Tödliche Gefäßarrosion nach Dilatationstracheotomie

Hürter, H.; Post-Stanke, A.; Tolksdorf, W.

doi:10.1055/s-2000-7362

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…We found 27 deaths (38.0%) due to hemorrhage [18,19,22-26,28-31,35,37,39,43],[46,49,54,57-59]. The source of bleeding was arterial in 16 cases (59.3%).…”

Section: Resultsmentioning

confidence: 98%

Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors

et al. 2013

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IntroductionSince the introduction and widespread acceptance of percutaneous techniques in the intensive care unit (ICU) setting, the number of critically ill patients undergoing tracheostomy has steadily increased. However, this procedure can be associated with major complications, including death. The purpose of this study is to estimate the incidence and analyze the causes of lethal complications due to percutaneous dilatational tracheostomy (PDT).MethodsWe analyzed cases of lethal outcome due to complications from PDT including cases published between 1985 and April 2013. A systematic literature search was performed and unpublished cases from our own departmental records were retrospectively analyzed.ResultsA total of 71 cases of lethal outcome following PDT were identified including 68 published cases and 3 of our own patients. The incidence of lethal complications was calculated to be 0.17%. Of the fatal complications, 31.0% occurred during the procedure and 49.3% within seven days of the procedure. The main causes of death were: hemorrhage (38.0%), airway complications (29.6%), tracheal perforation (15.5%), and pneumothorax (5.6%). We found specific risk factors for complications in 73.2% of patients, 25.4% of patients had more than one risk factor. Bronchoscopic guidance was used in only 46.5% of cases.ConclusionsAccording to this analysis, PDT-related death occurs in 1 out of 600 patients receiving a PDT. Careful patient selection, bronchoscopic guidance, and securing the tracheal cannula with sutures are likely to reduce complication rates.

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“…We found 27 deaths (38.0%) due to hemorrhage [18,19,22-26,28-31,35,37,39,43],[46,49,54,57-59]. The source of bleeding was arterial in 16 cases (59.3%).…”

Section: Resultsmentioning

confidence: 98%

Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors

et al. 2013

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“…Hereby, variation in the position of the brachiocephalic artery with respect to the trachea has to be taken into account [ 6 ]. Fracture of tracheal cartilage is described to be responsible for consistently increased cuff pressure [ 1 ] and local inflammation [ 7 ]. Ongoing mechanical irritation from the tracheal cartilage fragment and transmitted pressure from the tracheal cannula eroded the wall of the trachea and the brachiocephalic artery after only six days.…”

Section: Discussionmentioning

confidence: 99%

“…TIF formation was reported after long-term pressure due to a “Tracheosafe” device [ 2 ] or a cannula [ 1 , 9 , 10 ]. Pressure ulcerations from local inflammation, radiotherapy, high cuff pressure, mucosal trauma due to inappropriately-sized cannula, and malpositioned cannula tip due to atypical head and neck positions of the patient (as seen in severe neurological disorders) may be responsible for TIF formation even months after tracheostomy.…”

Section: Discussionmentioning

confidence: 99%

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Late Life-Threatening Hemorrhage after Percutaneous Tracheostomy

Richter

Gottschlich

Sutarski

et al. 2011

International Journal of Otolaryngology

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Purpose. Formation of a tracheoinnominate artery fistula (TIF) and consecutive hemorrhage is a rare and life-threatening complication with high mortality. Warning symptoms can be absent. The current literature contains only few considerations for misleading signs, especially in cases where the contact between the tissue and the cannula is tight. Method and Results. We report two cases of life-threatening hemorrhages that appeared six days and two months after percutaneous dilatational tracheostomy (PDT) in two patients, respectively. In these cases, diagnosis of tracheoinnominate artery fistula (TIF) was difficult. Tracheal ring fracture after PDT and pressure ulceration caused by cannula were implicated in TIF formation. The cannula was overblocked to buy time before surgical closure. Both patients survived without any additional neurological deficiency. Conclusion. Massive hemorrhage in patients after tracheostomy is likely due to TIF. Ultrasound scanning before PDT and careful periodical followup of the trachea are required.

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“…Nach In diesem Zusammenhang muss leider erwähnt werden, dass massive, durch Arrosionen großer Gefäße bedingte Blutungen bei Tracheostomapatienten -selbst wenn sie innerklinisch auftreten -aufgrund einer aspirationsbedingten Hypoxie oder Verblutens nur in Einzelfällen überlebt werden [8,15,18].…”

Section: Dislokation Der Trachealkanüleunclassified