The Journal of Thoracic and Cardiovascular Surgery, Vol 82, 341-344, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Management of necrotizing tracheostomy infections
N Snow, JD Richardson and LM Flint
Management of three patients with necrotizing tracheostomy infections
resulting in tracheal dissolution was reviewed with respect to
presentation, cause, and management. Loss of tracheal substance led to
difficulty in ventilation because of a large air leak. The stomal area
cavitated in two patients, denuding the right common carotid artery in one.
Purulent peristomal drainage was present in all three patients. Common
factors of possible etiologic significance included necrotizing
polymicrobial gram-negative tracheobronchial infections caused by
Pseudomonas, Enterobacter, and Klebsiella species. Also of possible
importance were suture fixation of the appliance, history of neurologic
injury, and closure of the incision. Immediate therapy consisted of oral
intubation for ventilatory purposes and a regimen of hourly application of
1% neomycin dressings. Seven to 21 days were necessary to allow formation
of sufficient granulation tissue to support replacement of the tracheostomy
appliance for continued mechanical ventilation. Once spontaneous
ventilation was possible, a Montgomery T- tube was inserted for long-term
tracheal stenting prior to reconstruction. The two patients treated by
tracheal stenting are long- term survivors. Avoidance of suture fixation of
the appliance, aggressive treatment of bronchopulmonary infection, and
adequate stomal toilet may help to avoid this devastating complication.
