Reduction of Complication Rate in Percutaneous Dilation Tracheostomies

Abstract

PDT provides an easy and convenient alternative to open tracheotomy (OT) and should be added to the otolaryngologist's armamentarium of surgical airway procedures. The complication rate of PDT is low and similar to that of open operative tracheotomy. However, with experience and the use of strict protocols in both patient selection and PDT procedure, the complication rate can be significantly reduced further both in frequency and severity, making it even safer than an open operative tracheotomy.

Who is performing percutaneous tracheotomies? Practice patterns of surgeons in the USA

“…Simultaneous video bronchoscopy was also used by a majority of physicians in this study; this also is similar amongst both disciplines. The use of simultaneous video bronchoscopy while performing PT has been shown to significantly reduce intraoperative complications such as false passage and tracheoesophageal puncture or bleeding and is a practice that is strongly recommended by experts and by many of the percutaneous tracheotomy manufacturers [8][9][10]17]. These data suggest that the procedure performed by the two specialties is currently comparable.…”

“…A 2007 meta-analysis concluded that although PT may have more early complications than open tracheotomies, long-term complications between the two techniques appear similar [8,9]. More recent studies have examined ways to reduce morbidity from the procedure.…”

“…More recent studies have examined ways to reduce morbidity from the procedure. These have shown that using a standardized technique with simultaneous video bronchoscopy, selecting appropriate patients, and employing experienced physicians have all contributed to the safety of PT [8][9][10]. Multiple current studies show either no difference or an improvement in the rate of complications and mortality between PT and open tracheotomies [9,[11][12][13][14][15][16].…”

A Novel, Adaptable Laryngeal Mask to Facilitate a Percutaneous Dilatational Tracheostomy

“…23,30,31 Some investigators have adequately addressed these challenges by use of blunt dissection and illumination by the FFB through the newly exposed, thinner section of tissue. 32,33 However, the presence of the FFB itself within the ETT is cause for concern 20,34 as the cross-sectional diameter of the ETT is effectively reduced by 41% to 76% (with a 5.7 mm OD FFB in a 9.0 mm and 7.0 mm ID ETT, respectively).…”

7-Year Survey after Percutaneous Dilatational Tracheotomy on a Medical Intensive Care Unit

“…Severe acute complications including death were only reported in few cases. 25 Bhatti et al 26 showed a reduction of the acute complication rate during the years correlating with an increased familiarity of physicians with the procedure. Therefore, percutaneous dilatational tracheotomy has become a standard procedure in many ICUs.…”