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Percutaneous dilatational tracheostomy — early results and long-term outcome of 326 critically ill patients

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Abstract

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 stenosis was influenced by the age of the patient (p=0.044), the duration of intubation prior to PDT (p=0.042) and by the duration of cannulation (p=0.006). These parameters had no statistical significance in a multiple regression model.

Conclusion: When performed by experienced physicians, percutaneous dilatational tracheostomy under fiberoptic guidance is a safe method. The risks of early complications and of clinically relevant tracheal stenoses are low. Subclinical tracheal stenoses are found in about 40 % of patients following PDT.

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References

  1. Ciaglia P, Firsching R, Syniec C (1985) Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest 87: 715–719

    Article  CAS  PubMed  Google Scholar 

  2. Barba CA, Angood PB, Kauder DR, Latenser B, Martin K, McGonigal MD, Phillips GR, Rotondo MF, Schwab CW (1995) Bronchoscopic guidance makes percutaneous tracheostomy a safe, cost-effective, and easy-to-teach procedure. Surgery 118: 879–883

    Article  CAS  PubMed  Google Scholar 

  3. Cobean R, Beals M, Moss C, Breden-berg CE (1996) Percutaneous dilatational tracheostomy: a safe, cost-effective bedside procedure. Arch Surg 131: 265–269

    Article  CAS  PubMed  Google Scholar 

  4. Fernandez L, Norwood S, Roettger R, Gass D, Wilkens H (1996) Bedside percutaneous tracheostomy with bronchoscopic guidance in critically ill patients. Arch Surg 131: 129–132

    Article  CAS  PubMed  Google Scholar 

  5. Hazard PB, Garrett HE Jr, Adams JW, Robbins ET, Aguillard RN (1988) Bedside percutaneous tracheostomy: experience with 55 elective procedures. Ann Thorac Surg 46: 63–67

    Article  CAS  PubMed  Google Scholar 

  6. Friedman Y, Mayer AD (1993) Bedside percutaneous tracheostomy in critically ill patients. Chest 104: 532–535

    Article  CAS  PubMed  Google Scholar 

  7. van Heurn LW, van Geffen GJ, Brink PR (1996) Clinical experience with percutaneous dilatational tracheostomy: report of 150 cases. Eur J Surg 162: 531–535

    PubMed  Google Scholar 

  8. Toursarkissian B, Zweng TN, Kearney PA, Pofahl WE, Johnson SB, Barker DE (1994) Percutaneous dilational tracheostomy: report of 141 cases. Ann Thorac Surg 57: 862–867

    Article  CAS  PubMed  Google Scholar 

  9. Bause H, Prause A, Schulte am Esch J (1995) Indikation und Technik der perkutanen Dilatationstracheotomie für den Intensivpatienten. Anästhesiol Intensivmed Notfallmed Schmerzther 30: 492–496

    Article  CAS  PubMed  Google Scholar 

  10. Hill BB, Zweng TN, Maley RH, Charash WE, Toursarkissian B, Kearney PA (1996) Percutaneous dilational tracheostomy: report of 356 cases. J Trauma 41: 238–243

    Article  CAS  PubMed  Google Scholar 

  11. Marx WH, Ciaglia P, Graniero KD (1996) Some important details in the technique of percutaneous dilatational tracheostomy via the modified Seldinger technique. Chest 110: 762–766

    Article  CAS  PubMed  Google Scholar 

  12. Ciaglia P, Graniero KD (1992) Percutaneous dilatational tracheostomy. Results and long-term follow-up. Chest 101: 464–467

    Article  CAS  PubMed  Google Scholar 

  13. Gaukroger MC, Allt-Graham J (1994) Percutaneous dilatational tracheostomy. Br J Oral Maxillofac Surg 32: 375–379

    Article  CAS  PubMed  Google Scholar 

  14. Manara AR (1994) Experience with percutaneous tracheostomy in intensive care: the technique of choice? Br J Oral Maxillofac Surg 32: 155–160

    Article  CAS  PubMed  Google Scholar 

  15. Winkler WB, Karnik R, Seelmann O, Havlicek J, Slany J (1994) Bedside percutaneous dilational tracheostomy with endoscopic guidance: experience with 71 ICU patients. Intensive Care Med 20: 476–479

    Article  CAS  PubMed  Google Scholar 

  16. Petros S, Engelmann L (1997) Percutaneous dilatational tracheostomy in a medical ICU. Intensive Care Med 23: 630–634

    Article  CAS  PubMed  Google Scholar 

  17. Bodenham A, Diament R, Cohen A, Webster N (1991) Percutaneous dilational tracheostomy. A bedside procedure on the intensive care unit. Anaesthesia 46: 570–572

    Article  CAS  PubMed  Google Scholar 

  18. Paul A, Marelli D, Chiu RC, Vestweber KH, Mulder DS (1989) Percutaneous endoscopic tracheostomy. Ann Thorac Surg 47: 314–315

