Tracheostomy Tube Management

This retrospective study evaluated the care, complications, and outcome of 42 dogs that underwent temporary tube tracheostomy and identified factors associated with complications and tracheostomy-related death. Medical records were evaluated for signalment, respiratory disease history, diagnosis, surgery, type and frequency of tube care procedures, type of complications, and outcome. Complications occurred in 86% of cases. In 81%, either the tracheostomy tube survived until removal (n = 25) or the patient had elective euthanasia with no tracheostomy tube complications (n = 9). Cases with 3 or more complication types underwent more routine care procedures than those with fewer complications; the most common complications included obstruction (26%), dislodgment (21%), aspiration pneumonia (21%), and stoma swelling (21%). The impact of a particular complication is probably the result of a complex interaction between severity and duration of the complication, its recognition, type and success of interventions, and subsequent development of other complications. Bulldogs and dogs that experienced bradycardia during treatment were more likely to have unsuccessful tube management, as were significantly younger dogs.

CommentaryAlthough many complications associated with tracheostomy are incidental, some are potentially life-threatening. Given the variation of surgical and management techniques as well as the retrospective nature of this article, it is impossible to comment on whether a specific technique negatively impacted complication rates or outcomes. For example, many veterinarians would consider oxygen administration a standard of care; however, only 14% of patients in this study were oxygenated before tube care. Not surprisingly, dislodgment of tubes was high in bulldogs; longer or custom-made tubes may be necessary to avoid dislodgment in brachycephalic breeds. Careful avoidance of complications could improve the success of tube management.—Andrew Linklater, DVM, DACVECC

SourceComplications associated with temporary tracheostomy tubes in 42 dogs (1998 to 2007). Nicholson I, Baines S. J SMALL ANIM PRACT 53:108-114, 2012.