title: Tracheal and tracheostomal hypergranulation and related stenosis in long-term cannulated patients: does the tracheostomy procedure make a difference?
abstract: OBJECTIVE
  Long-term cannulated patients are at risk of developing tracheal and tracheostomal hypergranulation. This study evaluated the incidence of hypergranulation and related tracheal stenosis in long-term cannulated patients. The relation between hypergranulation, specific tracheostomy techniques, and the duration of cannulation was investigated.
  
  
  METHODS
  A prospective observational study was conducted to analyze tracheostomal and tracheal hypergranulation in long-term cannulated patients. We compared complication rates in 344 postacute patients. Tracheas and tracheostomas were inspected visually and endoscopically at admission and at regular tube changes every 2 weeks until decannulation or discharge.
  
  
  RESULTS
  Hypergranulation appeared 3 times as often in the tracheostoma (n=338) as in the trachea (n = 109). There was no influence of the tracheostomy procedure on the frequency (p = 0.931), location (tracheostoma, p = 0.947; trachea, p = 0.918), or severity (stenoses grade I, p = 0.910; grade II, p = 0.649; grade III, p = 0.304) of the hypergranulation. The main factors to account for hypergranulation were the duration of cannulation (p < 0.001) and age (p = 0.033).
  
  
  CONCLUSIONS
  There was no influence of tracheostomy techniques on hypergranulation. Its development depends on the duration of cannulation. It is recommended to keep the duration of cannulation as short as possible with respect to the underlying neurologic impairment.
authors.affiliation: Department of Speech, Language, and Swallowing Disorders, Neurologic Hospital Bad Aibling, Bad Aibling, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ledl
authors.forename: Marion
authors.initials: M
authors.lastname: Mertl-Roetzer
mesh_terms: D004106:Dilatation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006097:Granulation Tissue / Q000473:pathology*; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013524:Surgical Flaps / Q000009:adverse effects; D054047:Surgical Stomas / Q000009:adverse effects / Q000473:pathology; D013997:Time Factors; D014135:Tracheal Stenosis / Q000209:etiology* / Q000473:pathology; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods*