Tracheostomy-related bleeding and stomal complications: a literature review
Year: 2026
Type: article
Abstract: Background and Objective: Tracheostomy is one of the most commonly performed procedures in critically ill patients, with bleeding representing the most frequent early complication. Stomal bleeding and granulation tissue formation create ongoing management challenges that can complicate patient care. Other complications include stomal infection, subcutaneous emphysema, focal airway stenosis, and tracheoinnominate fistula (TIF), which differ in clinical severity and management. Current management relies on reactive measures, yet no standardized approach exists for preventing or managing persistent minor bleeding around the tracheostomy site. This study aims to review the incidence, pathophysiology, risk factors, and current management of tracheostomy-related bleeding and stomal complications, with emphasis on identifying gaps in prevention and treatment strategies. Methods: We conducted targeted literature searches using PubMed/MEDLINE for English-language human studies published between January 1, 2000 and September 17, 2026 involving adults aged 19 years or older. Search terms included "tracheostomy", "tracheotomy", "bleeding", "hemorrhage", "granulation tissue", "tracheoinnominate fistula", "stomal infection", "cellulitis", "abscess", "decannulation", "dislodgement", "subcutaneous emphysema", "tracheal stenosis", "ECMO", "transplantation", "immunosuppression", "tranexamic acid", "epinephrine", and "cautery". We extracted data on incidence rates, management approaches, and clinical outcomes. Key Content and Findings: Bleeding is the most common early complication of tracheostomy procedures, occurring in 0.6-5.0% of cases overall, with rates reaching 5.7% for major or minor bleeding and up to 40% in high-risk populations such as patients on extracorporeal membrane oxygenation (ECMO). Stomal infections, airway complications, and early accidental decannulation is also important to consider in tracheostomy patients. Subcutaneous emphysema was primarily associated with early mechanical complications, whereas focal airway stenosis represented a later consequence of granulation. Management of minor superficial bleeding generally consisted of direct pressure, packing, correction of reversible coagulopathy, and selected topical or cautery-based interventions. TIF remained distinct from these complications because even limited or transient bleeding may precede catastrophic hemorrhage, necessitating urgent recognition and escalation when a vascular source is suspected. Conclusions: Tracheostomy-related bleeding and stomal oozing represent common complications with limited preventive options. Current management is reactive, relying on manual pressure application, packing materials, and procedural interventions. Particular attention should be made to distinguish minor superficial bleeding from sentinel or life-threatening hemorrhage. Novel approaches could potentially reduce bleeding complications, minimize granulation tissue formation, and improve patient comfort during the critical early post-tracheostomy period.
Source: Journal of Thoracic Disease
Authors: Shreya Gunji, Jacob Aron, John Lucas, David Kashmer
Institution: Augusta University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7221769221