Complications of Tracheostomy in 168 Cases

Nam, Eui Cheol; Nam, Soon Yuhl; Kim, Sang Yoon

Abstract

OBJECTIVES
The purpose of this study is to evaluate the incidence of complications accompanying tracheostomy, and in addition, to suggest ways to prevent serious complications.
MATERIALS AND METHODS
We performed tracheostomy in 168 patients and their data were analyzed retrospectively.
RESULTS
Twenty one patients (12.5%) had complications directly related to tracheostomy. The most common complication was postoperative bleeding which accounted for 11 cases (6.7%). Others complications included pneumothorax which claimed 3 cases (1.8%) with reduced morbidity, cannula dislodgment claimed 3 cases (1.8%), cannula obstruction 2, wound infection 2 and tracheal stenosis 2. Among them, two patients died of tracheostomy complications. Decannulation was tried in 44 patients, but it fell short since only 11 patients were decannulated without difficulty. The rest of patients could not be decannulated because of various reasons including death, underlying disease, subglottic stenosis, tracheal stenosis or vocal cord palsy.
CONCLUSION
In order to avoid complications of tracheostomy, it is important to treat preoperatively the tendency to bleeding, and meticulously control it during the operation as well. Also, the use of longer cannulas and tracheal fenestration technique is helpful for patients with short and stocky neck. Positive pressure applied through the cannula can make serious complications such as pneumothorax when cannula-obstruction or cannuladislodgment is suspected and the high volume-low pressure cuff is useful to prevent the decannulation difficulties by longterm cannulation, especially in patients using ventilator.