Aspiration of a tracheostomy plug.

Area of Science:

• Medical Device Safety
• Respiratory Medicine
• Surgical Complications

Background:

• Tracheostomy tubes are essential for patients requiring mechanical ventilation.
• Routine maintenance, such as inner cannula changes, carries inherent risks.
• Accidental aspiration of foreign objects can lead to severe respiratory compromise.

Observation:

• A plastic truncated conical tracheostomy plug was aspirated into a respirator-dependent patient's lungs during an inner cannula change.
• Multiple attempts at bronchoscopic removal and even exploratory thoracotomy failed to retrieve the aspirated plug.
• The patient, lacking a cough reflex, expectorated the plug spontaneously after 17 days.

Findings:

• Spontaneous expectoration of a deeply lodged tracheostomy plug is possible, even without a cough reflex.
• Percussion and postural drainage may aid in the dislodgement of foreign bodies in the airway.
• The incident highlighted a design flaw in the tracheostomy plug, prompting immediate modification.

Implications:

• Tracheostomy device components require rigorous safety assessments to prevent patient harm.
• Modified tracheostomy plugs with integrated safety features (e.g., a ring) can prevent accidental aspiration.
• This case underscores the importance of vigilance during routine tracheostomy care and the potential for unexpected foreign body expectoration.