Postoperative management

Immediately post-tracheostomy, bilateral breath sounds should be identified and stability of cardiac rhythm, blood pressure, and oxygen saturation should be assured. A chest radiograph is performed to exclude the presence of pneumothorax.

Meticulous care of the tracheostomy tube is necessary, particularly during the first few hours and days. Ideally, the tracheostomy tube should not be changed during the first 5 or 6 days to permit maturation of the tract. If accidental decannulation occurs before such a tract has developed, it may be extremely difficult to reinsert the tube through the opening. In such cases, it is usually best to intubate the patient orally to secure the airway and then address the problem of replacing the tracheostomy tube in a less harried fashion. The tracheostomy site should be covered with a simple split-gauze dressing, and it should be inspected regularly for bleeding from the stoma, which may develop even many hours after the procedure.

Over the ensuing days, regular inspection should be undertaken to detect any signs of wound breakdown, cellulitis, or purulent drainage. If signs of infection are noted, systemic antibiotics after appropriate cultures are indicated. Local cleansing with antiseptic solution may also be of benefit in such cases.

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