The Utility of Chest Radiography Following Percutaneous Dilational Tracheotomy

Abstract

Chest radiography following PDT is indicated when there are clinical findings suggesting pneumothorax or pneumomediastinum. Without clinical signs or symptoms, routine use of postoperative chest radiographs are unnecessary and not cost-effective.

Should pulmonary radiographs be taken routinely following paediatric tracheostomy?

“…In literature, there is increasing evidence that routine pulmonary radiographs are not necessary following a tracheostomy procedure in adults. 7,8 In a 2014 review by Yeo et al 9 related to the role of pulmonary radiographs following adult surgical tracheostomy, from 1382 cases and 1362 pulmonary radiographs (postoperative radiographs were not taken in 20 cases for unknown reasons), complications were determined in 30 (2.2%) patients as 9 pneumothorax, 8 atelectasia, 5 pulmonary oedema, 5 pneumomediastinum, and 3 subcutaneous emphysema. The rate of pneumothorax alone was reported as 0.7% (9/1362).…”

Asymptomatic hemilateral pneumothorax and pneumomediastinum following surgical tracheostomy in a patient with hyponatremia and zolpidem withdrawal delirium

“…The diagnosis of post-tracheostomy pneumothorax is usually based on clinical signs and symptoms, such as sudden and acute chest pain, dyspnea, tachycardia, decreased breath sounds and oxygen desaturation, and routine use of post-tracheostomy chest radiography has currently been reported as unnecessary in adults [3][4][5]. In this case, when tension pneumothorax and pneumomediastinum…”

Is routine chestX‐ray after surgical and percutaneous tracheostomy necessary in adults: a systemic review of the current literature

“…In fact, all nine cases of complications which required intervention were symptomatic, hence supporting the need for postoperative clinical examination, close monitoring and chest X-ray in these patients. 11,17,18,21 In most papers, it was unclear whether the chest X-rays were responsible for the diagnosis of complications or whether they served to confirm complications that were already clinically diagnosed beforehand. Nevertheless, what is certain is the importance of clinical examination and monitoring in post-tracheostomy patients.…”

“…For surgical tracheostomy, although the majority (60%) of patients with post‐operative complications were asymptomatic, those who exhibited signs and symptoms were more likely to require intervention (75%). In fact, all nine cases of complications which required intervention were symptomatic, hence supporting the need for post‐operative clinical examination, close monitoring and chest X‐ray in these patients . In most papers, it was unclear whether the chest X‐rays were responsible for the diagnosis of complications or whether they served to confirm complications that were already clinically diagnosed beforehand.…”