Incidence of Tracheal Stenosis and Other Late Complications After Percutaneous Tracheostomy (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.
PubMed, 1998
Percutaneous dilatational tracheostomy (PDT) is becoming an accepted cost-effective alternative to surgical tracheostomy. PDT is performed by progressive dilatation of a tracheal opening placed under bronchoscopic guidance. Case reports of hypoventilation with associated hypercarbia during the performance of PDT have raised concerns about the utility of this procedure in patients in whom hypercarbia is problematic (e.g., patients with closed head injury). In a prospective cohort analysis of 11 critically ill patients, we evaluated the effect of PDT on ventilation during and after the procedure using end tidal capnography. We found that hypercarbia does not occur during or after the performance of PDT as compared to baseline levels.
Journal of Anesthesiology and Clinical Research, 2024
Furthermore, PDT is generally more available than an open tracheostomy. Additionally, when performed at the bedside, it spares the need to transfer high-risk patients, making it the procedure of choice for highrisk, chronically ventilated patients in intensive care units (ICUs). 11,12 PDT in ICU is classically indicated to facilitate weaning in difficult-to-wean patients, to aid in tracheobronchial toileting, to protect airways in patients at risk of aspiration, in anticipated prolonged ventilator stay, and to minimize sedation requirement. The diagnosis of indications for percutaneous dilatational tracheostomy varies, one of which is in a study conducted by Koc et al. in 2022 which observed e
Predictors of short-term mortality in patients undergoing percutaneous dilatational tracheostomy☆
2011
Purpose: The purpose of the study was to identify the predictors of short-term mortality in patients undergoing percutaneous dilatational tracheostomy (PDT). Materials and Methods: Retrospective analysis of data pertaining to adult patients who underwent PDT between July 2005 and June 2008 in an urban, academic, tertiary care medical center was done. Clinical and demographic data were analyzed for 483 patients undergoing PDT via multivariate logistic regression. Results: Mortality data were examined at in-hospital, 14, 30, and 180 days postprocedure. Overall mortality rates were 11% at 14 days, 19% at 30 days, and 40% at 180 days. In-hospital mortality was 30%. Conclusions: Patients undergoing PDT have significant short-term mortality with 11% dying within 14 days and an in-hospital mortality rate of 30%. We identified an index diagnosis of ventilatorassociated pneumonia and trauma to be associated with a higher survival rate, whereas older age, oncological diagnosis, cardiogenic shock, and ventricular-assist devices were associated with higher mortality. There is significant heterogeneity in both underlying diagnosis and patient outcomes, and these factors should be considered when deciding to perform this procedure and discussed with patients/family members to provide a realistic expectation of potential prognosis.
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.
World journal of …, 2000
Percutaneous dilatational tracheostomy (PDT) is being increasingly used. Concerns have been raised as to its safety, especially when it is done at the bedside. A prospective evaluation was conducted of 100 consecutive, unselected critically ill patients with PDT. The mean intensive care unit (ICU) stay before PDT was 12 days. One surgeon performed PDT alone (5 cases) or assisted residents (95 cases) in all operations; 84 were performed at the ICU bedside. Only the first six patients were taken to the operating room solely for tracheostomy. A modified technique was used: (1) the endotracheal tube was left in place during sequential dilations; (2) dilators were inserted in a 60-degree cephalad orientation to the skin and directed caudally after penetration of the anterior tracheal wall;
Our Experience with Percutaneous and Surgical Tracheotomy in Intubated Critically Ill Patients
Turk Otolarengoloji Arsivi/Turkish Archives of Otolaryngology, 2019
Objective: Open surgical tracheotomy (OST) and percutaneous dilatational tracheotomy (PDT) are commonly used for securing airway in intubated critically ill patients. The purpose of this study was to compare the safety of OST and PDT, particularly in intubated critically ill patients. Methods: The medical records of intubated critically ill patients who underwent tracheotomy between August 2006 and July 2017 were analyzed retrospectively. Minor and major complication rates were compared according to the tracheotomy technique. Preoperative intubation time, postoperative decannulation time, reason for hospitalization, and demographic data, including the Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, were evaluated. Results: A total of 332 cases were enrolled into the study. The minor and major complication rates for both techniques were 27.2%, 8.8%, 9.7% and 3.2%, respectively. Minor and major complication rates were higher in the OST group (p=0.01, p=0.03, respectively). The rate of every single complication was also compared on groups' basis. Accidental decannulation (p=0.02) and pneumothorax (p=0.05) were found to be significantly frequent in the OST group. There was no impact of the preoperative intubation time on the minor (p=0.20) and major complication (p=0.29) rates found. There was no statistically significant difference regarding the postoperative decannulation time (p=0.32). Also, there was no statistically significant difference between two groups in terms of the APACHE II (p=0.69) and SOFA (p=0.37) scores. However, a statistically significant difference between the groups in terms of overall survival was found, in favor of PDT (p<0.001). Conclusion: This study revealed that PDT is safer than OST, particularly in intubated critically ill patients.