title: Diagnosis and conservative management of late tracheotomy complications in chronic ventilator-dependent patients.
abstract: BACKGROUND
  Complications associated with long-term tracheotomy are obstruction of the distal end of the tube by granulation tissue and tracheomalacia. These complications have traditionally been surgically treated.
  
  
  METHODS
  Prospective study in a chronic ventilator-dependent division, including 234 consecutive patients with tracheotomy and mechanical ventilation. Endoscopic evaluation was performed in patients in whom there was respiratory distress with difficulty in passing a suction catheter through the tube, and/or increased inspiratory resistance and increased peak inspiratory pressure.
  
  
  RESULTS
  Nineteen patients were diagnosed with granulation or tracheomalacia. Two patients were treated by surgical removal of the obstructing tissue. Nonsurgical patients were conservatively managed with symptoms' resolution by bypassing the pathology with a longer tube than the previous one or by an adjustable flange tube under endoscopic visualization, with a median symptom-free period of 433 days (range, 55-1230 days).
  
  
  CONCLUSIONS
  In nonsurgical candidates, insertion of a longer tube is a conservative and feasible long-term treatment.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ophir
authors.initials: O
authors.lastname: Ilan
authors.forename: Menachem
authors.initials: M
authors.lastname: Gross
authors.forename: Yacov
authors.initials: Y
authors.lastname: Zaltzman
authors.forename: Ady
authors.initials: A
authors.lastname: Sasson
authors.forename: Esther-Lee
authors.initials: EL
authors.lastname: Marcus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D001999:Bronchoscopy / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006097:Granulation Tissue / Q000473:pathology*; D006801:Humans; D007557:Israel; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000473:pathology; D011446:Prospective Studies; D012008:Recurrence; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D055090:Tracheomalacia / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D014140:Tracheotomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: chronic ventilated patient; granulation tissue; late tracheotomy complications; tracheomalacia; tracheostomy