Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy

Objective To determine the incidence of tracheal stenosis, voice and breathing change s, and stomal complications after percutaneous dilatational tracheostomy (P DT). Methods From December 1992 through June 1999, 420 critically ill patients underwent 422 PDTs. There were 340 (81%) long-term survivors, 100 (29%) of whom were interviewed and offered further evaluation by fiberoptic laryngotracheosco py (FOL) and tracheal computed tomography (CT). Tracheal stenosis was defin ed as more than 10% tracheal narrowing on transaxial sections or coronal an d sagittal reconstruction views. Forty-eight patients agreed to CT evaluati on; 38 patients also underwent FOL. CT and FOL evaluations occurred at 30 /- 25 (mean +/- standard deviation) months after PDT. Results Twenty-seven (27%) patients reported voice changes and 2 (2%) reported pers istent severe hoarseness. Vocal cord abnormalities occurred in 4/38 (11%) p atients, laryngeal granuloma in 1 (3%) patient, focal tracheal mucosal eryt hema in 2 (5%) patients, and severe tracheomalacia/stenosis in 1 (2.6%) pat ient. CT identified mild (11-25%) stenosis in 10 (21%) asymptomatic patient s, moderate (26-50%) stenosis in 4 (8.3%) patients, 2 who were symptomatic, and severe (>50%) stenosis in 1 (2%) symptomatic patient. Ten patients (10 %) reported persistent respiratory problems after tracheal decannulation, b ut only lour agreed to be studied. Two patients had moderate stenosis, and one had severe stenosis. One patient's CT scan was normal. No long-term sto mal complications were identified or reported. Conclusions Subjective voice changes and tracheal abnormalities are common after endotr acheal intubation followed by PDT. Long term follow-up of critically ill pa tients identified a 31% rate of more than 10% tracheal stenosis after PDT. Symptomatic stenosis manifested by subjective respiratory symptoms after de cannulation was found in 3 of 48 (6%) patients.