[Significance of systematic endoscopic decannulation. Retrospective study on intensive care patients]

We performed a retrospective study in 42 consecutive tracheotomy patients hospitalized in an intensive care unit. Endoscopy was used systematically to assess all patients at decanulation and whenever symptoms suggested possible tracheal granuloma. Nine tracheal granulomas were evidenced. There was no significant association between presence of a granuloma and patient status: age, underlying chronic respiratory failure, or tracheobronchial infection. In initial stages, tracheal granulomas usually have little clinical expression. Difficulty in weaning from ventilatory assistance is generally the main sign. The long-term course after decanulation can progress to major respiratory disorders due to tracheal stenosis. We emphasize the importance of systematic endoscopy at decanulation to recognize existing granulomas early when local treatment remains simple (usually laser vaporization).