Tracheal Stenosis After Placement of Percutaneous Dilational Tracheotomy

Christenson, Thomas; Artz, Greg; Goldhammer, Jordan E.; Spiegel, Joseph R.; Boon, Maurits

doi:10.1097/mlg.0b013e31815a9e87

Cited by 21 publications

(15 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The relevance of tracheal ring fractures in the development of tracheal stenosis is obvious but not fully understood. The development of tracheal stenosis after untreated tracheal ring fractures is probable [16, 17], and the possibility of immediate treatment of tracheal ring fragments after tracheal ring fracture may be an advantage of the TED.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of dilatational tracheotomy using the rigid endoscope: a multicenter study

et al. 2017

View full text Add to dashboard Cite

BackgroundFiberoptic tracheo-bronchoscopy is the most commonly used procedure for percutaneous dilational tracheotomy (PDT). However, PDT can be associated with major complications, including death. Furthermore it is unclear, whether the tracheal ring fractures may contribute to the development of tracheal stenosis after PDT nor whether tracheal ring fractures can be prevented by using a rigid endoscope for this procedure. The purpose of this study was to evaluate the feasibility of and the incidence of complications for PDT using the rigid tracheotomy endoscope (TED).MethodsIn a prospective multicenter observational study from 2006 to 2010, 180 adult patients in intensive care and those scheduled for ear, nose and throat surgery underwent PDT using TED. Data collection was performed using a structured protocol. The patients were observed according to PDT phase (phase 1: puncture, phase 2: dilatation and phase 3: cannula insertion). The descriptive data are given as the number (percent) of cases and the mean ± standard deviation (SD) where appropriate. The relationships between dichotomous and categorical parameters were analyzed using the chi-square test. P values ≤ 0.05 were considered significant.ResultsPDT was performed in 179 patients. The procedure time was 14.8 ± 6.2 (mean ± SD) minutes. Pneumothorax or procedure-related lethal complications did not occur. Other adverse events included tracheal ring fractures (17.1%), desaturations (6.8%), special incidents (6.2%), bleeding (5.5%), anesthesia complications (4.5%) and posterior tracheal wall injuries (1.1%).ConclusionThe use of TED in PDT is feasible, and the incidence of complications and adverse events was comparable with that of PDT using the flexible endoscope. Tracheal ring fractures in PDT cannot be avoided by the use of a rigid endoscope. With TED, the airway always remains open thus the use of jet ventilation via the TED during PDT is possible.

show abstract

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of dilatational tracheotomy using the rigid endoscope: a multicenter study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The majority of reported complaints were minor. Moreover, it is difficult to distinguish between complaints (like voice problems or tracheal stenosis) that are really due to the tracheostomy or due to prolonged endotracheal intubation and/or underlying disease [24, 25]. …”

Section: Discussionmentioning

confidence: 99%

Early and late outcome after single step dilatational tracheostomy versus the guide wire dilating forceps technique: a prospective randomized clinical trial

et al. 2011

View full text Add to dashboard Cite

PurposePercutaneous tracheostomy is frequently performed in long-term ventilated patients in the intensive care unit (ICU). Unfortunately, despite many years of experience, the optimal technique is still unknown, especially considering the occurrence of late complications. The purpose of this study was to determine which of the two most frequently used percutaneous tracheostomy techniques performs best with the emphasis on late complications.MethodsThis prospective randomized trial involved 120 patients, comparing two techniques of percutaneous tracheostomy, the guide wire dilating forceps (GWDF) and the single step dilatational tracheostomy (SSDT) technique.ResultsSixty patients in each group underwent a percutaneous tracheostomy and were followed for up to 3 months after decannulation. The majority of complications in both groups were minor (58.3% in the GWDF group and 61.7% in the SSDT group). We found a trend towards more major perioperative complications in the GWDF group versus the SSDT group, 10.0 versus 1.7% (p = 0.06). One patient in the SSDT group developed a significant tracheal stenosis. However, this may also have been related to prolonged translaryngeal intubation. Results of magnetic resonance imaging (MRI) investigations showed only minor tracheal changes. Only 37.5% of patients in the GWDF group and 31.8% in the SSDT group had no complaints after their percutaneous tracheostomy.ConclusionCompared with the GWDF, the SSDT shows a trend toward less major perioperative complications with a comparable long-term outcome.

show abstract

“…In a recent study reporting five events of stenosis following SDT, the development of stenosis was due to the fracture of the anterior tracheal wall because of compression. 19 SDT and GWDF were similar in terms of midterm (with in situ tracheal tube) and late (after decannulation) outcomes. Late outcomes are always difficult to be evaluated because of the limited percentage of critically ill patients surviving up to removal of tracheostomy and available for followup.…”

Section: Discussionmentioning

confidence: 54%

“…Excluding 1006 non-pertinent titles or abstracts, we retrieved in complete form and assessed according to the selection criteria 34 studies. After excluding 10 articles that were not randomised, [13][14][15][16][17][18][19][20][21][22] twelve articles that had another PDT as comparator [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] and seven that were reviews, 1,2,7,35-38 we finally identified five eligible RCTs, [8][9][10]39,40 which were included in the final analysis. …”

Section: Search Resultsmentioning

confidence: 99%

Single dilator vs. guide wire dilating forceps tracheostomy: a meta-analysis of randomised trials

Cabrini

Landoni²,

Greco³

et al. 2013

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

GWDF technique is associated with a higher incidence of intraprocedural bleeding and of technical difficulties in completing the procedure (difficult cannula insertions/difficult dilations or failures) compared with the SDT technique. No differences were identified in mid-term and long-term complications. Further studies comparing SDT and GWDF in the general population and in subgroups of high-risk patients (like obese or hypoxaemic patients) are warranted.

show abstract

Tracheal Stenosis After Placement of Percutaneous Dilational Tracheotomy

Cited by 21 publications

References 12 publications

Feasibility and safety of dilatational tracheotomy using the rigid endoscope: a multicenter study

Feasibility and safety of dilatational tracheotomy using the rigid endoscope: a multicenter study

Early and late outcome after single step dilatational tracheostomy versus the guide wire dilating forceps technique: a prospective randomized clinical trial

Single dilator vs. guide wire dilating forceps tracheostomy: a meta-analysis of randomised trials

Contact Info

Product

Resources

About