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Complication of Tracheostomy

  1. Immediate (Post Insertion)
    • Haemorrhage (minor or severe)
    • Misplacement (pre-tracheal tissues or to main bronchus)
    • Pneumothorax
    • Surgical emphysema
    • Occlusion of the tube by cuff herniation Oesophageal perforationDelayed (Post Insertion)

  2. Delayed (Post Insertion)
    • Tube blockage with secretions. May be sudden or gradual
    • Infection of the stoma site
    • Infection of the bronchial tree
    • Tracheal ulceration
    • Tracheal necrosis
    • Tube migration to pre-tracheal space
    • Risk of occlusion of the tracheostomy tube in obese or fatigued patients who have difficulty extending their neck
    • Tracheo-oesophageal fistula formation
    • Accidental decannulation
    • Haemorrhage (minor or severe)

  3. Late (Post Decannualtion)
    • Granulomata of the trachea may cause respiratory difficulty when the tracheostomy tube is removed
    • Persistent sinus at the tracheostomy site
    • Tracheal dilation
    • Tracheal stenosis at the cuff site
    • Scar formation requiring revision
    • Tracheomalacia
Historically, tracheostomy was associated with a high risk of complications and a significant mortality rate. The reported complication rates in adults undergoing tracheostomy vary considerably but it is generally held that complications are more frequent after emergency tracheostomy for airway obstruction (Waldron 1990).  

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