Percutaneous dilatational tracheostomy — early results and long-term outcome of 326 critically ill patients

Abstract

When performed by experienced physicians, percutaneous dilatational tracheostomy under fiberoptic guidance is a safe method. The risks of early complications and of clinically relevant tracheal stenoses are low. Subclinical tracheal stenoses are found in about 40% of patients following PDT.

Incidence of Tracheal Stenosis and Other Late Complications After Percutaneous Tracheostomy

“…Walz et al 16 identified 141 patients who were successfully decannulated of 326 patients who had PDT at seven intensive care units in Germany. One hundred six patients were evaluated with coronal and sagittal plane tracheal radiographs.…”

“…In patients who survive their critical illness or injury, access to long-term follow-up is often difficult because of the complexity of follow-up at tertiary referral centers, persistent medical problems, or a reluctance to return for evaluation by survivors who are asymptomatic. Recent studies to determine the incidence of late complications from PDT have used a variety of methods, including questionnaires, [12][13][14][15] tracheal roentgenograms, 16 tracheal tomograms, 17 magnetic resonance imag-ing, 18 laryngotracheoscopy, 12,13 and various pulmonary function tests. 12,15 The purpose of our study was to determine the incidence of tracheal stenosis and other late complications of PDT in a population of critically ill patients who survived their initial hospital stay and were successfully decannulated.…”

“…[12][13][14][15][16][17][18]26 Several different tests have been used to identify tracheal stenosis after PDT. These include plain tracheal roentgenograms, 16 tracheal tomograms, 17 pulmonary function tests, 12,15 laryngotracheoscopy, 12,13 and magnetic resonance imaging. 18 We chose a high-resolution tracheal CT technique previously used to identify bronchial stenosis and other central airway problems after lung transplantation.…”

Fiberoptic bronchoscopy-guided percutaneous tracheostomy in an infant

“…However, two larger trials compared percutaneous tracheostomies with and without broncoscopic guidance and found complication rates of 9.5% and 19%, respectively. [6,7] Because the complication rates associated with fiberoptic bronchoscopic-guided tracheostomies are lower, it is reasonable to use this technique in pediatric patients and even in low-body-weight infants. To the best of our knowledge, our case involved the youngest case with the lowest body weight who has undergone this procedure.…”

Percutaneous Tracheostomy in the Intensive Care

“…The latest tracheostomy cannula with a fallen cuff is placed over the combination of guidewire and guiding catheter. The tracheostomy balloon is inflated (28).…”