From the Guidelines
Tracheostomy bleeding is most commonly caused by bleeding diathesis, granulation tissue, wound breakdown, and mucosal or vascular injury.
Causes of Tracheostomy Bleeding
- Bleeding diathesis
- Granulation tissue
- Wound breakdown
- Mucosal or vascular injury
- Traumatic suctioning
- Local infection
- Tracheo-arterial fistulae
As noted in the study by 1, tracheostomy-related haemorrhage is a significant complication, with a two- to four-fold mortality risk. The most common causes of haemorrhage included bleeding diathesis, granulation tissue, wound breakdown, and mucosal or vascular injury. Additionally, 1 highlights that tracheostomy bleeding can be immediate, early, or late in presentation and can be minor, moderate, or life-threatening, with causes including traumatic suctioning, granulomata, local infection, bleeding disorders, and tracheo-arterial fistulae. In terms of management, 1 emphasizes the importance of differentiating between bleeding from suctioning and sentinel bleeding from arterial erosion, with the latter requiring immediate evaluation in the operating room. Overall, the evidence suggests that tracheostomy bleeding is a serious complication that requires prompt and careful management to prevent significant morbidity and mortality.
From the Research
Causes of Tracheostomy Bleeding
The causes of tracheostomy bleeding can be attributed to several factors, including:
- Tracheoarterial fistula, which occurs when there is erosion through the tracheal wall into the vascular structures that lie in the pretracheal space 2
- Mucosal damage from the tracheal cannula, pressure necrosis from high cuff pressure, or mucosal trauma from an improperly positioned cannula tip 2
- Infection, hypotension, malnutrition, and corticosteroid use, which can increase the risk of bleeding 2
- Improper surgical technique and improper inflation of the tracheostomy tube cuff, which can lead to tracheal damage and bleeding 2, 3
- Bleeding from the tracheostomy site, which can occur due to various reasons, including trauma, infection, or vascular erosion 4, 5, 3, 6
Types of Bleeding
There are different types of bleeding that can occur in tracheostomy patients, including:
- Intraoperative bleeding, which can occur during the tracheostomy procedure 6
- Immediate bleeding, which can occur shortly after the procedure 6
- Delayed bleeding, which can occur more than 72 hours post-operatively 3
- Sentinel hemoptysis, which can be a warning sign for tracheoarterial fistula 2
Risk Factors
Several risk factors can increase the likelihood of bleeding in tracheostomy patients, including: