Tracheostomy Complications—Chronic Tracheostomy with Tracheoinnominate Fistula

Patient is a 65-year-old man with prolonged recovery from ARDS due to pneumonia, requiring continued mechanical ventilatory support, who underwent percutaneous tracheostomy insertion 20 days ago. The learner is called to the bedside by the MICU nurse due to bright red blood oozing from the tracheostomy and from the stoma. The Learner should suspect a tracheoinnominate fistula (TIF), call for an airway team and stat ENT consult, and perform the appropriate bedside management for TIF.

Learning Objectives

– Recognize the importance of determining: a) why a tracheostomy was performed, b) when it was performed, and c) the type of tracheostomy tube in place.

– Demonstrate appropriate management of suspected tracheoinnominate fistula, including obtaining emergent ENT consultation.