Acute fatal haemorrhage during percutaneous dilatational tracheostomy

Summary Percutaneous tracheostomy is used primarily to assist weaning from mechanical ventilation in the intensive care unit. We report our experiences of 800 such procedures performed in the intensive care unit by a collaborative team (critical care and ENT specialists). Most procedures (85.6%) were performed by residents supervised by the intensive care unit staff. Complications occurred in 32 patients (4%). Intraprocedural complications occurred in 17 patients (2.1%), early postprocedural complications in six (0.75%), and late postprocedural complications in nine (1.1%). No deaths were directly related to percutaneous tracheostomy. The incidence of complications was greater in percutaneous tracheostomy performed by the residents during their initial five attempts compared to their later attempts (9.2% vs 2.6%, p < 0.05). The low incidence of complications indicates that bedside percutaneous tracheostomy can be performed safely as a routine procedure in daily care of intensive care unit patients.

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“…aberrant arterial anatomy have been reported [15,16]. Likewise, the small incision reduces bacterial colonisation and infection of the stoma.…”

Section: No Patientsmentioning

confidence: 99%

Safety and complications of percutaneous tracheostomy in a cohort of 800 mixed ICU patients

et al. 2008

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“…This is largely attributable to the favourable logistics of the intensivist performing the procedure at a convenient time, whilst avoiding the inconvenience and hazards of a trip to theatre. Death due to haemorrhage during percutaneous tracheostomy occurs [4][5][6], but none of the three published metaanalyses [9][10][11] reports any cases of mortality and as such were uninformative about the incidence of this specific complication. The three cases reported here form part of a series of 1187 patients who have undergone percutaneous tracheostomy in our ICU since 1991 and provide useful data on the incidence of mortality related to percutaneous tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

“…However, the mortality associated with percutaneous tracheostomy is not well defined. Reports of death following the procedure are few and are limited to case reports or reviews pooling the data from many different studies [4][5][6][7]. Anecdotal reports and local experience suggest that such adverse events are likely to be underreported [8].…”

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confidence: 99%

Mortality from percutaneous dilatational tracheostomy. A report of three cases*

McCormick¹,

Manara

2005

Anaesthesia

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SummaryWe report three deaths following percutaneous dilatational tracheostomy in a series of 1187 procedures undertaken in a single intensive care unit over a 13‐year period. All deaths were due to severe haemorrhage. The first patient died during the procedure from uncontrollable haemorrhage from the innominate vein. Delayed haemorrhage in the other two patients was caused by the tracheostomy tube eroding into the aorta in one patient and into the innominate vein in the other. In both these patients, the tracheal stoma was found at postmortem to be sited unexpectedly low. Fatal haemorrhage is a rare complication of percutaneous tracheostomy (0.25% in this series), but is probably under‐reported. While bronchoscopy is now used routinely during percutaneous tracheostomy insertion in most units, we speculate that ultrasound examination of the neck is more likely to identify major vascular structures at risk. However, whilst intuitive, there is little evidence that either bronchoscopy or ultrasound scanning reduces the incidence of complications. Magnetic resonance images of normal subjects are presented to demonstrate the anatomical relations of the trachea to major vascular structures and their variability.

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“…Pomimo tego, po odstawieniu sedacji pacjent nie odzyskiwał przytomności i oceniany był w dalszym blood coagulation disorders, prior procedures or neck radiotherapy. Furthermore, attention should be paid to possible anatomical variation in the adjacent blood vessels (brachiocephalic trunk, common carotid arteries, subclavian arteries) which may increase their susceptibility to injury during PDT [8].…”

Section: Opis Przypadkumentioning

confidence: 99%

“…They include, among others, the performance of the procedure without a bronchoscope, too low tracheotomy placement, Archiwum Medycyny Sądowej i Kryminologii Archives of Forensic Medicine and Criminology lub radioterapia w obrębie szyi. Ponadto zawsze trzeba brać pod uwagę ewentualną odmianę anatomiczną znajdujących się w otoczeniu naczyń (pień ramienno--głowowy, tętnice szyjne wspólne, tętnice podobojczykowe) mogąca predysponować do ich łatwiejszego uszkodzenia podczas wykonywania PTD [8].…”

unclassified

Brachiocephalic trunk damage resulted from percutaneous tracheotomy

Kwiatkowska¹,

Brzozowska²,

Olczak³

et al. 2016

amsik

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StreszczenieW pracy przedstawiono rzadki przypadek uszkodzenia ściany pnia ramienno-głowowego podczas wykonywania przezskórnej tracheotomii. Przypadek dotyczył mężczyzny będącego w ciężkim stanie ogólnym po nagłym zatrzymaniu krążenia. W trakcie hospitalizacji na oddziale intensywnej terapii doznał krwawienia w okolicy i z rurki intubacyjnej, a po kolejnym epizodzie masywnego krwawienia zmarł. Sekcyjnie stwierdzono, że źródłem krwawienia było uszkodzenie pnia ramienno-głowowego.Słowa kluczowe: pień ramienno-głowowy, powikłania, przezskórna tracheostomia, PTD. AbstractThe paper presents a rare case of injury to the brachiocephalic trunk wall during percutaneous tracheotomy. The complication developed in a post-cardiac arrest patient in a poor general condition. During hospitalization in the Intensive Care Unit, the patient suffered a haemorrhage directly from and around the endotracheal tube. After another episode of massive bleeding the patient died. The autopsy found that the source of the bleeding was injury to the brachiocephalic trunk.

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Acute fatal haemorrhage during percutaneous dilatational tracheostomy

Cited by 82 publications

References 22 publications

Safety and complications of percutaneous tracheostomy in a cohort of 800 mixed ICU patients

Safety and complications of percutaneous tracheostomy in a cohort of 800 mixed ICU patients

Mortality from percutaneous dilatational tracheostomy. A report of three cases*

Brachiocephalic trunk damage resulted from percutaneous tracheotomy

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