Incidence of Tracheal Stenosis and Other Late Complications After Percutaneous Tracheostomy

Abstract

ObjectiveTo determine the incidence of tracheal stenosis, voice and breathing changes, and stomal complications after percutaneous dilatational tracheostomy (PDT). MethodsFrom December 1992 through June 1999, 420 critically ill patients underwent 422 PDTs. There were 340 (81%) long-term survivors, 100 (29%) of whom were interviewed and offered further evaluation by fiberoptic laryngotracheoscopy (FOL) and tracheal computed tomography (CT). Tracheal stenosis was defined as more than 10% tracheal narrowing on transaxial sections or coronal and sagittal reconstruction views. Forty-eight patients agreed to CT evaluation; 38 patients also underwent FOL. CT and FOL evaluations occurred at 30 Ϯ 25 (mean Ϯ standard deviation) months after PDT.

Removal of the Tracheal Tube after Prolonged Mechanical Ventilation: Assessment of Risk by Oscillatory Impedance

“…Not infrequently, the technique of percutaneous dilatational tracheostomy leads to cartilage damage and the formation of granulation tissue with the development of stomal or suprastomal stricture [5,10,11]. As a rule, circumferential, fibrotic stenoses arising somewhere along the length of the tracheal tube, due to cuff-related ischemia, are less often reported [6].…”

“…Late complications of tracheotomy and long-term mechanical ventilation include tracheal and laryngeal obstructions, the former due to tracheal stenosis, tracheomalacia or the development of granulation tissue [3,4]. In as much as 16% of such cases, tracheolaryngeal obstruction leads to decannulation failure [4,5]. After percutaneous dilatational tracheostomy, in particular, the stomal and suprastomal regions prove to be predilection sites for the development of a tracheal stenosis, and frequently of granulation tissue.…”

A reply

“…The reported rates of stenosis after tracheostomy are very variable (<0.5-31%) depending on how they were assessed and whether there were clinical implications [4][5][6][7]. There is no comment about the relative roles of tracheal intubation and tracheostomy in causing airways stenosis in Halum et al's study, although one might assume that the posterior glottic stenoses are more likely to be tracheal tuberelated, while the rest could be either.…”

When is Surgical Tracheostomy Indicated? Surgical "U-shaped" versus Percutaneous Tracheostomy

“…The "Griggs" technique is performed with the use of special dilating forceps. 1,[3][4][5] However, no difference in complication rates was found between them. 6) Rapitrac described a percutaneous technique that was performed using a dilating forceps with a beveled metal cone.…”