The best method for determining the risk of aspiration in a patient with a tracheostomy is to

As with any surgery, there are some risks associated with tracheotomies. However, serious infections are rare.

Early Complications that may arise during the tracheostomy procedure or soon thereafter include:

• Bleeding
• Air trapped around the lungs (pneumothorax)
• Air trapped in the deeper layers of the chest(pneumomediastinum)
• Air trapped underneath the skin around the tracheostomy (subcutaneous emphysema)
• Damage to the swallowing tube (esophagus)
• Injury to the nerve that moves the vocal cords (recurrent laryngeal nerve)
• Tracheostomy tube can be blocked by blood clots, mucus or pressure of the airway walls.  Blockages can be prevented by suctioning, humidifying the air, and selecting the appropriate tracheostomy tube.

Many of these early complications can be avoided or dealt with appropriately with our experienced surgeons in a hospital setting.

Over time, other complications may arise from the surgery.

Later Complications that may occur while the tracheostomy tube is in place include:

• Accidental removal of the tracheostomy tube (accidental decannulation)
• Infection in the trachea and around the tracheostomy tube
• Windpipe itself may become damaged for a number of reasons, including pressure from the tube; bacteria that cause infections and form scar tissue; or friction from a tube that moves too much

These complications can usually be prevented or quickly dealt with if the caregiver has proper knowledge of how to care for the tracheostomy site.

Delayed Complications that may result after longer-term presence of a tracheostomy include:

• Thinning (erosion) of the trachea from the tube rubbing against it (tracheomalacia)
• Development of a small connection from the trachea (windpipe) to the esophagus (swallowing tube) which is called a tracheo-esophageal fistula
• Development of bumps (granulation tissue) that may need to be surgically removed before decannulation (removal of trach tube) can occur
• Narrowing or collapse of the airway above the site of the tracheostomy, possibly requiring an additional surgical procedure to repair it
• Once the tracheostomy tube is removed, the opening may not close on its own.  Tubes remaining in place for 16 weeks or longer are more at risk for needing surgical closure

A clean tracheostomy site, good tracheostomy tube care and regular examination of the airway by an otolaryngologist should minimize the occurrence of any of these complications.

High-risk groups

The risks associated with tracheostomies are higher in the following groups of patients:

• children, especially newborns and infants
• smokers
• alcohol abusers
• diabetics
• immunocompromised patients
• persons with chronic diseases or respiratory infections
• persons taking steroids or cortisone

Having a tracheostomy usually will not affect the patient's eating or swallowing patterns. Sometimes there are changes in swallowing dynamics that require adjusting to, but it is rare that this cannot be overcome in a short time. If swallowing problems do occur, it is usually due to limited elevation of the larynx or poor closure of the epiglottis and vocal cords, which allows food or fluids into the trachea. Your otolaryngologist and speech pathologists can be consulted for an evaluation, which may include a videofluoroscopic swallowing study or other procedures to make sure the patient is swallowing safely. The speech pathologist may be able to develop ways to improve swallowing if there is a problem.

Indications of a Swallowing Problem

• Difficulty or refusing to eat
• Over-reaction or no reaction to food in the mouth
• Choking and coughing while eating or drinking
• Vomiting
• Evidence of food in tracheostomy secretions
• Excessive drooling
• Large amounts of watery secretions from trach
• Congested lung sounds
• Frequent respiratory infections

If the patient eats by mouth, it is recommended that the tracheostomy tube be suctioned prior to eating. This often prevents the need for suctioning during or after meals, which may stimulate excessive coughing and could result in vomiting.

Encouraging fluid intake is helpful for a patient with a tracheostomy. Increased fluid intake will thin and loosen secretions making coughing and suctioning easier.

Always observe the patient while eating to be sure food does not get into the trach.

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