ABSTRACT NUMBER: ESOC2026A1907 TRACHEOSTOMY-RELATED COMPLICATIONS IN STROKE PATIENTS: A CASE-SERIES REPORT FROM AN ESO-CERTIFIED NEUROLOGICAL INTENSIVE CARE UNIT

Abstract Background and aims Stroke patients who require tracheostomy often have a poor prognosis, with no significant impact of the timing (either early or late after mechanical ventilation) on mortality, intensive care unit hospitalization, or neurological outcome. However, complications of tracheostomy (for example, pneumonia, tube obstruction or displacement, haemorrhage) often delay or impair rehabilitation. Moreover, the use of secondary prevention therapy (antiplatelets or anticoagulants) or coagulation disorders further influences the development of complications. Methods We analysed seven stroke patients from the Neurological Intensive Care Unit, admitted from November to December 2025 (six malignant ischemic strokes and one aneurysmal subarachnoid haemorrhage) who required tracheostomy (one was performed early, respectively two days after admission, and six were performed late, seven days after mechanical ventilation). Results One patient developed severe tracheal obstruction due to granuloma formation, requiring emergency bronchoscopic evaluation, one presented stoma haemorrhage (requiring pharmacological and local haemostasis performed by an otolaryngology specialist), two had respiratory failure by tube obstruction (also requiring otolaryngology evaluation), one patient developed pneumonia (with antibiotic therapy consequently being initiated), while two patients had no tracheostomy-related complications whatsoever. Conclusions Although necessary in severe cases, tracheostomy can lead to specific complications that might additionally delay rehabilitation after stroke and sometimes can become life-threatening situations. Four patients who developed complications required emergency measures (bronchoscopic and otolaryngology evaluation), which proved life-saving, while in one patient, the development of pneumonia prolonged the Neurological Intensive Care Unit stay and delayed the beginning of physical therapy. This case-series report further highlights the fundamental need for multidisciplinary teams in stroke care. Conflict of interest Alexandra Struta: nothing to disclose.