The complications of
tracheotomy are reviewed and divided into two categories: early and late complications depending on whether the
cannula has been removed or remains in situ. In the acute period, severe haemorrhages (0.3 to 2%) and oesophagotracheal fistulae (0.5 to 2%) result from a conflict between
cannula and trachea during prolonged
intensive care.
Cardiac arrhythmia is frequent during aspiration (35%) but rarely lethal. Various technical problems related to the
tracheotomy material are common (4 to 6%) and often very serious. Air leakage is represented mainly by severe
pneumothorax (1 to 5%) under artificial ventilation.
Tracheotomy wound infections (0.5 to 3.5%) may facilitate pulmonary
superinfections (15 to 30%) which have a 5 to 8.5% mortality rate. In the acute phase, the overall mortality rate due to the
tracheotomy itself is 1.7% (40 deaths in the 2,692
tracheotomies reviewed). The main post-decannulation complication is
tracheal stenosis. The incidence of severe
stenosis (more than two-thirds of the tracheal diameter) varies from 8 to 12%.
Stenosis is difficult to diagnose unless endoscopic examination is routinely performed. The classical treatment is surgical, but
laser is helpful in this as in
granulomas. In patients with in-dwelling
cannula,
granulomas may be responsible for
pain, obstruction and
bleeding which can be avoided by using an adequate equipment. Chronic invasion of the bronchi by Gram-negative organisms is almost constant and results in episodes of
superinfection. Finally, patients with a permanent
cannula often have psychological and social problems influencing their quality of life.