Tracheostomy and Tracheoinnominate Fistula

A tracheostomy procedure creates an opening from the skin of the neck through the anterior wall of the trachea. A tracheostomy tube (or other airway tube) can be inserted into this tract for airway access and management. Tracheostomy can be performed using an open or percutaneous technique. The most common indication for tracheostomy is respiratory failure requiring prolonged mechanical ventilation. It can be temporary or permanent. Tracheoinnominate fistula is a rare, but life-threatening, complication of tracheostomy and other tracheal surgeries. Tracheoinnominate fistula can present as bleeding through the tracheostomy tube, peristomal bleeding, or hemoptysis. Bleeding can be minor to massive. A herald or sentinel bleed (minor bleeding that spontaneously stops) may precede massive hemorrhage in some, but not all, cases. Tracheoinnominate fistula is a surgical emergency, and an early diagnosis is critical to increase the likelihood of survival. Despite successful and timely surgical management, the mortality rate is high; therefore, prevention is key.