Late complications of tracheostomy.

TLDR

Tracheostomy is associated with acute perioperative complications and a spectrum of late complications—including granulation tissue, tracheal stenosis, tracheomalacia, fistulas, pneumonia, and aspiration—that range from minimally symptomatic to life‑threatening. Treatment depends on the complication, with tracheal stenosis most effectively managed by a multidisciplinary approach using bronchoscopy, laser, airway stents, and surgery.

Abstract

Tracheostomy may be associated with numerous acute, perioperative complications, some of which continue to be relevant well after the placement of the tracheostomy. A number of clinically important unique late complications have been recognized as well, including the formation of granulation tissue, tracheal stenosis, tracheomalacia, tracheoinnominate-artery fistula, tracheoesophageal fistula, ventilator-associated pneumonia, and aspiration. The clinical relevance of these complications is considerable, as their manifestations range from minimally symptomatic to failure to wean from the ventilator (tracheal stenosis) to life-threatening hemorrhage (tracheoinnominate fistula). Treatment modalities vary depending upon the nature of the complication. For the most frequent complication, tracheal stenosis, a multidisciplinary approach utilizing bronchoscopy, laser, airway stents, and tracheal surgery is most effective.