Acquired Tracheomalacia Following Tracheostomy: A Case Report and Literature Review.

Tracheostomy is a widely performed procedure to manage prolonged respiratory failure, but it is not without risk. One rare but serious late complication is acquired tracheomalacia, which can lead to airway collapse and respiratory distress. We report the case of an 82-year-old male patient diagnosed with acute inflammatory demyelinating polyneuropathy who underwent a tracheostomy after failed extubation. The procedure was uncomplicated, and the patient was successfully decannulated after a few months. However, he developed biphasic stridor two months following decannulation. Further evaluation revealed a focal collapse of the right lateral tracheal wall, consistent with tracheomalacia. Given the patient's stable condition and localized collapse, a conservative management approach using continuous positive airway pressure (CPAP) was adopted, resulting in notable symptomatic improvement. This case highlights the importance of considering tracheomalacia in patients with prolonged intubation or challenging decannulation. Timely endoscopic evaluation is essential for diagnosis, and conservative measures like CPAP may be effective in selected cases, potentially avoiding the need for surgical intervention. The report emphasizes the need for clinical vigilance in the post-tracheostomy period and supports the role of individualized management strategies for late-onset airway complications.