How to manage subcutaneous emphysema after tracheotomy?

Subcutaneous emphysema after tracheotomy may be caused by loose sutures at the tracheotomy site, severe coughing, inappropriate tracheostomy tube size, alveolar rupture, or tracheoesophageal fistula. Management should be tailored according to the specific cause. It is recommended to seek timely medical attention and receive treatment under the guidance of a physician.

1. Loose Sutures at the Tracheotomy Site

If the skin around the tracheotomy incision is not tightly sutured after surgery, air can easily leak from the tracheal opening into the subcutaneous tissues, leading to subcutaneous emphysema. If loose sutures are detected, the physician may need to reevaluate the wound. Provided that airway patency and normal respiratory function are not compromised, the sutures should be appropriately tightened.

2. Severe Coughing

Severe coughing after tracheotomy can cause a sudden increase in intratracheal pressure, forcing air through the loose tissue spaces surrounding the tracheotomy site into the subcutaneous tissue, resulting in subcutaneous emphysema. Efforts should be made to calm the patient, stabilize their emotions, and avoid intense emotional fluctuations that may trigger coughing or labored breathing. Adjust the patient’s position to ensure comfort and facilitate smooth respiration.

3. Inappropriately Sized Tracheostomy Tube

If the diameter of the tracheostomy tube is too large relative to the tracheotomy opening, a significant gap may exist between the trachea and the tube. During respiration, air can pass through this gap into the surrounding subcutaneous tissues, causing subcutaneous emphysema. The physician should assess whether the tracheostomy tube is properly sized and promptly replace it with an appropriately sized one if necessary. Strict adherence to sterile techniques is essential during tube replacement to prevent infection.

4. Alveolar Rupture

In patients with tracheotomy, pulmonary infections can cause inflammation that damages the alveolar walls. Once alveoli rupture, air escapes into the lung interstitium and then spreads along the perivascular and peribronchial spaces into the mediastinum, eventually extending into the subcutaneous tissues to form subcutaneous emphysema. Patients often present additional symptoms of pulmonary infection such as fever, cough, and sputum production. Under medical supervision, medications such as cefoperazone sodium and sulbactam sodium for injection, ambroxol hydrochloride injection, and aminophylline injection may be used to relieve symptoms.

5. Tracheoesophageal Fistula

During tracheotomy, improper surgical technique or subsequent pathological changes in the trachea and esophagus may lead to the formation of a fistula between the trachea and esophagus. Gas from the esophagus can then pass through the fistula into the peritracheal area and subsequently enter the subcutaneous tissues, causing subcutaneous emphysema. Patients may experience symptoms such as dysphagia and choking cough. Treatment may include medications such as omeprazole injection, levofloxacin injection, and somatostatin for injection, as prescribed by a physician.

During recovery, a light and balanced diet is recommended, along with healthy and regular作息 (daily routines), to support healing. Avoid spicy and irritating foods such as garlic, spicy hot pot, and mustard. Excessive fatigue should also be avoided to prevent adverse effects on health.