---
title: "Complications of Tracheostomy"
description: "ENT notes on Complications of Tracheostomy."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/tracheostomy-complications"
categories: ["Surgery", "Larynx and Trachea"]
video: "https://www.youtube.com/watch?v=ojdymgRrU3c"
image: "https://media.theentresident.com/og-images/tracheostomy-complications.png"
---

# Complications of Tracheostomy

ENT notes on Complications of Tracheostomy. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=ojdymgRrU3c

## ⚠️ Tracheostomy Complications  

Complications of tracheostomy are classified into:

1️⃣ **Immediate complications** → During surgery  
2️⃣ **Intermediate complications** → Hours to days after surgery  
3️⃣ **Late complications** → Weeks to months later  

---

### 🚨 Immediate Complications of Tracheostomy (Intraoperative)

#### 🩸 1- Hemorrhage (Most Common & Most Fatal)

**Prevention**

- Strict **midline dissection**
- Good anatomical knowledge
- Proper **ligation / retraction of thyroid isthmus**

**Management**
- Explore wound
- Identify bleeding vessel
- Ligate vessel

> What are the vessels at risk of injury in Tracheostomy? 

#### 💨 2- Air Embolism (Rare but Life-Threatening)

> What is the mechanism of formation of Air embolism during Tracheostomy?

**Management**

- **Head-low position**
- Supportive management

#### 🧠 3- Damage to Local Structures

| Structures at Risk | Complication |
| --- | --- |
| Carotid artery | Catastrophic bleeding |
| Esophagus | Tracheoesophageal fistula |
| Recurrent laryngeal nerve | Hoarseness / airway distress |
| Apical pleura | Pneumothorax |
| Cricoid / Tracheal Wall Injury | Subglottic stenosis |

> What is the management of injury to oesophagus during Tracheostomy?

> What is the management of Pneumothorax during Tracheostomy?

> What is the management of injury to Cricoid / Tracheal Wall during Tracheostomy?

#### 😴 4- Apnea (Central Respiratory Failure)

**Mechanism**

Chronic obstruction → respiratory drive due to:
- Hypercapnia  
- Hypoxia  

After tracheostomy:
- CO₂ ↓
- O₂ ↑
→ Respiratory drive lost

> What is the management of Apnea during Tracheostomy?

> What is Carbogen?

#### 🩸 5- Aspiration of Blood / Secretions

- May cause airway obstruction

#### ❗ 6- False Passage Formation

**Features suggestive of False Passage Formation in Tracheostomy**

- Falling SpO₂
- Tachypnea
- Tachycardia
- Cyanosis (late)
- Bradycardia (terminal)

#### ❤️ 7- Cardiac Failure

> What are the causes of cardiac failure during Tracheostomy?

---

### ⏳ Intermediate Complications of Tracheostomy (Hours → Days)

#### 🔄 1- Tracheostomy Tube Dislodgement / Accidental Decannulation

> What are the causes of Accidental decannulation in a Tracheostomy case?

**When to suspect Tracheostomy Tube Dislodgement?**

- Sudden airway obstruction
- Unable to pass suction catheter
- Patient unable to speak

> How to prevent Accidental decannulation in a Tracheostomy case?

#### 🚫 2- Tracheostomy Tube Block

**Causes** 

- Crusts
- Granulation tissue
- Poor positioning

**Prevention**

- Regular suction
- Periodic tube change

#### 💥 3- Subcutaneous Emphysema

> What is the mechanism of formation of Subcutaneous Emphysema in Tracheostomy?

**Signs**
- Crepitus on palpation
- Swelling up to eyelids / chest

> How would you treat subcutaneous emphysema in a post Tracheostomy patient? 

#### 🔗 4- Tracheoesophageal Fistula

**Causes**

- Posterior tracheal wall injury
- Constant tube pressure

> What signs and symptoms would be suspicious of Tracheoesophageal fistula in a Tracheostomy patient?

> How would you manage a case of Tracheoesophageal Fistula?

#### 🩸 5- Tracheoarterial Fistula (⚠️ MCQ Important)

> What is the most common artery involved in Tracheoarterial Fistula?

**Presentation**

- Sudden massive hemorrhage

**Management**

- Immediate cuff inflation
- Compression
- Surgical exploration

#### 🔥 6- Tracheitis / Tracheobronchitis

- Due to infection / crusting

**Management**

- Antibiotics
- Regular dressing

#### 🫁 7- Atelectasis

- Partial → blood / secretion aspiration  
- Complete → tube in one bronchus

**Management**

- Tube repositioning
- Shorter tube if required

#### 🩸 8- Reactionary & Secondary Hemorrhage

| Type | Timing | Cause |
| --- | --- | --- |
| Reactionary | Within 48 hrs | Loss of adrenaline effect |
| Secondary | 5–8 days | Infection / granulation / pressure necrosis |

**Treatment**

- Antibiotics
- Hemostasis

#### 🧱 9- Crust Formation

**Cause**

- Loss of nasal humidification

**Prevention**

- Wet gauze
- HME device
- Nebulization

---

### 🕰️ Late Complications of Tracheostomy (Weeks → Months)

#### 🔽 1- Laryngeal Stenosis

**Causes**

- High tracheostomy
- Improper tube curvature
- Overinflated cuff
- Mucosal injury
- Chemical irritation

> What is the ideal cuff pressure to be maintained in a cuffed tracheostomy tube?

**Treatment**

- Steroids
- Antibiotics
- Surgery

#### 🔻 2- Tracheal Stenosis

**Causes**

- Infection
- Scar contracture
- Repeated tracheal incision

**Treatment**

- Tracheal dilatation
- Excision & primary closure

#### 🚫 3- Difficult Decannulation

- More common in children

> What is Difficult Decannulation?

> What are the causes of Difficult Decannulation?

#### 🔗 4- Persistent Tracheocutaneous Fistula

Seen In long term tracheostomy

**Features**

- Skin irritation
- Poor phonation

**Treatment**

- Excision of tract
- Layered closure

#### 🧬 5- Scar Complications

- Depressed scar
- Keloid formation

---

### ⭐ Exam Pearls

- Most fatal complication → **Hemorrhage**
- Most common artery in tracheo-arterial fistula → **Innominate artery**
- Apnea treated with → **Carbogen**
- Ideal cuff pressure → **15–25 mm H₂O**
- Most common intermediate complication → **Tube displacement**

---

## About This Note

This free ENT note on Complications of Tracheostomy was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

Canonical page of this note: https://www.theentresident.com/ent-notes-lectures/tracheostomy-complications

When citing or referencing this content, please credit The ENT Resident and link to the canonical page above.

## Related Notes by Category

- Surgery: https://www.theentresident.com/ent-notes-lectures/category/surgery.md
- Larynx and Trachea: https://www.theentresident.com/ent-notes-lectures/category/larynx-and-trachea.md

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