Tracheostomy and its complications. A retrospective study of 794 tracheostomized patients

The records of 794 tracheostomized patients were studied in order to discover complication associated with tracheostomy. Bacterial colonization was found in 92% of patients from whom tracheal secretions were cultured, crusted airways in 5%, tracheobronchitis is 16%, pneumonia in 22% and tracheobronchial bleeding in 22% of patients in the form of bloody secretions. Tracheo-arterial erosion with massive bleeding was confirmed in five patients and treatment was successful in one case only. Tracheo-oesophageal fistula was diagnosed in three patients at autopsy. After extubation, symptomatic tracheal stenosis developed in nine patients, two of whom died. The overall mortality rate was 46% reflecting the seriousness of patients' diseases. Tracheostomy related mortality rate was 1.4%. The study was divided into two periods, one before the introduction of an intensive care unit (ICU) and the second thereafter when most of the patients were treated in ICU. The total number of complications during tracheostomy operation was higher during the first period than that in the second period. During tracheostomy treatment, crusted airways were confirmed more often during the first period whereas tracheobronchitis was observed more frequently during the second period. In other respects the incidence of separate complications did not differ statistically. The total number of complications increased but the incidence of separate complications did not increase, although there was a greater number of patients who were tracheostomized or received respirator treatment for a long period.