Short-term complications of percutaneous tracheostomy: experience of a District General Hospital–Otolaryngology Department

Abstract

Percutaneous tracheostomy is a procedure frequently carried out in a critical care setting. It is performed in the majority of cases by anaesthetists in the United Kingdom. The ENT surgeon is only called in situations where it is deemed by the intensivist that percutanous tracheostomy would prove too great a risk. In this situation the patient was taken to the operating theatre for a surgical tracheostomy. In our paper, a retrospective analysis was performed of all percutaneous tracheostomies carried out by ENT surgeons in the Royal Glamorgan Hospital, during a two-year period from July 1999 to July 2001, to assess whether percutaneous tracheostomy is a feasible option as a first line procedure in all elective tracheostomies. Thirty-six patients were included in the study. The mean age was 60.2 years. Haemorrhage was noted to be a problem in only one patient and two patients developed postoperative wound infection that was treated with systemic antibiotics. No other complications were encountered. We propose that all ENT surgeons should be trained in performing percutaneous tracheostomy and that it should be used as the gold standard in elective tracheostomy insertion. In cases where difficulties are likely to be anticipated, percutaneous tracheostomy can still be considered as the first option. This can be performed in the operating theatre setting with the knowledge that if any complication should occur then conversion to surgical tracheostomy can be done without delay.

Endoscopic Percutaneous Dilatational Tracheotomy: A Prospective Evaluation of 500 Consecutive Cases

“…First, several fundamentally different techniques have been described, including the Shelden tracheostome, 6 the Schachner tracheostome (“Rapitrac”), 7,40 the Griggs Guidewire Dilating Forceps technique, 41 the cutting bougie device by Toye and Weinstein, 8,42 the Fantoni translaryngeal or retrograde method, 43,44 and, more recently, the PercuTwist dilator technique 45 ; overall complication rates for each of these techniques varies widely, 46 and lumping them together with those of endoscopic PDT is likely to lead to erroneous conclusions. Several descriptive and outcome studies have been published for each of them 47–59 and are discussed separately in . Second, since the definition of complications is highly variable, under‐reporting or over‐reporting are likely to occur; some studies list even the most minor events whereas others list only what are deemed significant complications.…”