Tracheostomy Tube Displacement: An Update on Emergency Airway Management

Abstract

The formation of tracheal stomas and insertion of tracheostomy tubes is increasing in frequency. Although tracheostomy tube displacement is uncommon, the associated mortality is high. This is because rapid intervention is required, management is often difficult and even specialists in airway management often have limited experience with tracheostomized patients. Anyone caring for a patient with a tracheostomy should be aware of the clinical presentation of tracheostomy tube displacement and be able to manage it rapidly. This review describes the application of fundamental principles of airway management to tracheostomy tube displacement to reinforce its similarity to most other airway emergencies. The first and most important question is: Does the airway need to be re-secured? If so can the tracheostomy be reinserted easily? Assessment of the patient's upper airway must determine whether translaryngeal oxygenation and endotracheal intubation are possible. Information about the other factors that influence management can be obtained from the medical records about the formation of the tracheal stoma. Even airway specialists find it challenging to acquire and process this information to formulate an appropriate management plan, off the cuff, in the heat of the moment. Hence, multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies recommend that this information be displayed on posters at the bedside. This poster should also be accompanied by a written plan for emergency orotracheal intubation or tracheostomy replacement in the event of an airway emergency. All the equipment required to execute these plans should be immediately available at the bedside.