benger J; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth. 2011 May;106(5):632-42.
  9. C. A. Grant, G. Dempsey, J. Harrison, T. Jones, Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical reviewBJA: British Journal of Anaesthesia, Volume 96, Issue 1, January 2006, Pages 127131, https://doi.org/10.1093/bja/aei282.
  10. Nelems JM. Tracheo-innominate artery fistula. Am J Surg. 1981;141(5):526-527. doi:10.1016/0002-9610(81)90038-6
  11. Jones JW, Reynolds M, Hewitt RL, Drapanas T. Tracheo-innominate artery erosion: Successful surgical management of a devastating complication. Ann Surg. 1976;184(2):194-204.
  12. GrilloCG: Tacheal fistula barchiocephalic artery, in GrilloCG (ed): Surgery of the Trachea and Bronchi. Hamilton, Ontario, BC Decker, Ch. 13, 2003, pp 1-9.
  13. Warrilow S, Ward J, McMurray K. National Tracheostomy Safety Project. Tracheostomy Emegerncies: Bleeding. [Cited date 20/08/21].
  14. Bloss RS, Ward RE. Survival after tracheoinnominate artery fistula. Am J Surg. 1980;139(2):251-253. doi:10.1016/0002-9610(80)90266-4
  15. Pool, C, Goyal N. Operative management of catastrophic bleeding in the head and neck. Operative Techniques in Otolaryngology-Head and Neck Surgery. Volume 28, Issue 4, 2017, Pages 220-228, ISSN 1043-1810.

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