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| EDITORIAL |
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| Year : 2014 | Volume
: 4
| Issue : 1 | Page : 1 |
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The savior becomes the devil
Rakesh Datta
Department of ENT, Base Hospital, Delhi Cantt, New Delhi, India
| Date of Web Publication | 22-Sep-2014 |
Correspondence Address:
Rakesh Datta
Department of ENT, Base Hospital, Delhi Cantt, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2230-9748.141436
How to cite this article:
Datta R. The savior becomes the devil
. J Laryngol Voice 2014;4:1 |
Tracheostomy is a common procedure and often done to protect the respiratory system. However, there are occasions when the savior (tracheostomy tube) itself may become the devil and endanger the life of the patient. The present issue of Journal of Laryngology and Voice attempts to highlight this in a couple of reports in the current issue. [1],[2] Though tracheostomy is an extremely common surgery, there is a surprising lack of good quality evidence regarding its post-operative care and prevention of complications. It would therefore be difficult to put an exact estimate with which these fatal complications occur. Furthermore, the chequered history of the procedure and its potential to lead to fatal consequences has added a bit of dread around the procedure itself. [3]
The potential fatal complications include incorrect positioning of the tracheostomy tube with consequent hypoxia, pneumothorax following tracheal wall perforation, accidental dislodgement, mucus plugging, and hemorrhage from trachea-vascular fistulas. [4] As highlighted by the twin case reports, tracheostomy remains a life-saving procedure, which has the potential to take lives too. Complications need to be always anticipated, and optimal care, early detection and timely intervention are the key to managing them.
What does however bring to my mind is not the reporting of these rather rare situations and complications, but the need for sharing such cases. The learning potential of such cases cannot be underestimated. We learn from mistakes and has often been said "mistake is the best teacher." Subsequently, we have included these cases as a new type of case reports which we are calling the "Learning Cases." The aim of these cases would be to drive home an important learning point. The development of any specialty requires peers to learn from each other and sharing adverse outcomes with colleagues would go a long way toward this aim. I would encourage experts in the field of laryngology and voice to use this opportunity to publish their experiences to enhance learning in the sub-specialty.
Second, the case does exist for more robust scientific evidence on the incidence and managements of complications of tracheostomy. Although there is some evidence available on the complications of both standard tracheostomy and percutaneous tracheostomy, more contemporary data is needed considering changing techniques, material of tubes and standard of care. A clinical consensus statement recently attempted to collate the experience of multidisciplinary experts about what would constitute appropriate tracheostomy care. [5] Well planned trials and descriptive studies in clear-cut defined sub-sets of populations will go a long way in formulating best evidence-based practices and are the need of the times. This will perhaps justify not only the rationalized indications of the procedure, but also in preventing and managing complications.
 References | |  |
| 1. | Poduval J, Benazir F, Ninan P. Pneumopericardium - an unusual complication of broken tracheostomy tube presenting as foreign body trachea. J Laryngol Voice 2014;4:32-5. 
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| 2. | Jain S, Kumar S, Deshmukh P, Gaurkar S. Bilateral pneumothorax: Perils of emergency tracheostomy. J Laryngol Voice 2014;4:36-8.
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| 3. | Szmuk P, Ezri T, Evron S, Roth Y, Katz J. A brief history of tracheostomy and tracheal intubation, from the Bronze Age to the Space Age. Intensive Care Med 2008;34:222-8.
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| 4. | Byard RW, Gilbert JD. Potentially lethal complications of tracheostomy: Autopsy considerations. Am J Forensic Med Pathol 2011;32:352-4.
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| 5. | Mitchell RB, Hussey HM, Setzen G, Jacobs IN, Nussenbaum B, Dawson C, et al. Clinical consensus statement: Tracheostomy care. Otolaryngol Head Neck Surg 2013;148:6-20.
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