Tracheostomy - complications

One of the immediate complication of tracheostomy is surgical emphysema.This is presence of air in subcutaneous tissue and its main cause in tracheostomy is

1. Tight sutures
2. Tight packing around tube
3. Wrong placement of tube in subcutaneous tissue in a false passage

The tight sutures act as ball valve. Air gets sucked into subcutaneous tissue but cannot comes out. So it gets collected under skin. If not checked, there can be pneumothorax and pneumomediastinum.

On examination ,on palpation creps can be felt under skin which can also be auscultated.

Treatment - Open the tight sutures. If extensive surgical emphysema is there oh face, neck and shoulders, then small nicks can be given to release air. If there is pnemothorax and pneumomediastinum, they are treated actively.