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.