A Retrospective Review of 589 Percutaneous Tracheostomies in a Canadian Community Teaching Hospital

Abstract

Objective: The primary objective of this study was to review the complication rate of percutaneous tracheostomies performed by a single surgeon in a community teaching hospital. Methods: This retrospective study reviewed the patients who underwent percutaneous tracheostomy with bronchoscopic guidance in a community hospital setting between 2009 and 2017. Patients older than the age of 18 requiring percutaneous tracheostomy were chosen for this retrospective study. Patients who were medically unstable, had no palpable neck landmarks, and inadequate neck extension were excluded. Indications for percutaneous tracheostomy included patients who had failed to wean from mechanical ventilation, required pulmonary toileting, or in whom airway protection was required. Results: Of the 600 patients who received percutaneous tracheostomy, 589 patients were included in the study. Intraoperative complication (2.6%) and postoperative complication rates (11.4%) compared similarly to literature reported rates. The most common intraoperative complications were bleeding, technical difficulties, and accidental extubation. Bleeding, tube obstruction, and infection were the most common postoperative complications. Overall burden of comorbidity, defined by Charlson Comorbidity Index, and coagulopathy were also found to be associated with higher complication rates. The decannulation rate at discharge was 46.3%. Conclusion: Percutaneous tracheostomy is a safe alternative to open tracheostomies in the community setting for appropriately selected patients.

Evaluation of the Effect of Morphological Structure on Dilatational Tracheostomy Interference Location and Complications with Ultrasonography and Fiberoptic Bronchoscopy

“…Cartilage fracture is an essential complication because of its potential to cause tracheal stenosis in the long term [47][48][49], but its actual frequency is not clearly identified because most PDT procedures are not visualized with FOB during the procedure. In our study, all PDT procedures from tracheal puncture to cannula placement were monitored by FOB, and, unlike many previously published studies, the most common peroperative complication was cartilage fracture, not minor bleeding [29,[50][51][52]. For this reason, detailed research was conducted on morphologic features and procedural practices that may be related to cartilage fracture.…”

A Cohort Study of the Surgical Risks and Prediction of Complications in Surgical Tracheostomies

“…The advantages of percutaneous tracheostomy are well known [7][8][9]. Most prominent are: it is a fast, bedside, easy to perform and safe procedure, performed by internists as well as by surgeons [10].…”