Complications of Endotracheal Intubation, Tracheostomy, and Artificial Airways

Complications of tracheal tubes are common and occasionally severe. They may be classified according to their time of occurrence: during the intubation or tracheotomy, while the endotracheal or tracheostomy tube is in place, during extubation or decannulation, or after extubation or decannulation. Numerous factors, of which excessive cuff pressure is the best understood, contribute to the pathogenesis of these complica-tions. Each of the four varieties of tracheal intubation (nasotracheal intubation, orotracheal intubation, cricothyroidotomy, tracheostomy) has unique advantages and disadvantages. Although tracheostomy is the preferred method for long-term airway management, optimal timing of tracheotomy remains controversial. Tracheotomy should be performed only after consideration is given to many clinical factors relevant to each patient and should not be performed solely because an arbitrary number of days of intubation has elapsed. Following simple guidelines will allow respiratory care personnel to avoid many of the complications of artificial airways and to recognize early those that do occur.