KQ 9.1 Complications associated with tracheotomy are irreversible in rare cases. Thorough preparation should be made to avoid prolonged desaturation of the patient, particularly in non-intubated situations. In some cases, false lumen formation should be suspected and must be promptly addressed. KQ 9.2 Delayed or late complications may arise from prolonged tracheotomy tube insertion. This chapter will provide insights into the management of long-term complications associated with tracheotomy. KQ 9.3 Prolonged complications following tracheotomy encompass tracheoesophageal fistula and tracheomalacia, both stemming from ischemia and irritation induced by the cannula balloon and the cannula itself. However, in instances where these complications manifest, it becomes crucial to eliminate risk factors immediately and address the complications with surgical repair. KQ 9.4 Bleeding from innominate artery erosion is a common and fatal complication of tracheotomy. The initial step is inflation of the cuff and direct digital compression of the vessel, and then the patient should be transported to the operating room, and the innominate artery should be repaired. KQ 9.5 Careful patient selection is important in preventing complications in percutaneous dilatational tracheostomy. Patients with well-identified anatomical landmarks should be selected, and caution should be exercised in those with previous neck surgery or anatomic distortion.