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Bleeding around a tracheostomy wound: what to consider and what to do?

Published online by Cambridge University Press:  20 April 2009

P J Bradley
P J Bradley*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Nottingham University Hospitals, UK
*
Address for correspondence: Professor Patrick J Bradley, Department ORL-HNS, Nottingham University Hospitals, Queen's Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK. E-mail: pjbradley@zoo.co.uk
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Abstract

All patients with bleeding in and around a tracheostomy must be investigated to exclude a serious cause. The overall incidence is approximately 5 per cent of tracheostomies performed in Adult Intensive Care Units (AICU). When bleeding commences more than 72 hours post-operatively, the possibility of a trachea innominate artery fistula needs to be excluded by endoscopic examination of the trachea in an operating theatre environment, with the facility to proceed to exploration of the neck and possibly to sternotomy to enable ligation of the innominate artery. With appropriate recognition, diagnosis, resuscitation and surgical intervention, the associated high death rate of trachea innominate artery fistula can be reduced.

Keywords

TracheostomyHaemorrhageInnominate ArteryPostoperative Complications
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 9 , September 2009 , pp. 952 - 956
Copyright
Copyright © JLO (1984) Limited 2009

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References

1 Byhahn, C. A useful and safe intervention. Current techniques of percutaneous tracheostomy. International Journal of Intensive Care 2003;10:155–65Google Scholar
2 Cheng, E, Fee, WE Jr. Dilatational versus standard tracheostomy: a meta-analysis. Ann Otol Rhinol Laryngol 2000;109:803–7CrossRefGoogle ScholarPubMed
3 Higgins, KM, Punthakee, X. Meta-analysis comparison of open versus percutaneous tracheostomy. Laryngoscope 2007;117:447–54CrossRefGoogle ScholarPubMed
4 Patel, A, Swan, P, Dunning, J. Does a percutaneous tracheostomy have a lower incidence of complications to an open surgical technique? Interact Cardiovasc Thoras Surg 2005;4:563–8CrossRefGoogle Scholar
5 Shlugman, D, Satya-Krishna, R, Loh, L. Acute fatal haemorrhage during percutaneous dilatational trachesotomy. Brit J Anaesthesia 2003;90:517–20CrossRefGoogle Scholar
6 McCormick, B, Manara, AR. Mortality from percutaneous dilatational tracheostomy. A report of three cases. Anaesthesia 2005;60:490–5CrossRefGoogle ScholarPubMed
7 Dulguerov, P, Gysin, C, Perneger, TV, Chevrolet, J-C. Percutaneous or surgical tracheostomy: a meta-analysis. Crit Care Med 1999;27:1617–25CrossRefGoogle ScholarPubMed
8 Ferlito, A, Rinaldo, A, Shaha, AR, Bradley, PJ. Percutaneous tracheostomy. Acta Otolaryngol 2003;123:1008–12CrossRefGoogle Scholar
9 Casserly, P, Lang, E, Fenton, JE, Walsh, M. Assessment of health care professionals’ knowledge of managing emergency complications in patients with a tracheostomy. Br J Anaesth 2007;99:380–3CrossRefGoogle ScholarPubMed
10 Koitschev, A, Simon, C, Blumenstock, G, Mach, H, Graumeller, S. Surgical technique affects the risk for tracheostoma-related complications in post-ICU patients. Acta Otolaryngol 2006;126:1303–8CrossRefGoogle ScholarPubMed
11 Kapural, L, Sprung, J, Gluncie, I, Kapural, M, Andelinovic, S, Primorac, D et al. Tracheo-innominate artery fistula after tracheostomy. Anaesth Analg 1999;88:777–80Google ScholarPubMed
12 Muhammad, JK, Major, E, Wood, A, Patton, DW. Percutaneous dilatation tracheostomy: haemorrhagic complications and the vascular anatomy of the anterior neck. A review based on 497 cases. Int J Oral Maxillofac Surg 2000;29:217–22CrossRefGoogle Scholar
13 Nelems, JM. Tracheo-innominate artery fistula. Am J Surg 1981;141:526–7CrossRefGoogle ScholarPubMed
14 Bertelsen, D, Jensen, NM. Innominate artery rupture. A fatal complication of tracheostomy. Ann Chir Gynaecol 1987;76:230–3Google ScholarPubMed
15 Beiderlinden, M, Eikermann, M, Lehmann, N, Adamzik, M, Peters, J. Risk factors associated with bleeding during and after percutaneous dilational tracheostomy. Anaesthesia 2007;62:342–6CrossRefGoogle ScholarPubMed
16 Friedman, Y, Fildes, J, Mizock, B, Samuel, J, Patel, S, Appavus, S et al. Comparison of percutaneous and surgical tracheostomies. Chest 1996;110:480–5CrossRefGoogle ScholarPubMed
17 Holdgaard, HO, Pederson, J, Jensen, RH, Outzen, KE, Midtgaard, T, Johansen, LV et al. Percutaneous dilatational tracheostomy versus conventional surgical tracheostomy. Acta Anaesthesiol Scand 1998;42:545–50CrossRefGoogle ScholarPubMed
