Complications of tracheostomies in neurosurgical patients

The records of the neurosurgical patients with tracheostomies who were treated at the University of Mississippi Medical Center during the past 5 years were reviewed. Of the 84 such patients, 45% had posttracheostomy complications, including pneumonitis, pneumothorax, pneumomediastinum, infected stoma, subcutaneous emphysema, tracheal stenosis, aspiration, swallowing dysfunction, and tracheoarterial fistula. Reported complications related to prolonged nasotracheal intubation, the alternative to tracheostomy, are reviewed. These complications appear to be less frequent and less serious than those of tracheostomy, in the authors' experience as well as in the reports of others. It is concluded that in neurosurgical patients, tracheostomy is not a benign procedure. Unless a specific indication for tracheostomy exists, consideration should be given to the use of prolonged nasotracheal intubation for airway maintenance.