Surgery Today

, Volume 44, Issue 1, pp 107–114 | Cite as

Relative contraindications for percutaneous tracheostomy: from the surgeons’ perspective

  • Chien-Sheng Huang
  • Pin-Tarng Chen
  • Shu-Hui Cheng
  • Chun-Ku Chen
  • Po-Kuei Hsu
  • Chih-Cheng Hsieh
  • Chun-Che Shih
  • Wen-Hu Hsu
Original Article



Percutaneous tracheostomy (PT) has gained worldwide acceptance as a bedside procedure by intensivists, but its popularity has declined based on reports of some relative contraindications. The aim of this study was to ascertain the perioperative comorbidities of PT when it is performed by surgeons with experience performing standard tracheostomy.


Prospective data were collected and analyzed for consecutive PTs performed in intensive care units.


No procedure-related mortality occurred in the present study. No significant differences in perioperative comorbidities, such as transient hemodynamic instability and postoperative wound infection, were noted between the relative contraindication (RC) and normal condition (NC) groups. Otherwise, instrument failure (5 cases, p = 0.052) and procedure failure (2 cases, p = 0.222) occurred in the RC group, but not in the NC group. Two patients in the NC group and one patient in the RC group needed to undergo a reoperation to check for bleeding. In a subgroup analysis, more bleeding events were noted for the patients with coagulopathy (p = 0.057), and premature extubation of the endotracheal tube/instrument failure (p = 0.073) was more common in the patients with neck anatomical difficulty in the RC group.


For patients with relative contraindications, the potential of using PT should be determined on an individual basis. Special attention should be paid to the possibility of instrument failure and bleeding events for the patients with relative contraindications for PT.


Bronchoscope Intensive care Practice guidelines Tracheostomy 



This work was supported in part by a grant from the Lung Cancer Foundation in memory of Doctor K.S. Lu, Taipei, Taiwan.

Conflict of interest

CS Huang and co-authors have no conflict of interest to declare.