18 Kearney, PA, Griffen, MM, Ochoa, JB, Boulanger, BR, Tseui, B, Mentzer, R. A single centre 8-year experience with percutaneous dilatational tracheostomy. Ann Surg 2000;231:701–9CrossRefGoogle Scholar
19 Beiderlinden, M, Groeben, H, Peters, J. Safety of percutaneous dilatational tracheostomy in patients ventilated with high positive end-expiratory pressure (PEEP). Intensive Care Med 2003;29:944–8CrossRefGoogle ScholarPubMed
20 Nates, JL, Cooper, J, Myles, PS, Scheinkestel, C, Tuxen, D. Percutaneous tracheostomy in critically ill patients: a prospective randomized comparison of two techniques. Crit Care Med 2000;28:3734–9CrossRefGoogle ScholarPubMed
21 Technology Appraisal Guidance No 49: Guidance on the Use of Ultrasound Location Devices for Placing Central Venous Catheters. In: http://www.nice.org.uk/pdf/Ultrasound_49_GUIDANCE.pdf [10 November 2008]Google Scholar
22 Muhammad, JK, Patton, DW, Evans, RM, Major, E. Percutaneous dilatational tracheostomy under ultrasound guidance. Brit J Oral Maxfac Surg 1999;37:309–11CrossRefGoogle ScholarPubMed
23 Sustic, A. Role of ultrasound in the airway management of critically ill patients. Crit Care Med 2007;35(Suppl 5):S173–7CrossRefGoogle ScholarPubMed
24 Diaz-Reganon, G, Minambres, E, Ruiz, A, Gonzalez-Herrera, S, Holanda-Pena, M, Lopez-Espadas, F. Safety and complications of percutaneous tracheostomy in a cohort of 800 mixed ICU patients. Anaesthesia 2008;63:1198–203CrossRefGoogle Scholar
25 Walz, MK, Schmidt, U. Tracheal lesions caused by percutaneous dilatational tracheostomy – a clinic-pathologic study. Intensive Care Med 1999;25:102–5CrossRefGoogle Scholar
26 Allan, JS, Wright, CD. Tracheo-innominate fistula: diagnosis and management. Chest Surg Clin N Am 2003;13:331–41CrossRefGoogle Scholar
27 Oshinsky, AE, Rubin, JS, Gwozdz, CS. The anatomical basis for post-tracheostomy innominate artery rupture. Laryngoscope 1988;98:1061–4CrossRefGoogle Scholar
28 Grant, CA, Dempsey, G, Harrison, J, Jones, T. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review. Brit J Anaesth 2006;96:127–31CrossRefGoogle Scholar
29 Ridley, RW, Zwischenberger, JB. Tracheo-innominate fistula: surgical management of an iatrogenic disaster. J Laryngol Otol 2006;120:676–80CrossRefGoogle Scholar
30 Singh, N, Fung, A, Cole, IE. Innominate artery haemorrhage following tracheostomy. Otolaryngol Head Neck Surg 2007;136:S68–72CrossRefGoogle ScholarPubMed
31 Jones, JW, Reynolds, M, Hewitt, RL, Drapanas, T. Tracheo-innominate artery erosion: successful surgical management of a devastating complication. Ann Surg 1976;184:194–204CrossRefGoogle ScholarPubMed
32 Hazarika, P, Kamath, SG, Balakrishnan, R, Gisish, R, Harish, K. Tracheo-innominate artery fistula: a rare complication in a laryngectomised patient. J Laryngol Otol 2002;116:562–4CrossRefGoogle Scholar
33 Utley, JR, Singer, MM, Roe, BB, Fraser, DG, Dedo, HH. Definitive management of innominate artery haemorrhage complicating tracheostomy. JAMA 1972;220:577–9CrossRefGoogle ScholarPubMed
34 Cooper, JD. Tracheo-innominate artery fistula: successful management of three consecutive patients. Ann Thorac Surg 1977;24:439–47CrossRefGoogle Scholar
35 Cokis, C, Towler, S. Tracheo-innominate fistula after initial percutaneous tracheostomy. Anaesth Intensive Care 2000;28:566–9CrossRefGoogle ScholarPubMed
36 Bloss, RS, Ward, R. Survival after tracheoinnominate artery fistula. Am J Surg 1980;139:252–3CrossRefGoogle ScholarPubMed
37 Gelman, JJ, Aro, M, Weiss, SM. Tracheo-innominate artery fistula. J Am Coll Surg 1994;179:626–34Google ScholarPubMed
38 Roh, JL, Na, MH, Kim, KH. Treating trachea-innominate artery fistula with interposition of a pectoralis major myocutaneous flap. Eur Arch Otorhinolaryngol 2006;263:180–2CrossRefGoogle Scholar
39 Deguchi, J, Furuya, T, Tanaka, N, Nobori, M, Seki, Y, Nomura, Y et al. Successful management of trachea-innominate artery fistula with endovascular stent graft repair. J Vasc Surg 2001;33:1280–2CrossRefGoogle Scholar
40 Vianello, A, Ragazzi, R, Mirri, L, Arcaro, G, Cutrone, C, Fitta, C. Tracheoinnominate fistula in a Duchanne muscular dystrophy patient: successful management with an endovascular stent. Neuromuscul Disord 2005;15:569–71CrossRefGoogle Scholar
41 Cohen, JE, Klimov, A, Rajz, G, Paldor, I, Spektor, S. Exsanguinating tracheoinnominate artery fistula repaired with endovascular stent-graft. Surg Neurol 2008;69:306–9CrossRefGoogle ScholarPubMed
42 Wall, LP, Gasparis, A, Criado, E. Endovascular therapy for tracheoinnominate artery fistula: a temporizing measure. Ann Vasc Surg 2005;19:99–102CrossRefGoogle ScholarPubMed
43 Takasaki, K, Enatsu, K, Nakayama, M, Uchida, T, Takahashi, H. A case with trachea-innominate artery fistula. Successful management of endovascular embolization of innominate artery. Auris Nasus Larynx 2005;32:195–8CrossRefGoogle Scholar