    Article  CAS  PubMed  Google Scholar 

  19. Wang MB, Berke GS, Ward PH, Calca-terra TC, Watts D (1992) Early experience with percutaneous tracheotomy. Laryngoscope 102: 157–162

    Article  CAS  PubMed  Google Scholar 

  20. Walz MK (1997) Percutaneous dilatational tracheostomy: method, indications, contraindications and results. Curr Opin Anaesthesiol 10: 101–105

    Article  Google Scholar 

  21. Muhl E, Franke C, Bruch HP (1995) Verbesserte Technik der Dilatations-tracheostomie und erste Ergebnisse. Anästhesiol Intensivmed Notfallmed Schmerzther 30: 497–500

    Article  CAS  PubMed  Google Scholar 

  22. Marelli D, Paul A, Manolidis S, Walsh G, Odim JN, Burdon TA, Shennib H, Vestweber KH, Fleiszer DM, Mulder DS (1990) Endoscopic guided percutaneous tracheostomy: early results of a consecutive trial. J Trauma 30: 433–435

    Article  CAS  PubMed  Google Scholar 

  23. Friedman Y, Fildes J, Mizock B, Samuel J, Patel S, Appavu S, Roberts R (1996) Comparison of percutaneous and surgical tracheostomies. Chest 110: 480–485

    Article  CAS  PubMed  Google Scholar 

  24. Stauffer JL, Olson DE, Petty TL (1981) Complications and consequences of endotracheal intubation and tracheotomy. Am J Med 70: 65–76

    Article  CAS  PubMed  Google Scholar 

  25. Upadhyay A, Maurer J, Turner J, Tiszenkel H, Rosengart T (1996) Elective bedside tracheostomy in the intensive care unit. J Am Coll Surg 183: 51–55

    CAS  PubMed  Google Scholar 

  26. Dayal VS, el-Masri W (1986) Tracheostomy in intensive care setting. Laryngoscope 96: 58–60

    Article  CAS  PubMed  Google Scholar 

  27. Crofts SL, Alzeer A, McGuire GP, Wong DT, Charles D (1995) A comparison of percutaneous and operative tracheostomies in intensive care patients. Can J Anaesth 42: 775–779

    Article  CAS  PubMed  Google Scholar 

  28. Hazard P, Jones C, Benitone J (1991) Comparative clinical trial of standard operative tracheostomy with percutaneous tracheostomy. Crit Care Med 19: 1018–1024

    Article  CAS  PubMed  Google Scholar 

  29. McFarlane C, Denholm SW, Sudlow CL, Moralee SJ, Grant IS, Lee A (1994) Laryngotracheal stenosis: a serious complication of percutaneous tracheostomy. Anaesthesia 49: 38–40

    Article  CAS  PubMed  Google Scholar 

  30. van Heurn LWE, Goei R, de Ploeg I, Ramsay G, Brink PRG (1996) Late complications of percutaneous dilatational tracheotomy. Chest 110: 1572–1576

    Article  PubMed  Google Scholar 

  31. Fischler MP, Kuhn M, Cantieni R, Frutiger A (1995) Late outcome of percutaneous dilatational tracheostomy in intensive care patients. Intensive Care Med 21: 475–481

    Article  CAS  PubMed  Google Scholar 

  32. Law RC, Carney AS, Manara AR (1997) Long-term outcome after percutaneous dilatational tracheostomy. Endoskopie and spirometry findings. Anaesthesia 52: 51–56

    Article  CAS  PubMed  Google Scholar 

  33. Friman L, Hedenstierna G, Schildt B (1976) Stenosis following tracheostomy. Anaesthesia 31: 479–493

    Article  CAS  PubMed  Google Scholar 

  34. van Heurn LWE, Theunissen PHMH, Ramsay G, Brink PRG (1996) Pathologic changes of the trachea after percutaneous dilatational tracheostomy. Chest 109: 1466–1469

    Article  PubMed  Google Scholar 

  35. Dexter TJ (1995) A cadaver study appraising accuracy of blind placement of percutaneous tracheostomy. Anaesthesia 50: 863–864

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Medical School, University of Essen, Hufelandstrasse 55, D-45122, Essen, Germany

    M. K. Walz, K. Peitgen, C. Ahmadi & F. W. Eigler

  2. Department of Anesthesiology, Medical School, University of Essen, Hufelandstrasse 55, D-45122, Essen, Germany

    N. Thürauf & A. Sander

  3. Department of Neurosurgery, Medical School, University of Essen, Hufelandstrasse 55, D-45122, Essen, Germany

    H. A. Trost

  4. Department of Thoracic and Cardiovascular Surgery, Medical School, University of Essen, Hufelandstrasse 55, D-45122, Essen, Germany

    U. Wolfhard

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  1. M. K. Walz
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  2. K. Peitgen
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Walz, M.K., Peitgen, K., Thürauf, N. et al. Percutaneous dilatational tracheostomy — early results and long-term outcome of 326 critically ill patients. Intensive Care Med 24, 685–690 (1998). https://doi.org/10.1007/s001340050645

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  • DOI: https://doi.org/10.1007/s001340050645

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