Tracheal Stenosis After Placement of Percutaneous Dilational Tracheotomy (original) (raw)
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Intensive Care Medicine, 1998
Objective: To analyze perioperative and postoperative complications and long-term sequelae following percutaneous dilatational tracheostomy (PDT). Design: A prospective clinical study of patients undergoing PDT. Setting: Seven intensive care units at a University hospital Patients: 326 intensive care patients (202 male, 124 female; age: 11–95 years) with indications for tracheostomy. Interventions: Using tracheoscopic guidance, 337 PDTs were performed according to Ciaglias’ method. In 106 decannulated patients, tracheal narrowing was assessed by plain tracheal radiography. Results: Two procedure-related deaths were seen (0.6%). Perioperative and postoperative complications occurred with 9.5 % of the PDTs. One of 106 patients, who were followed-up for at least 6 months, showed a clinically relevant tracheal stenosis. Subclinical tracheal stenosis of at least 10% of the cross-sectioned area was recognized in 46 of 106 patients (43.4%). In the univariate analysis, the degree of stenosi...
The Laryngoscope, 1997
To directly compare percutaneous dilational tracheostomy (PDT) with conventional surgical tracheostomy, a prospective study was performed in 83 patients requiring tracheostomy for prolonged mechanical ventilation in the intensive care unit or after surgery for a large tumor in the upper respirodigestive tract. Median follow-up was 355 days after PDT and 338 days after conventional tracheostomy. The overall morbidity rate was significantly lower with PDT than with conventional tracheostomy (6.4% vs 36.1%; P c 0.001). Compared with conventional tracheostomy, PDT was also associated with a significantly lower incidence of postoperative bleeding (2.1% vs 13.9%; P c 0.05) and postoperative wound infection (0% vs 22.2%; P c 0.001). There were no clinical signs of laryngotracheal stenosis in either group. In conclusion, PDT is a simple, fast, safe bedside procedure that is associated with significantly lower morbidity than standard surgical tracheostomy.
Fiberoptic-Guided Blue Rhino Dilator-Assisted Dilation of Postintubation Tracheal Stenosis
A & A Case Reports, 2017
P osttracheostomy tracheal stenosis or postintubation tracheal stenosis is a serious complication after prolonged endotracheal intubation or tracheostomy. The condition was first described by Macewen 1 in 1880. The reported incidence of posttracheostomy tracheal stenosis after tracheostomy ranges from 10% to 22%, and symptomatic stenosis occurs only in 1% to 2% of the patients. 2-4 The proposed mechanism behind its occurrence is the ischemic tracheal injury because of the pressure effect of the tube cuff. Surgical resection and anastomosis are the preferred treatment modality wherever feasible, but endoscopic approaches are frequently used. Dilation using a rigid bronchoscope with or without electrocautery or using a controlled radial expansion (CRE) balloon is commonly used. 2-6 We describe a case in which a novel salvage modality for dilation of a tight tracheal stenosis using the Rhino dilator of a percutaneous dilation tracheostomy (PDT) set was used when rigid bronchoscopy and balloon dilation had been unsuccessful. Consent The patient reviewed the case and gave written permission for the authors to publish the report.
Intensive Care Medicine, 2002
Objective: To assess the complication rate of bronchoscopically guided percutaneous dilational tracheostomy (PDT), with tracheal tube suture fixation and no elective tracheostomy tube exchange, after experience had been gained. Design: Prospective clinical study. Setting: Anaesthesiological ICU with mixed surgical and medical patients in a university hospital. Patients: Hundred thirty-three mechanically ventilated patients (mean age: 54.8 years, range: 13-87 years) with indication for PDT, many with thrombocytopenia and/or coagulation deficits. Interventions: Hundred thirty-six consecutive PDTs performed by residents under bronchoscopic guidance with stepwise dilation (n=114, Ciaglia's conventional system) or conic dilation (n=22, "Blue Rhino" approach) and supervision of experienced staff anaesthesiologists. Tracheostomy tubes were fixed to the skin with a suture and no routine exchange of tracheo-stomy tubes was performed. Complications were categorised and the results were also compared to an earlier prospective study. Results: The incidence of tracheostomy tube-related complications (hypoxaemia, cannula misplacement, accidental decannulation, cuff rupture and hernia, or posterior tracheal wall lesion) was low (0.7%) and significantly less (6.2%, p=0.01) than in our earlier study. No patient died of PDT-associated complications. We recorded four (2.9%) clinically relevant bleeding episodes. Insertion of tracheal tubes was easy or only moderately difficult in 86.7%. Conclusion: With experience in performing PDT, fixation of the tracheal cannula, and omission of routine change of tracheostomy tubes complication rate of PDT is low.
