Incidence of complications of emergency tracheostomy in a rural medical college setting: a prospective study
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20171465Keywords:
Tracheostomy, Preoperative complications, Postoperative complicationsAbstract
Background: Tracheostomy done as an emergency procedure for the purpose of saving lives, is mostly associated with aerodigestive tract malignancies, though a few may be associated with foreign body aspiration. The incidences of complications intraoperatively as well as postoperatively are high in emergency tracheostomies. Few studies exist documenting the incidence of these complications .Thus this study was undertaken in a rural Medical College setting to find the incidence of complications associated with emergency tracheostomy.
Methods: After Institutional ethical committee clearance, a prospective study was conducted over a period of 2 years which included 120 patients of all ages and both genders, who presented to the emergency room with stridor. All tracheostomies were performed, using standard techniques, in the emergency operation theatre under monitored anaesthesia care or general anaesthesia. Complications were noted during the procedure as well as in the postoperative period at regular intervals upto one year and were categorized as immediate, intermediate and late.
Results: Though there was no case of mortality, the incidence of complications was 53.3%. The commonest immediate complication was haemorrhage (12.5%) followed by cardiopulmonary arrest (5%) and apnoea (3.3%). The commonest intermediate complications were infection (18.3%), crusting (12.5%), displacement of tube (8.3%) and bleeding (8.3%).Late complications noted were stomal stenosis (8.3%), keloid formation (5%) and tracheocutaneous fistula (3.3%).
Conclusions: Some of these complications can be avoided by early intervention as a semi emergency procedure when you first think about it. This can avoid the hazzle of hurried tracheostomy in a struggling patient thus bringing down the incidence of complications.
Metrics
References
Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, Brown III CA, Brandt C, Deakins K, Hartnick C, Merati A. Clinical consensus statement: tracheostomy care. Otolaryngol Head Neck Surg. 2013;148(1):6-20.
Morris LL, Whitmer A, McIntosh E. Tracheostomy care and complications in the intensive care unit. Critical care nurse. 2013;33(5):18-30.
Arola MK, Inberg MV, Sotarauta M, Vänttinen E. Tracheo-arterial erosion complicating tracheostomy. Annales chirurgiae et gynaecologiae. 1978;68(1):9-17.
Frost EA. Tracing the tracheostomy. Annals of Otology, Rhinol Laryngol. 1976;85(5):618-24.
Astrachan DI, Kirchner JC, Goodwin WJ. Prolonged intubation vs. tracheotomy: complications, practical and psychological considerations. Laryngoscope. 1988;98(11):1165-9.
Muhammad R, Khan F, Rehman F, Iqbal J, Khan M, Ullah G. Early complications of elective and emergency tracheostomy. J Ayub Med Coll Abbottabad. 2012;24(1):44-7.
Bobdey S, Jain A, Balasubramanium G. Epidemiological review of laryngeal cancer: An Indian perspective. Indian journal of medical and paediatric oncology: official journal of Indian Soc Med Paediatric Oncol. 2015;36(3):154.
El-Menyar A, El-Hennawy H, Al-Thani H, Asim M, Abdelrahman H, Zarour A, Parchani A, Peralta R, Latifi R. Traumatic injury among females: does gender matter? J Trauma Management Outcomes. 2014;8(1):8.
Chew JY, Cantrell RW. Tracheostomy: complications and their management. Arch Otolaryngol. 1972;96(6):538-45.
Gaudet PT, Peerless A, Sasaki CT, Kirchner JA. Pediatric tracheostomy and associated complications. Laryngoscope. 1978;88(10):1633-41.
McClelland RM. Complications of tracheostomy. British Med J. 1965;2(5461):567.
Waldron J, Padgham ND, Hurley SE. Complications of emergency and elective tracheostomy: a retrospective study of 150 consecutive cases. Annals Royal Coll Surg Engl. 1990;72(4):218.
Rajgor MB, Multani ST. Management of cardiac arrest in operation theatre. J Indian Med Assoc. 1998;96(11):341-4.
Greene NM. Fatal cardiovascular and respiratory failure associated with tracheotomy. New Engl J Med. 1959261(17):846-8.
Kumar KS, Nampoothiri PM, Suma R, Renu P. Pneumothorax following tracheostomy and its management. Indian J Otolaryngol Head Neck Surg. 2002;54(3):236-7.
Jain S, Kumar S, Deshmukh P, Gaurkar S. Bilateral pneumothorax: Perils of emergency tracheostomy. J Laryngol Voice. 2014;4(1):36.
Panajaroen P, Tangjaturonrasme N. Pneumothorax after tracheostomy: A prospective study. Otolaryngologia polska= The Polish. Otolaryngol. 2014;69(3):26-30.
Stock MC, Woodward CG, Shapiro BA, Cane RD, Lewis V, Pecaro B. Perioperative complications of elective tracheostomy in critically ill patients. Critical Care Medicine. 1986;14(10):861-3.
Berg LF, Campos M, Mafee MF, Applebaum EL. Mechanisms of pneumothorax following tracheal intubation. Ann Otol, Rhinol Laryngol. 1988;97(5):500-5.
Mostert MJ, Stuart H. Subcutaneous emphysema caused by a fenestrated tracheostomy tube. Anaesthesia. 2001;56(2):191-2.
Paraschiv M. Tracheoesophageal fistula-a complication of prolonged tracheal intubation. J Med Life. 2014;7(4):516.
Dulguerov P, Gysin C, Perneger TV, Chevrolet JC. Percutaneous or surgical tracheostomy: a meta-analysis. Critical Care Med. 1999;27(8):1617-25.
Watanabe Y, Umehara T, Harada A, Aoki M, Tokunaga T, Suzuki S, et al. Successful closure of a tracheocutaneous fistula after tracheostomy using two skin flaps: a case report. Surg Case Rep. 2015;1(1):1-3.
Downloads
Published
How to Cite
Issue
Section
