Infection
Measures to prevent ventilator-associated pneumonia should be in place, including elevation of the head of the bed, mouth care, and gastrointestinal prophylaxis. Lung infections are treated with appropriate antibiotics. Cuff pressure should be optimized to ensure that no leakage of secretions around the cuff occurs. However, the cuff should not be overinflated, because overinflation can contribute to the development of tracheomalacia and tracheal stenosis.38,43
The tracheostomy site should be inspected for indications of inflammation and infection, such as increased redness, swelling, odor, and drainage. Stomal infections can be stubborn, but they can be effectively treated locally with silver-infused products such as primary wound dressings made from sodium carboxymethylcellulose containing 1.2% silver in an ionic form (Aquacel Ag), silver-impregnated nylon dressings (Silverlon), or colloidal silver gel.31