Bakht Zada, Zafar Iqbal, Tahir Muhammad, Rehan Saleem, Muhammad Tayyab Rasheed, Muhammad Habib

Management of Post Tracheotomy Hemorrhage and Evaluation of Causing Factors

Bakht Zada, Zafar Iqbal, Tahir Muhammad, Rehan Saleem, Muhammad Tayyab Rasheed, Muhammad Habib



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ABSTRACT

Objective: To understand the frequency, causes, and treatment of post-tracheostomy hemorrhage.

Study Design: A prospective study of tracheostomy cases. Place and duration: ENT, Head & Neck Surgery department of Lady Reading Hospital MTI, Peshawar and Azra Nahid Medical College, Lahore for duration of one year from July 2019 to June 2020.

Methodology: All hospitalized patients who underwent tracheostomy and had bleeding during this period were included. The parameters specified were demographics, time since surgery, degree of bleeding, causes of bleeding, and treatment. A total of 208 patients who have done with tracheostomy were selected.

Results: Tracheostomy was performed in a total of 208 patients, 142 men and 66 women. Their ages ranged from 20 to 70 years old. 22 patients (10.6%) had postoperative bleeding, most of them have oozingfrom or around the stoma, but 5 patients were taken to the operating room for hemostasis. Three of them had Tracheo- innominate artery fistula and two died before undergoing surgery. One of the three trachea-innominatefistulae were successfully treated by a cardiac surgeon. The remaining cases required diathermy, transfixing thyroid isthmus or vein descent or relegation of veins.

Conclusions: Hemorrhage after tracheostomy is not uncommon in intensive practice, bleeding occurred in 10.5% of our cases. Hemorrhage occurs because of inadequate hemostasis, aspiration trauma, infection, coagulopathy and granulation. Rarely, there may be massive and life-threatening bleeding from tracheo-innominate fistula that requires aggressive and urgent exploration. In such a situation, an experienced cardiac surgeon and anesthesiologist is very important and can lead to a better result.

Key words: Tracheostomy, post-tracheostomy hemorrhage, Tracheo-innominate artery fistula (TIF)



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