Management of Tracheal Granulation after Tracheostomy

Abstract

Post-tracheostomy management of tracheal granulation is discussed in this article. Two cases of a tracheal granulation were successfully and conservatively treated with some useful tools in a novel way. A 2-year-old girl that had a tracheostomy with a 3.5mm tube suffered from an enlarged tracheal granulation. It was flattened out using a 3.5mm endotracheal tube and a stabilizer originally designed for ureteric, biliary and gastric catheters on the abdominal wall. This stabilizer allowed us to secure an endotracheal tube at the tracheostoma to avoid inadvertent decannulation or incorrect intubation. A 20-year-old woman with muscle dystrophy developed tracheal granulation after having a tracheostomy. Although she required 24-hour ventilation support, she wanted to speak. The granulation was initially resolved by using a long tracheostomy tube that did not allow her to speak. This was replaced with a speech tracheostomy tube (Merasofit clear CF) that is usually prohibited when using the ventilator because of excessive leakage through conduits. Merasofit clear CF is a kind of speech tracheostomy tube, which has a mobile flange to prevent tracheal granulation as well as smaller expiration conduits than other conventional tubes. It was found that this speech tracheostomy tube is compatible with ventilation, preserves oral communication and allows safe alimentation by mouth while preventing recurrence of granulation.