Review of tracheostomy usage: Complications and decannulation procedures. Part II

Although creation of a tracheostomy does facilitate suctioning of the airway and often simplifies usage of mechanical ventilation (as discussed in Part I), numerous complications can occur. Some occur immediately after tracheostomy placement (e.g., bleeding, laryngeal nerve damage, and pneumomediastinum) and others during long term follow-up (e.g., tracheoesophageal fistula, tracheal stenosis, tracheomalacia, swallowing dysfunction, and aspiration). Therefore, in each patient in whom this procedure is performed, the potential long-term risks and possible benefits must be carefully weighed. In some patients, tracheostomy usage will be needed on a life-long basis. In others, once the primary process that led to the placement of the tracheostomy is reversed or when alternative noninvasive measures are thought to be adequate, decannulation should be contemplated, However, the procedure of decannulation and the timing should be individualized. Some guidelines are provided in this article and are based, when possible, on objective data. For many of the issues regarding tracheostomy usage (e.g., timing of decannulation, best decannulation approach, and best approach to dealing with swallowing dysfunction induced by tracheostomy), additional studies are needed to objectively define the best therapeutic approaches.