Videobronchoscopic guidance makes percutaneous dilational tracheostomy safer

  • M. Oberwalder
  • H. Weiss
  • H. Nehoda
  • R. Kafka-Ritsch
  • H. Bonatti
  • R. Prommegger
  • F. Aigner
  • C. Profanter
Original article



Percutaneous dilational tracheostomy (PDT) can be performed under either conventional bronchoscopic or videobronchoscopic guidance. Only the latter procedure provides the surgeon with direct visual information. This study prospectively assessed procedural parameters and complications of PDT guided by conventional bronchoscopy (CB) or videobronchoscopy (VB).


Consecutive intensive care unit (ICU) patients who underwent PDT were enrolled in this study. Videobronchoscopy was available in two ICUs, whereas CB was available in three ICUs. Demographic data, procedural variables, and complications were recorded.


In this study, 36 patients underwent PDT guided by VB (group V), and 38 patients underwent PDT guided by CB (group C). The two groups were well matched in terms of gender, anatomic aspects, and positioning of the patient. Operating time, procedural difficulty, and extent of tracheal bleeding were not different between the two groups. Group V showed a tendency to younger age (p = 0.055). Surgeons significantly more often considered PTD to be “completely safe” in group V (92% vs 61% in group C). The skin incisions were smaller (p = 0.003), and the extent of stomal bleeding was less (p = 0.001). Complications were tendentiously less frequent in group V (5.5%) than in group C (23.7%; p = 0.062).


The surgeon performing PDT guided by VB has a higher degree of safety, resulting in less bleeding than with PDT guided by CB.


