Late outcome of percutaneous dilatational tracheostomy in intensive care patients

Abstract

Late outcome of percutaneous dilatational tracheostomy in critically ill patients is mostly good. Pending further studies, the use of this technique in intensive care units appears justified.

Incidence of Tracheal Stenosis and Other Late Complications After Percutaneous Tracheostomy

“…Its advantages include the relative ease of performing the procedure at the bedside, the documented cost savings, and the low perioperative complication rate. 6,[23][24][25][26] These reported advantages have led to an increase in the number of trache- 27 showed that the number of critically ill patients at their facility undergoing tracheostomy had increased from 8.5% to 16.8% of all critically ill patients since the advent of PDT. Tracheostomy was also being performed significantly earlier, at a median of 4 versus 8 days of mechanical ventilation.…”

“…Others have also reported no significant tracheal lesions when patients were evaluated by clinical assessment and FOL. 26 Few studies have used objective testing to determine structural changes in the trachea after PDT in both symptomatic and asymptomatic patients. Most investigators have focused on patients with symptoms of airway compromise.…”

“…Indeed, although thousands of PDTs have been performed in the United States and Europe, our literature review identified only a few studies with long-term follow-up and relatively few patients who have undergone objective studies to identify tracheal stenosis. [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.…”

Percutaneous dilatational tracheotomy

“…Many patients have died during the period of cannulation, but deaths were not attributable to the procedure or to the tracheal cannula. Two patients are reported who died of a massive tracheal bleeding after tracheotomy presumably due to a tracheo-innominate artery fistula, and the cause of death was tracheotomy related [91,97].…”

“…However, only a limited number of prospective studies have been done to assess the late complications of percutaneous dilatational tracheotomy and these comprise only limited numbers of patients [88,97]. The incidence of symptomatic tracheal stenosis is probably low, between 0% and 2%.…”