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Quoted rates of complications following tracheostomy insertion vary greatly, with little information available on complications occurring in patients with tracheostomies in situ or following their removal. A series of 200 consecutive tracheostomies in critical care patients were reviewed for complications occurring at insertion, in patients while cannulated, and following decannulation. A questionnaire was completed at insertion and patients then received weekly follow-up where any complications were recorded. High rates of follow-up were achieved. Insertion complications included: major bleeding (5%), tracheal wall injury (0.5%), pneumothorax (0.5%). Complications in cannulated patients included: prolonged bleeding (5%), pneumothorax (2%), accidental decannulation (4%) and tube blockage (6%). Of the blockages and displacements, 40% resulted in severe hypoxia and in two patients, cardiac arrest. Post-decannulation one patient (0.8%) required immediate recannulation. Initial problems relating to swallowing difficulties post-decannulation were seen to resolve with time. This work demonstrates that tracheostomy can be safely performed in critical care patients although serious adverse events may occur due to tube blockage or displacement.

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