Video 1_Persistent refractory hypercapnia following tracheostomy decannulation in a patient with brainstem hemorrhage: a case report.mp4

However, some patients may remain at risk of chronic hypoventilation after decannulation because of impaired central ventilatory drive and other concomitant factors, even when anatomical airway patency has been restored.</p>Case presentation<p>An elderly male with brainstem hemorrhage underwent decannulation after excision of granulation tissue in January 2024, with no immediate complications.

During follow-up, he developed persistent carbon dioxide (CO₂) retention and was readmitted nine times for hypercapnic respiratory failure over the subsequent 19 months, with a peak arterial partial pressure of carbon dioxide of 172 mmHg. Despite repeated medical therapy and noninvasive ventilation, long-term ventilatory stability was not achieved, and a repeat tracheostomy was performed in August 2025.</p>Conclusions<p>This case suggests that decannulation in brainstem-injury patients can be followed by a prolonged compensated phase—chronic compensated hypercapnia was clinically well tolerated for 19 months in this patient—before late, event-triggered decompensation.