Introduction
Tracheostomies remain an essential part of care Intensive Care Units
around the world.1 As of 2014, approximately 800,000
tracheostomies were performed in the United States and studies have
documented a statistically significant increase in
tracheostomies.2 Indications for tracheostomies are
semi-elective and are determined on an individual basis while
considering the patient’s future complication risk.3Although more invasive than endotracheal intubation, tracheostomies are
safer, more comfortable, allow easier verbal communication, shorter
intensive care unit stays, days spent on mechanical ventilation, and
hospital stay lengths.4 The only absolute indication
for tracheostomy placement is a difficult airway, while the most common
indication is airway security following prolonged mechanical
ventilation.5 An estimated 10% of mechanically
ventilated patients undergo tracheostomy.2 Other
common indications include catastrophic neurologic insult, copious
secretions, upper airway obstructions, and severe obstructive sleep
apnea.2,6
Tracheostomies are placed most often through an open surgical technique
(OST) or percutaneous dilational technique (PDT). Complications
significantly increase the mean cost and total charges burden on ICU
patients and any attempt to mitigate complications benefits the patient
as well as the healthcare system.7 Early complications
include bleeding, infection, subcutaneous emphysema, tube dislodgement,
posterior tracheal wall injury, and tracheostomy tube
obstruction.8,9 The incidence of serious and fatal
complications as well as readmission, however, is miniscule in
comparison.9 While PDT and OST have similar overall
complication rates, OST does have higher incidence of bleeding and
infections8 and bleeding remains the most common
complication in both techniques.10
Other predictors of complication incidence have been thoroughly studied.
When considering overall complication incidence, several studies show
that age, gender, smoking status, anatomical variants, tracheostomy
size, tracheostomy type, and suture stabilization are not highly
predictive of acute complications.11,12 In contrast,
obesity is a highly described predictor of tracheostomy
complications.13 Obesity was found to be independently
associated with an increased risk of all complications, acute kidney
injury, and unplanned readmission within the first 30 days of tracheal
tube placement.14 Beyond obesity, factors that were
also predictive of increased complications include number of
comorbidities, neck pathology, tracheostomy placement in operating room
vs inpatient unit, previous radiotherapy, and previous
tracheotomy.11 Additionally, certain demographic
groups may be associated with increased mortality in tracheostomy
patients. Specifically, African American children, Hispanic adults, and
adults with lower levels of education have a higher mortality rate, but
the same complication rate as other groups with
tracheostomy.15
The relationship between obstructive pulmonary diseases and acute
post-tracheostomy complications has been incompletely studied. Chronic
obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and
asthma are some of the most common pulmonary pathologies in the United
States and worldwide and are associated with high disease
burdens.16-18 Mechanical ventilation, and in severe
cases, tracheostomy are fundamental tools in the management of patients
with COPD and asthma suffering from acute respiratory
failure.19 Given the high incidence of obstructive
lung diseases worldwide and the clinical utility of tracheostomies among
patients with these diseases, it is important to characterize the risk
of post-procedure complications.