From the Guidelines
A deformity trach, or deformity tracheostomy, is a surgical procedure that creates an opening in the neck directly into the trachea (windpipe) for patients with significant facial or neck deformities that make standard tracheostomy placement challenging, and it is typically performed when anatomical abnormalities prevent safe conventional tracheostomy placement, as described in the most recent guidelines 1.
Key Considerations
- The procedure involves careful pre-operative planning, often with imaging studies to map the distorted anatomy, and the surgeon identifies safe entry points into the trachea, sometimes requiring modified incision placement or specialized techniques to navigate around the deformity.
- The tracheostomy tube selected may need customization in terms of length, angle, or diameter to accommodate the patient's unique anatomy, and post-procedure care includes regular suctioning, stoma care, and monitoring for complications like tube displacement or obstruction.
- Patients typically require specialized follow-up with both pulmonary and surgical teams to ensure proper tube function and to address any complications related to their underlying deformity, as outlined in recent studies 1.
Management of Tracheostomy Emergencies
- In the event of a tracheostomy emergency, it is essential to assess airway patency and take immediate action to establish a secure airway, as recommended in the guidelines 1.
- The use of a dedicated obturator may ease insertion and reduce trauma during tracheostomy tube replacement, and a soft suction catheter can be used to guide placement if necessary, as described in the literature 1.
- It is crucial to prioritize the patient's safety and well-being, and to be aware of the potential complications and risks associated with tracheostomy, as highlighted in the studies 1.
From the Research
Tracheostomy Tube Deformity
- A tracheostomy tube deformity can occur due to various complications, including stenosis, malacia, and tracheocutaneous fistulas 2
- Tracheostomy tubes can be placed either surgically or percutaneously, with each approach having its own set of risks and benefits 2
- Late complications of tracheostomy tube placement, such as stenosis and malacia, can lead to deformity of the trachea 2
Management of Tracheostomy Tubes
- The management of patients with tracheostomy tubes includes many components of care provided by clinicians from various health care disciplines 3
- Tracheostomy bundles, tracheostomy teams, and protocol-directed care can help decrease time to decannulation, length of stay, and tracheostomy-related adverse events 3
- Regular assessment and maintenance of the tracheostomy tube are crucial to prevent deformity and other complications 4, 5
Prevention and Treatment of Deformity
- Early recognition and correction of malpositioned tracheostomy tubes can help prevent deformity and patient distress 4
- Airway endoscopy can be helpful to ensure optimal positioning of a replacement tracheostomy tube 4
- There is limited evidence to guide the timing of routine tracheostomy tube changes, but some guidelines are suggested 4, 6