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

Abstract

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.

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

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

Brachiocephalic trunk damage resulted from percutaneous tracheotomy

“…Krwotoki będące powikłaniem PTD można podzielić na występujące w trakcie zabiegu, będące skutkiem bezpośredniego uszkodzenia naczynia w polu operacyjnym oraz późniejsze spowodowane najczęściej powstaniem przetoki tchawiczo-tętni-czej [6,7]. Pojawienie się nieprawidłowego połą-czenia najczęściej związane jest z wytworzeniem się martwicy ściany tchawicy, powstałej, np.…”

“…Haemorrhages representing complications of PDT can be divided into two types: intraoperative haemorrhages resulting from direct blood vessel injury in the operative field, and delayed haemorrhages caused primarily by the development of a tracheoarterial fistula [6,7]. The formation of an abnormal connection is usually associated with necrosis in the tracheal wall which can arise, for example, from excessively high cuff pressure in the intubation or tracheotomy tube [6].…”

The ultrasound neck imaging for tracheostomy study: A study prompting ultrasound screening prior to percutaneous tracheostomy procedures to improve patient outcomes

“…3 Fatal haemorrhage from PT is a known but rare complication, although it is thought to be under-reported. 4 One study highlighted injury to blood vessels, which could have possibly been identified using ultrasound. 5 It was considered significant in 24 (5%) of 497 PT procedures performed without ultrasound evaluation prior to tracheal dilatation.…”