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Zouk AN, Batra H. Managing complications of percutaneous tracheostomy and gastrostomy. J Thorac Dis 2021; 13:5314-5330. [PMID: 34527368 PMCID: PMC8411191 DOI: 10.21037/jtd-19-3716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 08/05/2020] [Indexed: 01/02/2023]
Abstract
Percutaneous tracheostomy and gastrostomy are some of the most commonly performed procedures at bedside in the intensive care unit. While they are generally considered safe, they can be associated with numerous short and long-term complications, many of which can occur long after their placement and cause significant morbidity. Performers of these procedures should possess a comprehensive understanding of procedural indications and contraindications, and know how to recognize and manage complications that may arise. In this review, we highlight complications of percutaneous tracheostomy and describe strategies for their prevention and management, with a special focus on post-tracheostomy tracheal stenosis. Other complications reviewed include bleeding, pneumothorax and subcutaneous emphysema, posterior wall injury, tube displacement, tracheomalacia, tracheoinominate artery fistula, tracheo-esophageal fistula, and stomal cellulitis. Gastrostomy complications and their management are also discussed including bleeding, internal organ injury, necrotizing fasciitis, aspiration pneumonia, buried bumper syndrome, tumor seeding, wound infection, tube displacement, peristomal leakage, and gastric outlet obstruction. In light of the potentially serious outcomes associated with complications of percutaneous tracheostomy and gastrostomy, the emphasis should be placed on risk-reduction strategies to minimize morbidity and mortality. We therefore present detailed pragmatic and comprehensive checklists to serve as a reference for clinicians involved in performing these procedures.
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Affiliation(s)
- Aline N Zouk
- Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hitesh Batra
- Division of Pulmonary, Allergy, and Critical Care Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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Ovári A, Just T, Dommerich S, Hingst V, Böttcher A, Schuldt T, Guder E, Mencke T, Pau HW. Conservative management of post-intubation tracheal tears-report of three cases. J Thorac Dis 2014; 6:E85-91. [PMID: 24977034 DOI: 10.3978/j.issn.2072-1439.2014.03.30] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 03/05/2014] [Indexed: 12/11/2022]
Abstract
Iatrogenic tracheal rupture is a rare complication after intubation. We present three patients with tracheal tears. In all of these patients, a common finding was a lesion of the posterior tracheal wall with postoperative subcutaneous and emphysema as the first clinical sign of the rupture. Diagnosis and follow-up were based on clinical and endoscopic findings and chest computed tomography (CT) scans. In our cases with progressive subcutaneous and mediastinal emphysema or dyspnea, we performed a tracheotomy and bypassed the lesion with a tracheostomy tube to avoid an increase in air leakage into the mediastinum. Under broad-spectrum antibiotic therapy, no mediastinitis occurred and all patients survived without sequelae. Closure of tracheostomy was scheduled for 1-2 months after tracheal injury. Analysis of surgical and anesthesiological procedures revealed no abnormalities and the accumulation of tracheal injuries was considered as accidental. We found that in clinically stable patients with spontaneous breathing and with no mediastinitis, a conservative management of tracheal tears is a safe procedure.
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Affiliation(s)
- Attila Ovári
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Tino Just
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Steffen Dommerich
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Volker Hingst
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Arne Böttcher
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Tobias Schuldt
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Ellen Guder
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Thomas Mencke
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
| | - Hans-Wilhelm Pau
- 1 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center, Rostock, Germany ; 2 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Mitte, Berlin, Germany ; 3 Department of Diagnostic and Interventional Radiology, University Medical Center, Rostock, Germany ; 4 Department of Otorhinolaryngology, Head & Neck Surgery, University Medical Center Charité, Campus Virchow, Berlin, Germany ; 5 Department of Anesthesiology and Intensive Therapy, University Medical Center, Rostock, Germany
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