Percutaneous dilational tracheostomy Conventional bronchoscopy Videobronchoscopy 


  1. 1.
    Barba, CA, Angood, PB, Kauder, DR, Latenser, B, Martin, K, McGonigal, MD, Phillips, GR, Rotondo, MF, Schwab, CW 1995Bronchoscopic guidance makes percutaneous tracheostomy a safe, cost-effective, and easy-to-teach procedure.Surgery118879883PubMedGoogle Scholar
  2. 2.
    Ciaglia, P 1999Video-assisted endoscopy, not just endoscopy, for percutaneous dilatational tracheostomy.Chest115915916CrossRefPubMedGoogle Scholar
  3. 3.
    Cobean, R, Beals, M, Moss, C, Bredenberg, CE 1996Percutaneous dilatational tracheostomy: a safe, cost-effective bedside procedure.Arch Surg131265271PubMedGoogle Scholar
  4. 4.
    Cokis, C, Towler, S 2000Tracheo-innominate fistula after initial percutaneous tracheostomy.Anaesth Intensive Care28566569PubMedGoogle Scholar
  5. 5.
    Delank, KW, Schmal, F, Stoll, W 2002Trauma of the membranous trachea managed by the ENT surgeon.Laryngorhinootologie81299304Google Scholar
  6. 6.
    Dulguerov, P, Gysin, C, Perneger, TV, Chevrolet, JC 1999Percutaneous or surgical tracheostomy: a meta-analysis.Crit Care Med2716171625PubMedGoogle Scholar
  7. 7.
    Fernandez, L, Norwood, S, Roettger, R, Gass, D, Wilkins, H,III 1996Bedside percutaneous tracheostomy with bronchoscopic guidance in critically ill patients.Arch Surg131129132PubMedGoogle Scholar
  8. 8.
    Freeman, BD, Isabella, K, Cobb, JP, Boyle, WA,III, Schmieg, RE,Jr, Kolleff, MH, Lin, N, Saak, T, Thompson, EC, Buchman, TG 2001A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients.Crit Care Med29926930Google Scholar
  9. 9.
    Griggs, WM, Myburgh, JA, Worthley, LI 1991A prospective comparison of a percutaneous tracheostomy technique with standard surgical tracheostomy.Intensive Care Med17261263PubMedGoogle Scholar
  10. 10.
    Griggs, WM, Worthley, LI, Gilligan, JE, Thomas, PD, Myburg, JA 1990A simple percutaneous tracheostomy technique.Surg Gynecol Obstet170543545PubMedGoogle Scholar
  11. 11.
    Gysin, C, Dulguerov, P, Guyot, JP, Perneger, TV, Abajo, B, Chevrolet, JC 1999Percutaneous versus surgical tracheostomy: a double-blind randomized trial.Ann Surg230708714CrossRefPubMedGoogle Scholar
  12. 12.
    Hinerman, R, Alvarez, F, Keller, CA 2000Outcome of bedside percutaneous tracheostomy with bronchoscopic guidance.Intensive Care Med2618501856PubMedGoogle Scholar
  13. 13.
    Hurter, H, Post-Stanke, A, Tolksdorf, W 2000Lethal vascular erosion after percutaneous dilatation tracheostomy.Anasthesiol Intensivmed Notfallmed Schmerzther35658660CrossRefPubMedGoogle Scholar
  14. 14.
    Jefferson, P, Ball, DR 2002Endoscopy is useful during percutaneous tracheostomy.BMJ324977978CrossRefGoogle Scholar
  15. 15.
    Kaylie, DM, Wax, MK 2002Massive subcutaneous emphysema following percutaneous tracheostomy.Am J Otolaryngol23300302CrossRefPubMedGoogle Scholar
  16. 16.
    Kedjanyi, WK, Gupta, D 2001Near total transection of the trachea following percutaneous dilatational tracheostomy.J R Coll Surg Edinb46242243Google Scholar
  17. 17.
    Khalili, TM, Koss, W, Margulies, DR, Morrison, E, Shabot, MM 2002Percutaneous dilatational tracheostomy is as safe as open tracheostomy.Am Surg689294PubMedGoogle Scholar
  18. 18.
    Lin, JC, Maley, RH,Jr, Landreneau, RJ 2000Extensive posterior-lateral tracheal laceration complicating percutaneous dilational tracheostomy.Ann Thorac Surg7011941196PubMedGoogle Scholar
  19. 19.
    Maddali, MM, Pratap, M, Fahr, J, Zarroug, AW 2001Percutaneous tracheostomy by guidewire dilating forceps technique: review of 98 patients.J Postgrad Med47100103PubMedGoogle Scholar
  20. 20.
    Madden, B, Datta, S, Hussain, I, McAnulty, G 2001Tracheal stenting for rupture of the posterior wall of the trachea following percutaneous tracheostomy.Monaldi Arch Chest Dis56320321PubMedGoogle Scholar
  21. 21.
    Muhammad, JK, Patton, DW, Evans, RM, Major, E 1999Percutaneous dilatational tracheostomy under ultrasound guidance.Br J Oral Maxillofac Surg37309311CrossRefPubMedGoogle Scholar
  22. 22.
    Sustic, A, Krstulovic, B, Eskinja, N, Zelic, M, Ledic, D, Turina, D 2002Surgical tracheostomy versus percutaneous dilational tracheostomy in patients with anterior cervical spine fixation: preliminary report.Spine.2719421945CrossRefPubMedGoogle Scholar
  23. 23.
    Heurn, LW, Mastboom, WB, Scheeren, CI, Brink, PR, Ramsay, G 2001Comparative clinical trial of progressive dilatational and forceps dilatational tracheostomy.Intensive Care Med27292295CrossRefPubMedGoogle Scholar
  24. 24.
    Wein, RO, Popat, SR, Watson, T, Orlando, G 2002Management of an acquired tracheoesophageal fistula with a fascial free flap.Head Neck24609613CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • M. Oberwalder
    • 1
  • H. Weiss
    • 1
  • H. Nehoda
    • 1
  • R. Kafka-Ritsch
    • 1
  • H. Bonatti
    • 1
  • R. Prommegger
    • 1
  • F. Aigner
    • 1
  • C. Profanter
    • 1
  1. 1.Department of General and Transplant SurgeryUniversity of InnsbruckInnsbruckAustria

Personalised recommendations