Emergent Management of a Tracheoinnominate Fistula in the Community Hospital Setting

Tracheoinnominate fistula is a rare but highly lethal complication of tracheostomy. Early recognition and interventions are key to patient survival. A 63-year-old woman had undergone tracheostomy for respiratory failure secondary to disseminated histoplasmosis. She presented to the community hospital intensive care unit from a long-term acute care facility for presumed gastrointestinal bleeding. A tracheoinnominate fistula was suspected when there was bleeding around the tracheostomy. The patient underwent a median sternotomy with innominate artery ligation. The article will discuss the presentation, evaluation, and emergent management of this lethal complication of tracheostomies. The patient survival is dependent on high clinical suspicion, rapid diagnosis, and emergent surgical management.