Tracheostomy

Indications:

The most common indication for tracheostomy is a need for prolonged mechanical ventilation. This is usually due to pulmonary disease, or severe brain injury.
Indications for percutaneous tracheostomy (PCT) are the same as those for standard open tracheostomy.  As with any surgery, there are some risks associated with tracheostomy.

Early Complications that may occur during the tracheostomy procedure include:

• Bleeding
• Damage to the esophagus
• Injury to the nerve that moves the vocal cords (recurrent laryngeal nerve)

Later Complications that may occur include:

• Accidental removal of the tracheostomy tube
• Infection in the trachea (windpipe) and the skin and tissue around the tracheostomy tube
• A trachea (windpipe) itself may become damaged for a number of reasons, including: infection and formation of scar tissue secondary to pressure or friction from the tube.

Delayed Complications that may occur include:

• Thinning (erosion) of the trachea from the tube rubbing against it (tracheomalacia)
• Development of a small connection from the trachea (windpipe) to the esophagus (swallowing tube) which is called  tracheo-esophageal fistula

Examples of possible medical negligence:

• Placement of a tracheostomy is an elective procedure.  It should be done in a controlled environment, with critical attention to maintaining the patient’s oxygenation and ventilation.  Breach of these guidelines may result in brain injury and therefore may be considered deviation from the standard of care. 

• Any bleeding at the tracheostomy site should be evaluated carefully.  It will usually stop with time and pressure; if bleeding persists however after the procedure it should raise the possibility of tracheal-innominate fistula (connection between the trachea and innominate artery).  If not recognized and treated immediately it may lead to death.  Failure to diagnose and treat such a condition may be considered deviation from the standard of care.