Prolonged respiratory assistance by positive pressure ventilation via cuffed tracheostomy or endotracheal tube can be complicated by mucosal erosions, tracheal stenosis, tracheomalacia, excavation of the tracheal wall with loss of tissue and tracheoesophageal fistula. Stenosis can occur at the subglottic region, at the stoma, or at the cuff site, whereas the other complications occur most often at the cuff site. This paper is concerned with complications occurring below the first tracheal ring.