Percutaneous Dilatational Tracheostomy: A Prospective Study in 45 Patients
Journal of Anaesthesiology Clinical Pharmacology
Introduction: Percutaneous dilatational tracheostomy (PDT) is a simple bedside procedure, particularly useful in the intensive care units. Over the last few decades, the technique of PDT has gained popularity due to its comparable safety to the more surgical tracheostomy (ST). Objective: To describe the outcome of PDT using modified Ciaglia's technique in patients of Surgical ICU. Methodology: This was a prospective cohort study that analysed the outcomes of PDTs carried out on critically ill patients admitted in the surgical ICU, Pakistan Institute of Medical Sciences, Islamabad from August 2015 to January 2017. All PDTs were performed by the presiding consultant and his team using modified Ciaglia's (Blue Rhino) technique. The main outcome was the frequency of perioperative and early complications within the first six days. Demographic variables and complications were recorded. Data was analysed using SPSS version 18. Results: Seventy-four patients underwent PDTs in the surgical ICU with mean age of the patients was 49.17 ± 12.82 years. The commonest indication of tracheostomy was prolonged mechanical ventilation followed by failure to wean. Complications rate was 12.16% of which perioperative bleeding occurred in 6.7% of patients. Early complications within the first six days were wound infection, tube displacement and blocked tube. Conclusion: PDT is a valuable, efficacious and safe method that can be performed at the bedside with minimal complication rate and needs to be considered more frequently in the intensive care units in developing countries.
Percutaneous Dilatational Tracheostomy: Experience of 100 Cases at a Tertiary Care Centre
Indian Journal of Surgery, 2020
Tracheostomy has been accepted as standard of care for patients requiring prolonged mechanical ventilation. There has been a shift from the era of open surgical tracheostomy to percutaneous tracheostomy. Some studies have reported certain advantages of percutaneous tracheostomy over open tracheostomy, yet some centres debate about its effectiveness and, hence, have not adopted it as a routine technique. We present our centre's experience of performing 100 bedside percutaneous tracheostomies, including those in 27 patients of cervical spine injury. The aim of the study is to demonstrate the safety and efficacy of percutaneous tracheostomy such that it can be embraced as a routine technique. One hundred consecutive neurosurgical patients requiring tracheostomy for prolonged ventilation were included in the study. Patients requiring emergency tracheostomy were excluded. A prospective database was created which included demographic profile of the patient, diagnosis and related indications, procedure time and complications. Ciaglia multiple dilator technique was used for performing percutaneous tracheostomy using Cook set. Time taken was measured from skin incision to insertion of tracheostomy tube. All related complications were noted. Mean duration of procedure was 7.92 ± 0.17 min and 7.14 ± 0.1 min in patients of cervical spine injury. Cannula misplacement occurred in 5 patients and minor bleeding occurred in 4 patients, including 3 complications in patients of cervical spine injury(2 had bleeding while 1 had cannula misplacement corrected during the procedure). Conversion to open procedure was required in one patient. Percutaneous tracheostomy is a safe and effective alternative to open tracheostomy. It can be considered the first line of care in patients requiring tracheostomy, especially in patients of cervical spine injury.
Percutaneous dilational tracheostomy: Report of 141 cases
Annals of Thoracic Surgery, 1994
Tracheostomy is indicated frequently in the treatment of critically ill patients who require prolonged mechanical ventilation. The purpose of this prospective study was to evaluate our initial experience with 141 cases of percutaneous dilational tracheostomy (PDT) performed over a 2-year period. One hundred twenty PDTs (85%) were placed at the bedside, and 21 (15%) were performed in the operating room in conjunction with other procedures. The procedural complication rate was 11% (16 of 141). Most complications were easily recognized and did not preclude the completion of PDT. One death occurred racheostomy is frequently required in the treatment of