What are the complications of a tracheostomy (tracheotomy)?

From the Guidelines

Complications of tracheotomy are a significant concern, with accidental decannulation being the most common adverse event, followed by tracheostomy-related haemorrhage, tube obstruction, and skin breakdown, as reported in the most recent study 1. The most common complications of tracheotomy can be categorized into early and late adverse events. Early complications include:

• Accidental decannulation, which is the most common adverse event, with a rate of 1.52 per 1000 tracheostomy bed days in pediatric patients and 2.28 per 1000 tracheostomy bed days in adult patients 1
• Tracheostomy-related haemorrhage, which is associated with a two- to four-fold mortality risk, with a rate of 0.35 per 1000 tracheostomy bed days in pediatric patients and 1.74 per 1000 tracheostomy bed days in adult patients 1
• Tube obstruction, with a rate of 0.88 per 1000 tracheostomy bed days in pediatric patients and 0.98 per 1000 tracheostomy bed days in adult patients 1
• Skin breakdown, with a rate of 0.55 per 1000 tracheostomy bed days in pediatric patients and 0.92 per 1000 tracheostomy bed days in adult patients 1 Late complications include:
• Tracheal stenosis at the stoma site
• Granulation tissue formation
• Tracheomalacia (weakening of the tracheal wall)
• Tracheo-esophageal fistula
• Tracheo-innominate artery fistula (a rare but life-threatening complication)
• Persistent stoma after decannulation
• Cosmetic issues from scarring Patients may also experience swallowing difficulties, voice changes, or chronic pain. Proper surgical technique, meticulous postoperative care, and regular monitoring can help minimize these risks, as emphasized in the study 1. Additionally, the selection of a tracheostomy tube of the proper diameter, length, and curvature for the individual patient can minimize the incidence of potential complications, as suggested in the study 1. It is also crucial to have a tracheostomy tube one size smaller than usual available for emergency use in case of accidental decannulation, as recommended in the study 1. Overall, the management of tracheotomy complications requires a multidisciplinary approach, including specialized care, regular monitoring, and prompt intervention in case of adverse events, as highlighted in the most recent study 1.

From the Research

Complications of Tracheotomy

• Tracheostomy predisposes patients to various complications, including:
  • Granuloma formation, which can lead to bleeding, obstruction, respiratory distress, and death 2
  • Tracheal stenosis, which can occur after tracheotomy and may be symptomatic only in severe cases 3
  • Bleeding, infection, and fistula development 2
• Nosocomial infections can influence the outcome of tracheal resections after tracheotomy, with bacterial contamination presenting a negative predictor for the outcome of primary tracheal end-to-end resections 4
• The risk of stenosis after tracheostomy is estimated to be around 8.8%, with repeat surgical tracheostomies being a main risk factor for stenosis 3
• Other complications of tracheostomy include:
  • Respiratory distress
  • Death
  • Tracheal granulation tissue, which can be difficult to treat, especially in patients with difficult anatomy 2

Types of Complications

• Early complications:
  • Bleeding
  • Infection
• Late complications:
  • Granuloma formation
  • Tracheal stenosis
  • Fistula development

Management of Complications

• Treatment options for granuloma formation include trans-stomal Coblation, which offers advantages such as better hemostasis and less risk of distal tissue loss 2
• Prophylactic postoperative antibiotic therapy can improve the short- and long-term results of tracheal resections after tracheotomy 4
• Tracheostomy teams and tracheostomy hospital services with standardized protocols for tracheostomy insertion and care have been associated with improved outcomes 5