Complications of tracheostomy

Tracheostomy is a common procedure performed in critically ill patients requiring extended mechanical ventilation for acute respiratory failure and to manage upper airway disorders and obstruction. The recent Coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented surge in the number of patients who are critically ill and require mechanical ventilation. Tracheostomy is a high-risk procedure in this patient cohort for both the patient and operator due to the need for apnoea at a time of critical illness and the aerosol generating nature of the procedure. Careful consideration of timing, environment, equipment, personnel, and technique are required. In this chapter we will outline the common problems that can occur with tracheostomy during the procedure, in the early stages and late complications. We will highlight both management options for these complications and preventative strategies. The different techniques that can be used including a hybrid surgical and percutaneous approach are described. In addition, the experience of a single surgeon operator during the COVID-19 pandemic, between March and June 2020, who performed a total of 22 tracheostomies on 21 COVID positive patients at St. Bartholomew’s hospital: 8 percutaneous dilatational tracheostomies and 14 surgical tracheostomies is presented. We will discuss the outcomes, the specific challenges of performing tracheostomy during a pandemic and how these were overcome. © Shanghai Chest. All rights reserved.