Perioperative Complications of Percutaneous Dilational Tracheostomy

Abstract

Percutaneous dilational tracheostomy (PDT) has replaced conventional tracheostomy for long-term intubated patients in many intensive care units (ICUs). In a prospective study carried out between September 1994 and August 1996, 76 patients underwent PDT. In 41 patients, PDT was performed "blind." In 35 patients it was executed with simultaneous bronchoscopic monitoring. The type and rate of complications of the two techniques were compared. Comparing the groups with and without bronchoscopy, the perioperative complication rate was equivalent (7% vs 6%); however, more severe complications occurred in the group without bronchoscopy (one death due to tension pneumothorax, two cases of perforating the rear tracheal wall) than in the group with bronchoscopy (two cases of intratracheal hemorrhage). PDT is a suitable bedside method for ICU patients undergoing long-term ventilation. Simultaneous endoscopy minimizes the severity of complications.

Loss of the airway during tracheostomy: rescue oxygenation and re-establishment of the airway

“…7 The anesthesiologist and the surgeon must be prepared to act promptly to prevent hypoxic brain damage or death. To re-establish the airway if lost during tracheostomy, we recommend that a jet ventilation airway exchange catheter be inserted in the endotracheal tube through a bronchoscope port attachment prior to surgical entry into the trachea (Figure).…”

Tips and tricks in tracheobronchial perforations

“…When compared to open tracheostomy, complication rate of this technique is equivalent while its complication severity is greater than conventional tracheostomy. [20] For this technique, the incidence of tracheal injury was reported as a rate of between 0.2% to 4.8% in the literature. [20,21] One of the most severe complications of PDT is esophageal perforation and its incidence was reported as 0.2% in a large series.…”

“…[20] For this technique, the incidence of tracheal injury was reported as a rate of between 0.2% to 4.8% in the literature. [20,21] One of the most severe complications of PDT is esophageal perforation and its incidence was reported as 0.2% in a large series. [21] Membranous tear of trachea is usually accompanied by esophageal injury.…”

Grigss forseps dilatasyon tekniği ile perkütan trakeostomi: 60 yoğun bakım hastasının retrospektif analizi

“…Deneysel ve kadavra çalışmalarında bu prensiplerin uygulanmasıyla trakea arka duvarı perforasyonunun mümkün olmadığı gösterilmiştir (12). Klinik bir çalışmada, Griggs tekniği ile trakeostomi açılan 76 olgunun 35'inde bronkoskopi eşliğinde 41'inde bronkoskopisiz yapılmış ve komplikasyonlar karşılaştırıl-mıştır (13). Bu çalışmada genel komplikasyon oranları benzer bulunmakla birlikte bronkoskopisiz uygulanan Griggs tekniği sonrası bir olgunun tansiyon pnömotoraks sonucu öldüğü, 2 olguda ise trakea arka duvarı hasarı geliştiği bildirilmiştir (13).…”