Editing Tracheostomy (section)

== '''Late complications''' ==

* Tracheal stenosis and malacia
* Bleeding
** Tracheoarterial fistula
*** See full topic under 'vascular trauma'
*** Sentinel bleeds are common!
**** If you suspect sentinel bleed, do a CT angio (?high-riding innominate artery - ?relationship of wall to artery) and bronchoscopy
*** Survival 14%
*** Erosion into anterior tracheal wall, resulting in fistulous connection with innominate artery
*** Ward:
**** Resuscitation
**** Bleeding from stoma site - apply pressure, silver nitrate
**** Bleeding from deep to stoma - overinflate cuff to compress artery. Can also try inserting ETT and inflating cuff distal to bleed. Otherwise put a finger through the hole then pull anteriorly. And put pressure above sternal notch to compress innominate artery.
*** Operative management:
**** Utley maneuvre - involves dissection to innominate artery
**** Definitive control will probably require sternotomy
* Reduced phonation
* Late displacement
** Check cuff, tube, other components
** Preoxygenate via stoma
** Use obturator to reinsert - stop if resistance



[[Category:Thoracics]]