Update Tracheotomie

Braune, Stephan; Kluge, Stefan

doi:10.1007/s00063-012-0089-y

Cited by 14 publications

(5 citation statements)

References 38 publications

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“…Of note, in all of these cases bronchoscopic guidance was not used. Despite the lack of randomized controlled trials many authors think that the use of bronchoscopic guidance significantly increases the safety of PDT as it can guide correct placement of the introducer needle, the guidewire, and the cannula during the procedure [68,69]. …”

Section: Discussionmentioning

confidence: 99%

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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 A systematic literature search was performed and unpublished cases from our own departmental records were retrospectively analyzed.ResultsA total of 71 cases of lethal outcome following PDT were identified including 68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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Section: Discussionmentioning

confidence: 99%

“…Contraindications to PDT include anatomic distortion of the neck, the presence of a difficult airway, severe ARDS, uncorrectable coagulopathy, and the presence of an unstable cervical spine [68]. However, most of these contraindications are relative and also dependent on the skill of the operator.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…Long‐term ventilated critically ill patients often receive a tracheostomy to facilitate weaning from the ventilator, reduce dead space and avoid laryngeal injury …”

Section: Advantages and Disadvantages Of Techniques Supporting The Pementioning

confidence: 99%

Feasibility of an endotracheal tube‐mounted camera for percutaneous dilatational tracheostomy

Grensemann

Eichler

Hopf

et al. 2017

Acta Anaesthesiol Scand

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“…Percutaneous dilatational tracheotomy (PDT) is a standard procedure in critical care patients requiring long-term ventilator support [ 1 , 2 ]. The intervention is accompanied by repetitive suction maneuvers, application of high oxygen fractions, reduced ventilation and loss of positive end-expiratory pressure (PEEP) [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Lung aeration and ventilation after percutaneous tracheotomy measured by electrical impedance tomography in non-hypoxemic critically ill patients: a prospective observational study

Eichler

Mueller²,

Grensemann

et al. 2018

Ann. Intensive Care

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BackgroundPercutaneous dilatational tracheotomy (PDT) may lead to transient impairment of pulmonary function due to suboptimal ventilation, loss of positive end-expiratory pressure (PEEP) and repetitive suction maneuvers during the procedure. Possible changes in regional lung aeration were investigated using electrical impedance tomography (EIT), an increasingly implied instrument for bedside monitoring of pulmonary aeration.MethodsWith local ethics committee approval, after obtaining written informed consent 29 patients scheduled for elective PDT under bronchoscopic control were studied during mechanical ventilation in supine position. Anesthetized patients were monitored with a 16-electrode EIT monitor for 2 min at four time points: (a) before and (b) after initiation of neuromuscular blockade (NMB), (c) after dilatational tracheostomy (PDT) and (d) after a standardized recruitment maneuver (RM) following surgery, respectively. Possible changes in lung aeration were detected by changes in end-expiratory lung impedance (Δ EELI). Global and regional ventilation was characterized by analysis of tidal impedance variation.ResultsWhile NMB had no detectable effect on EELI, PDT led to significantly reduced EELI in dorsal lung regions as compared to baseline, suggesting reduced regional aeration. This effect could be reversed by a standardized RM. Mean delta EELI from baseline (SE) was: NMB − 47 ± 62; PDT − 490 ± 180; RM − 89 ± 176, values shown as arbitrary units (a.u.). Analysis of regional tidal impedance variation, a robust measure of regional ventilation, did not show significant changes in ventilation distribution.ConclusionThough changes of EELI might suggest temporary loss of aeration in dorsal lung regions, PDT does not lead to significant changes in either regional ventilation distribution or oxygenation.

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Update Tracheotomie

Cited by 14 publications

References 38 publications

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

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

Feasibility of an endotracheal tube‐mounted camera for percutaneous dilatational tracheostomy

Lung aeration and ventilation after percutaneous tracheotomy measured by electrical impedance tomography in non-hypoxemic critically ill patients: a prospective observational study

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