Early experience with percutaneous tracheotomy

Abstract

Early reports of a percutaneous dilatational technique for tracheotomy tube placement have been encouraging. This method uses a needle for placement into the trachea, a J-tipped guidewire, and progressively larger dilators to widen the stoma for insertion of a tracheotomy tube. A prospective study was undertaken to assess the efficacy of this percutaneous tracheotomy technique. Serious complications were encountered, including difficulty with dilatation, excessive bleeding, false passage of the tracheotomy tube, and death. Because of this unacceptable morbidity, the study was terminated after enrollment of only seven patients. Percutaneous tracheotomy is a dangerous procedure with potential for catastrophic complications. These complications were encountered by third- and fourth-year surgical residents performing the procedure under close supervision. If the puncture technique is further popularized and attempted by untrained physicians, these authors predict many disasters.

Percutaneous tracheostomy by forceps dilation: report of 162 cases

“…If a pneumothorax does occur, we think that it is secondary to the insuf¯ation of high-pressure gases either through the stoma into the extrapleural space or as a result of a false passage formation and not secondary to damage of the posterior wall of the trachea [6,27]. Some authors argue that early tracheostomy tube change is not a problem in practice [28].…”

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

“…There is an increase in perioperative complications and mortality in studies in which PCT was performed by inexperienced physicians [24]. However, Liao et al [25] considered 10 attempts were sufficient to learn how perform this procedure.…”

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

“…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.…”

“…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].…”