From the Guidelines
The management of tracheal edema obstructing a tracheostomy tube in tracheostomized patients requires immediate removal of the tracheostomy tube if a suction catheter cannot be passed and deflating the cuff fails to improve the clinical condition, as the tube may be completely blocked or displaced, and the patient cannot breathe around it adequately 1. The primary approach involves a combination of non-pharmacological measures to ensure airway patency.
- Start by removing the tracheostomy tube if it is obstructed, as continued attempts at rescue ventilation will not be effective and may cause harm.
- Reassess the patient's airway at both the mouth and trachea after tube removal, ensuring oxygen is reapplied to the face and stoma.
- Perform frequent suctioning of the tracheostomy tube to remove secretions that may exacerbate the obstruction, using a closed-circuit suctioning system for mechanically-ventilated patients or a T-connector or Kelley Circuit for non-ventilated patients to decrease aerosolization risk 1.
- Consider using a longer or adjustable-length tracheostomy tube to bypass the area of edema, and maintain adequate humidification of inspired air to prevent drying of secretions and further irritation of the tracheal mucosa.
- Monitor for signs of respiratory distress, oxygen saturation, and carbon dioxide levels, and be prepared for potential emergency airway management if obstruction worsens. This approach prioritizes the patient's airway patency and safety, and is supported by the most recent and highest-quality evidence available 1.
From the Research
Management of Tracheal Edema
The management of tracheal edema obstructing the tracheostomy (trach) tube in tracheostomized patients involves several strategies, including:
- Removal of obstructing material: This can be achieved through suctioning of the tracheostomy tube 2
- Stabilization of the airway: This can be done using a tracheostomy tube or other airway devices 2
- Management of underlying causes: This may involve treatment of conditions such as tracheal stenosis, which can be caused by prolonged intubation or tracheostomy 3
- Multidisciplinary care: Involvement of anesthesiologists, surgical specialists, and perioperative nurses is crucial in managing patients with tracheostomy 4
Airway Management Considerations
Airway management in patients with tracheostomy requires careful planning and consideration of several factors, including:
- Indication for tracheostomy: This can impact the type of airway management required 4
- Type and size of tracheostomy tube: This can affect the ease of airway management and the risk of complications 4
- Presence of concurrent health conditions: This can increase the complexity of airway management and require specialized care 4
Complications of Tracheostomy
Tracheostomy can be associated with several complications, including:
- Tracheal stenosis: This can be caused by prolonged intubation or tracheostomy and requires multidisciplinary management 3
- Pneumothoraces and pulmonary edema: These can occur as a result of acute tracheal obstruction and require prompt management 5
- Airway obstruction: This can be caused by various factors, including clot formation or granulations, and requires rapid relief and stabilization of the airway 2