Bedside percutaneous dilational tracheostomy with endoscopic guidance: Experience with 71 ICU patients
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To assess the value of endoscopic guidance in bedside percutaneous dilational tracheostomy.
The medical critical care unit of a large community hospital.
71 consecutive adult patients who required prolonged mechanical ventilation.
72 elective percutaneous dilational tracheostomies using the Ciaglia technique were performed under view of a flexible fiberoptic bronchoscope.
Measurements and results
Patients were examined during tracheostomy and on days 2 and 7 after the procedure, at discharge and after half a year if they were still alive. A correct median puncture was observed by endoscopic control in 59 interventions. an initial paramedian puncture was detected in 13/72 (18%) procedures and was corrected by renewed insertion in all cases. No severe complications related to percutaneous dilational tracheostomy were noticed. Minor complications occurred in 4/71 (5.6%) patients including minor bleeding in 2, inflammatory infiltration in 1 and one superficial lesion of the posterior tracheal mucosa. Long-term follow-up revealed stomal granulation in 3 patients including one at the tracheal site. At the end of the observation period the tracheostomy still was in use in 14/71 (20%) patients and 12/71 (17%) patients were decannulated. Due to their severe underlying diseases 45/71 (63%) patients had died. To facilitate weaning from the tracheostomy a minitracheostomy tube was used in 3 patients.
Percutaneous dilational tracheostomy is a simple bedside procedure associated with a low complication rate. We recommend the use of endoscopic guidance to increase the safety of tracheal puncture and dilation procedure.
Key wordsPercutaneous Dilational Tracheostomy Endoscopy Complications Minitracheostomy
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- 1.Stauffer JL, Olson DE, Petty TL (1981) Complications and consequences of endotracheal intubation and tracheotomy. Am J Med 70:65–76Google Scholar
- 2.Ciaglia P, Graniero KD (1992) Percutaneous dilational tracheostomy: Results and long-term follow-up. Chest 101:464–467Google Scholar
- 3.Griggs WM, Myburgh JA, Worthley LI (1991) A prospective comparison of a percutaneous tracheostomy technique with standard surgical tracheostomy. Intensive Care Med 17:261–263Google Scholar
- 4.Bodenham A, Diament R, Cohen A, Webster N (1991) Percutaneous dilational tracheostomy. A bedside procedure on the intensive care unit. Anaesthesia 46:570–572Google Scholar
- 5.Hazard P, Jones C, Benitone J (1991) Comparative clinical trial of standard operative tracheostomy with percutaneous tracheostomy. Crit Care Med 19:1018–1024Google Scholar
- 6.Ciaglia P, Firsching R, Syniec C (1985) Elective percutaneous dilational tracheostomy: a new simple bedside procedure; preliminary report. Chest 87:715–719Google Scholar
- 7.Marelli D, Paul A, Manolidis S, Walsh G, Odim JNK, Burdon TA, Shennib H, Vestweber KH, Fleiszer DM, Mulder DS (1990) Endoscopic guided peructaneous tracheostomy: early results of a consecutive trial. J Trauma 30:433–435Google Scholar
- 8.Paul A, Marelli D, Chiu CJ, Vestweber KH, Mulder DS (1989) Percutaneous endoscopic tracheoscopy. Ann Thorac Surg 47:314–315Google Scholar
- 9.Lewis GA, Hopkins RB, Matthews HR (1986) Minitracheostomy: a report of its use in intensive therapy. Anaesthesia 41:931–935Google Scholar
- 10.Ryan DW (1990) Minitracheostomy. A new, simple technique for treating patients with retention of sputum. BMJ 300:958–959Google Scholar
- 11.Heffner JE, Miller KS, Sahn SA (1986) Tracheostomy in the intensive care unit. Part 2: Complications. Chest 90:430–436Google Scholar
- 12.Meade JW (1961) Tracheostomy — its complications and their management — a study of 212 cases. N Engl J Med 265:519–523Google Scholar
- 13.Hutchinson RC, Mitchell RD (1991) Life-threatening complications from percutaneous dilational tracheostomy. Crit Care Med 19:118–120Google Scholar
- 14.Leinhardt DJ, Mughal M, Bowles B, Glew R, Kishen R, MacBeath J, Irving M (1992) Appraisal of percutaneous tracheostomy. Br J Surg 79:255–258Google Scholar
- 15.Schachner A, Ovil Y, Sidi J, Rogev M, Heilbronn Y, Levy MJ (1989) Percutaneous tracheostomy — a new method. Crit Care Med 17:1052–1056Google Scholar
- 16.Hazard P, Garrett E, Adams J, Robbins T, Aguillard R (1988) Bedside percutaneous tracheostomy: experience with 55 elective procedures. Ann Thorac Surg 46:63–67Google Scholar
- 17.Claffey LP, Phelan DM (1989) A complication of cricothyroid minitracheostomy — oesophageal perforation. Intensive Care Med 15:140–141Google Scholar
- 18.Pederson J, Schurizek BA, Melson NC, Juhl B (1991) Is minitracheostomy a simple and safe procedure? A prospective investigation in the intensive care unit. Intensive Care Med 17:333–335Google Scholar
- 19.Cook PD, Callanan VI (1989) Percutaneous dilational tracheotomy — technique and experience. Anaesth Intensive Care 17:456–457Google Scholar
- 20.Ivatury R, Siegel JH, Stahl WM, Simon R, Scorpio R, Gens DR (1992) Percutaneous tracheostomy after trauma and critical illness. J Trauma 32:133–140Google Scholar
- 21.Toye FJ, Weinstein JD (1986) Clinical experience with percutaneous tracheostomy and cricothyroidotomy in 100 patients. J Trauma 26:1034–40Google Scholar