2. Tracheal trauma and subglottic stenosis
Tracheal trauma, particularly erosion, results from unsupported
ventilator tubing pulling on tracheostomy canula and improper tracheal
aspiration 9. Flexible endoscopy can be used to check
that the location of the tracheostomy tube is centered in the trachea
and that the trachea is healthy. The American Thoracic Society (ATS)
statement “Care of the Child with a Chronic Tracheostomy” recommends a
control bronchoscopy every 6-12 months to evaluate the underlying airway
pathology, detect and treat complications, assess tube size and
position, and determine readiness for decannulation10. If complications are suspected, additional
bronchoscopies can be carried out.
Subglottic stenosis may occur due to the placement of the tracheostomy
tube above the airway. Other contributing factors include trauma from
prolonged endotracheal intubation before tracheostomy opening and
inflammation often associated with uncontrolled reflux. To avoid this,
correct tracheostomy care and proper placement are essential. With
appropriate endoscopic evaluation before decannulation, this
complication can be predicted and surgically corrected with cartilage
graft or segmental tracheal resection.
The aforementioned Canadian study evaluated several aspects, including
tracheostomy tube care, caregiver qualification, home monitoring,
speaking valves, medical management of tracheostomy complications, and
decannulation assessment. The frequency of tracheostomy cannula
replacement is most recommended on a monthly basis. Clinical indications
for more frequent tracheostomy tube changes were respectively; mucous
plugs (94.1%), upper respiratory tract infection with increased
secretions (70.6%), pseudomonas colonization (23.5%), and younger age:
age <3 years (17.6%), and <1 year (11.8%)8.