Patient number | RUSG used | High-risk factor present | Nature of complication | Days from procedure | Details | Technical/procedural issue identified |
---|---|---|---|---|---|---|
1 | N | None | Bleeding requiring intervention, inability to complete procedure | 0 | Large neck hematoma during procedure, surgical tracheostomy and hemostatsis performed urgently in OR | Laceration of arterial branch along superior border of isthmus |
2 | N | Coagulopathy: dual antiplateley therapy | Bleeding requiring intervention | 1 | Copious persistent bleeding from stoma, requiring platelet transfusion and cessation of dual antiplatelet therapy | Vascular injury likely, specific source not identified |
3 | N | None | Tracheal granuloma | 13 | Inability to perform routine tube change at bedside, fiberoptic evaluation revealed a large tracheal granuloma causing luminal stenosis. Soft tracheal tube introduced over fiberoptic scope | None |
4 | N | None | Early dislodgment, need for surgical revision | 5 | Tracheal tube dislodged, inability to replace at bedside. Surgical revision required, initial stoma noted to be below 6th tracheal ring | Too low placement of tracheal tube |
5 | N | Coagulopathy: from therapeutic plasma exchange on consecutive days. | Bleeding requiring intervention | 3 | Persistent oozing with large hematoma in upper left quadrant of stoma. Surgical hemostasis with Surgicell® Fibrillar® absorbable hemostats | Vascular injury: focal bleeding identified at bedside at upper left quadrant of stoma |
6 | N | Coagulopathy: warfarin for venous thromboembolism | Death, bleeding requiring intervention | 266 | Massive bleeding and death from trachea-innominate fistula | Too low placement of tube on autopsy, proximity to innominate artery. |
7 | N | Coagulopathy: anticoagulation for venous thromboembolism | Bleeding requiring intervention | 7 | Persistent copious oozing during and after procedure. Anticoagulation reversed; surgical hemostasis performed in OR on day 7 | Vascular injury: focus of bleeding identified in OR |
8 | N | None | Need for revision of tracheostomy | 1 | Persistent large air leak with loss of >30% tidal volume. Fiberoptic evaluation and emergent bedside revision performed post-procedure day 1 | Too low placement: tube seen below 6th tracheal ring with suboptimal positioning on fiberoptic evaluation |
9 | N | None | Need for revision of tracheostomy, early dislodgment | 4 | Persistent large (20-25%) cuff leak post-procedure with dislodgment and inability to ventilate on day 4, surgical revision in OR | Too low placement of tracheal tube (below 8th ring) with consequent poor positioning |
10 | Y | Coagulopathy: end-stage liver disease, repeat tracheostomy | Early dislodgment | 6 | Tube dislodged following agitation and head shaking with subsequent brief period of hypoxia. Extended length tube replaced at bedside into stoma over a bougie. | ? Inappropriate selection of tube length. Sonographic measurement pre-tracheal tissue thickness not performed. |