One of the most impoant complication of tracheostomy is: September 2008
Ans. B: Hemorrhage Indications for tracheostomy To relieve upper airway obstruction Foreign body Trauma Acute infection - acute epiglottitis, diphtheria Glottic oedema Bilateral abductor paralysis of the vocal cords Tumours of the larynx Congenital web or atresia - To improve respiratory function Fulminating bronchopneumonia Chronic bronchitis and emphysema Chest injury and flail chest Respiratory paralysis Unconscious head injury Bulbar poliomyelitis Tetanus Advantages of tracheostomy over endotracheal intubation Reduces patient discomfo Reduces need for sedation Improves ability to maintain oral and bronchial hygiene Reduces risk of glottic trauma Reduces dead space and reduces work of breathing Augments process of weaning from ventilatory suppo Complications of tracheostomy - Immediate Haemorrhage Surgical trauma - oesophagus, recurrent laryngeal nerve Pneumothorax - Intermediate Tracheal erosion Tube displacement Tube obstruction Subcutaneous emphysema Aspiration and lung abscess Late Persistent tracheo-cutaneous fistula Laryngeal and tracheal stenosis Tracheomalacia Tracheo-oesophageal fistula Post-operative tracheostomy care Maintain patent airway Frequent atraumatic suction Humidification of inspired air and oxygen Mucolytic agents Coughing and physiotherapy Occasional bronchial lavage Prevent infection and complications Aseptic tube suction, handling and tube changing Prophylactic antibiotics Deflate cuff for 5 minutes every hours Avoid tube impinging on posterior tracheal wall Percutaneous tracheostomy Indicated in patients likely to require ventilatory suppo for more than 2 weeks Usually performed at the bedside in an ITU Has significant cost benefits compared to open procedure
Surgical emphysema
Hemorrhage
Recurrent laryngeal nerve palsy
Displacement of tube