Challenges in closure of long-term tracheostomy-prevention and management protocol

Suprastomal granulation tissue can result in bleeding and difficulty in replacing tracheostomy tube. It delays decannulation and may interfere with the ventilation. Granulation tissue formation is generally a consequence of rather than a complication of tracheostomy. We present a pediatric and adult case who suffered from long term complications of tracheostomy. Purpose of these case studies is to highlight how we can prevent such complications and the management protocol. Suprastomal granulation in both cases were excised with help of RF ablation and stenosed segment of airway was subsequently dilated by airway balloon. Both patients were followed over a period of 6 months, with regular flexible endoscopy. After ensuring the healing and patency of the airway tract, they were decannulated as per protocol. Hereby we want to emphasize that tracheostomy tube care and decision to decannulate at right time must involve multispecialty experts including critical care team and otorhinolaryngologists.