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Infection of tracheostomy stoma — Clinical Guidelines

Overview

Infection of the tracheostomy stoma is a significant complication associated with tracheostomy, contributing to morbidity and potentially mortality through mechanisms such as impaired healing, increased risk of systemic infections, and complications like tracheocutaneous fistula formation 6.

Diagnosis

Clinical signs include redness, swelling, purulent discharge, and foul odor at the stoma site 6.

Regular monitoring and inspection of the stoma are essential for early detection 6.

Cultures may be necessary to identify specific pathogens in cases of suspected infection 6.

Management

Antiseptic Care: Regular cleaning with antiseptic solutions (e.g., chlorhexidine) to maintain stoma hygiene 6.

Antibiotics: Consider empirical antibiotic therapy based on local resistance patterns if signs of infection are present 6.

Wound Care: Proper dressing changes and management of any exudate to prevent secondary infections 6.

Stoma Size Adjustment: Ensuring appropriate stoma size and patency to reduce trauma and infection risk 6.

Special Populations

Pediatrics: Increased vigilance due to higher risk of complications like suprastomal collapse and persistent tracheocutaneous fistulas; specialized training and readiness tools are recommended 3 5.

Elderly: Higher susceptibility to infections due to compromised immune systems; meticulous stoma care is crucial 6.

Key Recommendations

Implement regular, multidisciplinary training for managing tracheostomy emergencies, including infection, to enhance preparedness and response quality (Evidence: Expert opinion) 1.

Use antiseptic solutions for routine stoma care to prevent infection and maintain hygiene (Evidence: Expert opinion) 6.

Monitor tracheostomy sites closely for signs of infection and consider empirical antibiotic therapy when clinical infection is suspected (Evidence: Expert opinion) 6.

Tailor emergency readiness assessments and training specifically for pediatric populations to address unique risks like suprastomal collapse (Evidence: Expert opinion) 3.

References

1 Knight J, Richelieu J, Velasco JM, Lubinsky G, Day E, Weiss T et al.. Improving the Team Response to Surgical Airway Emergencies: A Simulation-based, Multidisciplinary Approach to Quality Improvement. Journal of surgical education 2025. link 2 Saniasiaya J, Toll E, McCaffer C, Neeff M, van der Meer G, Barber C et al.. Management of persistent tracheocutaneous fistula in children: Survey among paediatric otorhinolaryngologists. International journal of pediatric otorhinolaryngology 2025. link 3 Schiff E, Propst EJ, Balakrishnan K, Johnson K, Lounsbury DW, Brenner MJ et al.. Pediatric Tracheostomy Emergency Readiness Assessment Tool: International Consensus Recommendations. The Laryngoscope 2023. link 4 Duymaz YK, Bayram F, Şahin Ş, Erkmen B, Uzar T, Önder S et al.. Effectiveness of Training: Airway Management of Tracheostomized Pediatric Patients by Pediatric Residents and Anesthesiology Residents. The Journal of craniofacial surgery 2023. link 5 Doody J, Alkhateeb A, Balakrishnan K, Bedwell J, Carter J, Choi SS et al.. International Pediatric Otolaryngology Group (IPOG) consensus recommendations: Management of suprastomal collapse in the pediatric population. International journal of pediatric otorhinolaryngology 2020. link 6 Bontempo LJ, Manning SL. Tracheostomy Emergencies. Emergency medicine clinics of North America 2019. link 7 McKinstry RE. Dual interlocking tracheostoma vents. The International journal of prosthodontics 1993. link 8 Jensen OV, Pedersen U. Fractures in polyvinyl chloride tracheostomy tubes. The Journal of laryngology and otology 1988. link

Infection of tracheostomy stoma