Objective: To understand the frequency, causes, and treatment of post-tracheostomy hemorrhage.

Study Design: A prospective study of tracheostomy cases. Place and duration: ENT, Head & Neck Surgery department of Lady Reading Hospital MTI, Peshawar and Azra Nahid Medical College, Lahore for duration of one year from July 2019 to June 2020.

Methodology: All hospitalized patients who underwent tracheostomy and had bleeding during this period were included. The parameters specified were demographics, time since surgery, degree of bleeding, causes of bleeding, and treatment. A total of 208 patients who have done with tracheostomy were selected.

Results: Tracheostomy was performed in a total of 208 patients, 142 men and 66 women. Their ages ranged from 20 to 70 years old. 22 patients (10.6%) had postoperative bleeding, most of them have oozingfrom or around the stoma, but 5 patients were taken to the operating room for hemostasis. Three of them had Tracheo- innominate artery fistula and two died before undergoing surgery. One of the three trachea-innominatefistulae were successfully treated by a cardiac surgeon. The remaining cases required diathermy, transfixing thyroid isthmus or vein descent or relegation of veins.

Conclusions: Hemorrhage after tracheostomy is not uncommon in intensive practice, bleeding occurred in 10.5% of our cases. Hemorrhage occurs because of inadequate hemostasis, aspiration trauma, infection, coagulopathy and granulation. Rarely, there may be massive and life-threatening bleeding from tracheo-innominate fistula that requires aggressive and urgent exploration. In such a situation, an experienced cardiac surgeon and anesthesiologist is very important and can lead to a better result.

Key words: Tracheostomy, post-tracheostomy hemorrhage, Tracheo-innominate artery fistula (TIF)