Bedside Percutaneous Tracheostomy With Bronchoscopic Guidance in Critically Ill Patients

Fernandez, Luis; Norwood, Scott; Roettger, Richard H.; Gass, David; Wilkins, Harry

doi:10.1001/archsurg.1996.01430140019005

Cited by 113 publications

(61 citation statements)

References 11 publications

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“…The current preoperative intubation and postoperative observation times match results in international studies (Table I). [12][13][14]19,22,25 Also, the great variation in cannulation time is reflected in literature. 15,[20][21][22]25 In contrast to other studies, patients were not selected, and 88 (26.7%) high-risk patients, of whom 13 (4%) had acute dyspnea, were included in our study.…”

Section: Discussionmentioning

confidence: 99%

“…[12][13][14]19,22,25 Also, the great variation in cannulation time is reflected in literature. 15,[20][21][22]25 In contrast to other studies, patients were not selected, and 88 (26.7%) high-risk patients, of whom 13 (4%) had acute dyspnea, were included in our study. [9][10][11][12][13][14][15][16][17] Complications not related to tracheotomy are acknowledged to occur in a considerable number of patients in intensive care units after tracheotomy due to severe comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…In other studies, the criteria for wound infections often remained unclear, or different definitions were used, possibly lowering the number of wound infections reported. 13,18,20,22,25 Finally, many wound infections arose just weeks after tracheotomy, illustrating the importance of accurately defining the period of observation.…”

Section: Discussionmentioning

confidence: 99%

“…Of all tracheotomies, 72.9% were performed in the first 3 weeks after endotracheal intubation (Table II). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The period of cannulation varied strongly (range, 1-730 days) (n ¼ 291). In 146 patients (49.5%), the cannula remained in situ for a time period between 1 week and 1 month (20.3% 1-7 days and 25.3% 30-90 days).…”

Section: Clinical Time Intervalsmentioning

confidence: 99%

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Complications of midline‐open tracheotomy in adults

et al. 2009

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Objectives/Hypothesis: Percutaneous tracheotomy is progressively replacing open tracheotomy as a consequence of promising results of comparative studies. However, this comparison has four considerable weaknesses: 1) selected indications (high-risk patients excluded for percutaneous tracheotomy); 2) varying spectra of complications included in different studies; 3) varying operative settings (experienced surgeons exclusively, surgeons in training, or both); and 4) missing differentiation between different surgical techniques. Our study was performed to collect complete datasets of unselected patients who all underwent a tracheotomy in a uniform technique in an academic teaching hospital setting.Methods: Retrospective evaluation of all complications following 303 consecutive surgical tracheotomies (midline-open technique) performed by different surgeons and surgeons in training at one academic institution. Complications were classified and compared to results in the literature.Results: Rates of 21.5% minor and 1.0% major complications and 0% tracheotomy-related mortality were registered. The most prevalent complications were local wound infections (10.9%), intra-and postoperative hemorrhages (4.2%), and cartilage damage (1.7%). No significant difference was found for highrisk patients and emergency tracheotomies.Conclusions: Our study demonstrates that open tracheotomy is a safe procedure, particularly if performed in high-risk patients even by inexperienced surgeons. Therefore, we emphasize the advantages of the midline-open tracheotomy in an academic teaching hospital setting.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Time Intervalsmentioning

confidence: 99%

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Complications of midline‐open tracheotomy in adults

et al. 2009

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“…Some authors documented fiberoptic bronchoscopy to affect gas exchange retaining carbon dioxide, to decrease partial oxygen tension, to raise intracranial pressure due to the increase in partial carbon dioxide tension, and to increase the length of time of the procedure 10,11 . On the other hand, routine use of fiberoptic bronchoscope has been shown to reduce the incidence of complications and several studies advocate its routine use 12,13 . For this reason, nowadays, most institutions routinely perform the procedure under bronchoscopic guidance.…”

Section: T Klancir Et Almentioning

confidence: 99%

Bilateral Pneumothorax as a Complication of Percutaneous Tracheostomy: Case Report

Klancir¹,

Adam

Mršić³

et al. 2016

ACC

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SUMMARY -Percutaneous dilatational tracheostomy is a common surgical procedure that is becoming the method of choice in critically ill patients whenever prolonged airway secure and/ or ventilation support is needed. Although adverse events are relatively uncommon, serious life threatening complications can arise from this bedside procedure. We report a case of a 70-year-old female who developed extensive subcutaneous emphysema and bilateral pneumothorax immediately after a percutaneous dilatational tracheostomy procedure. Different mechanisms, such as damage to posterior or anterior tracheal wall, false passage or paratracheal placement or dislocation of the cannula are considered to be responsible for the development of pneumothorax and subcutaneous emphysema. Although bronchoscopic control after the tracheostomy procedure did not reveal any tracheal in jury, we believe that subcutaneous emphysema and bilateral pneumothorax are most likely caused by procedure induced injuries of the trachea in addition to the applied high airway pressure induced by excessive or inappropriate ventilation. In our case report, we would like to emphasize that continuous bronchoscopic guidance during percutaneous tracheostomy is invaluable in decreasing the incidence of its overall complications, especially during enhancing the team experience.

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Percutaneous Tracheotomy: Is It Time to Reconsider Our Approach?

Fazekas-May¹

2001

Arch Otolaryngol Head Neck Surg

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Bedside Percutaneous Tracheostomy With Bronchoscopic Guidance in Critically Ill Patients

Abstract: Bedside percutaneous tracheostomy with bronchoscopic guidance is safe and cost-effective. Complications compare favorably with that of open tracheostomy. Major complications should be avoided with continuous bronchoscopic observation during the procedure.

Cited by 113 publications

References 11 publications

Complications of midline‐open tracheotomy in adults

Complications of midline‐open tracheotomy in adults

Bilateral Pneumothorax as a Complication of Percutaneous Tracheostomy: Case Report

Percutaneous Tracheotomy: Is It Time to Reconsider Our Approach?

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