  1. 1.
    Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest. 1985;87:715–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Bacchetta MD, Girardi LN, Southard EJ, et al. Comparison of open versus bedside percutaneous dilatational tracheostomy in the cardiothoracic surgical patient: outcomes and financial analysis. Ann Thorac Surg. 2005;79:1879–85.PubMedCrossRefGoogle Scholar
  3. 3.
    Madsen KR, Guldager H, Rewers M, et al. Guidelines for percutaneous dilatational tracheostomy (PDT) from the Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM). Dan Med Bull. 2011;58:C4358.PubMedGoogle Scholar
  4. 4.
    Silvester W, Goldsmith D, Uchino S, et al. Percutaneous versus surgical tracheostomy: a randomized controlled study with long-term follow-up. Crit Care Med. 2006;34:2145–52.PubMedCrossRefGoogle Scholar
  5. 5.
    Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care. 2006;10:R55.PubMedCrossRefGoogle Scholar
  6. 6.
    Lin TY, Huang CJ, Lin HC. Massive subcutaneous emphysema following bronchoscopy-guided percutaneous dilatational tracheostomy. J Formos Med Assoc. 2005;104:942–5.PubMedGoogle Scholar
  7. 7.
    Grant CA, Dempsey G, Harrison J, Jones T. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review. Br J Anaesth. 2006;96:127–31.PubMedCrossRefGoogle Scholar
  8. 8.
    Walz MK, Peitgen K, Thurauf N, et al. Percutaneous dilatational tracheostomy—early results and long-term outcome of 326 critically ill patients. Intensive Care Med. 1998;24:685–90.PubMedCrossRefGoogle Scholar
  9. 9.
    McCormick B, Manara AR. Mortality from percutaneous dilatational tracheostomy. A report of three cases. Anaesthesia. 2005;60:490–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Beiderlinden M, Karl Walz M, Sander A, et al. Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve. Intensive Care Med. 2002;28:59–62.PubMedCrossRefGoogle Scholar
  11. 11.
    Ngaage DL, Cale AR, Griffin S, et al. Is post-sternotomy percutaneous dilatational tracheostomy a predictor for sternal wound infections? Eur J Cardiothorac Surg. 2008;33:1076–9. (discussion 1080–1071).PubMedCrossRefGoogle Scholar
  12. 12.
    Sheu CC, Tsai JR, Hung JY, et al. A simple modification of Ciaglia Blue Rhino technique for tracheostomy: using a guidewire dilating forceps for initial dilation. Eur J Cardiothorac Surg. 2007;31:114–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Ben Nun A, Altman E, Best LA. Extended indications for percutaneous tracheostomy. Ann Thorac Surg. 2005;80:1276–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Shiwaku K, Anuurad E, Enkhmaa B, et al. Appropriate BMI for Asian populations. Lancet. 2004;363:1077.PubMedCrossRefGoogle Scholar
  15. 15.
    Susarla SM, Peacock ZS, Alam HB. Percutaneous dilatational tracheostomy: review of technique and evidence for its use. J Oral Maxillofac Surg. 2012;70:74–82.PubMedCrossRefGoogle Scholar
  16. 16.
    Fikkers BG, van Veen JA, Kooloos JG, et al. Emphysema and pneumothorax after percutaneous tracheostomy: case reports and an anatomic study. Chest. 2004;125:1805–14.PubMedCrossRefGoogle Scholar
  17. 17.
    Shlugman D, Satya-Krishna R, Loh L. Acute fatal haemorrhage during percutaneous dilatational tracheostomy. Br J Anaesth. 2003;90:517–20.PubMedCrossRefGoogle Scholar
  18. 18.
    Beiderlinden M, Eikermann M, Lehmann N, et al. Risk factors associated with bleeding during and after percutaneous dilational tracheostomy. Anaesthesia. 2007;62:342–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Rahmanian PB, Adams DH, Castillo JG, et al. Tracheostomy is not a risk factor for deep sternal wound infection after cardiac surgery. Ann Thorac Surg. 2007;84:1984–91.PubMedCrossRefGoogle Scholar
  20. 20.
    Force SD, Miller DL, Petersen R, et al. Incidence of deep sternal wound infections after tracheostomy in cardiac surgery patients. Ann Thorac Surg. 2005;80:618–21. (discussion 621–612).PubMedCrossRefGoogle Scholar
  21. 21.
    Curtis JJ, Clark NC, McKenney CA, et al. Tracheostomy: a risk factor for mediastinitis after cardiac operation. Ann Thorac Surg. 2001;72:731–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Berrizbeitia LD. Invited commentary. Respiratory failure should be managed aggressively and a tracheostomy should not be withheld once the need for prolonged ventilatory support has been established. Ann Thorac Surg. 2007;84:1991–2.PubMedCrossRefGoogle Scholar
  23. 23.
    Huang CS, Chen PT, Chen CK, Shih CC. Contraindications to percutaneous tracheostomy due to anomaly of aortic-arch branches origin and running: relative or absolute. Eur J Cardiothorac Surg. 2012;41:458. (author reply 459).PubMedCrossRefGoogle Scholar
  24. 24.
    De Leyn P, Bedert L, Delcroix M, et al. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg. 2007;32:412–21.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Chien-Sheng Huang
    • 1
    • 6
  • Pin-Tarng Chen
    • 2
    • 6
  • Shu-Hui Cheng
    • 3
    • 6
  • Chun-Ku Chen
    • 4
    • 6
  • Po-Kuei Hsu
    • 1
    • 6
  • Chih-Cheng Hsieh
    • 1
    • 6
  • Chun-Che Shih
    • 5
    • 6
  • Wen-Hu Hsu
    • 1
    • 6
  1. 1.Division of Thoracic Surgery, Department of SurgeryTaipei Veterans General HospitalTaipeiTaiwan
  2. 2.Department of AnesthesiologyTaipei Veterans General HospitalTaipeiTaiwan
  3. 3.Department of NursingTaipei Veterans General HospitalTaipeiTaiwan
  4. 4.Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan
  5. 5.Division of Cardiovascular Surgery, Department of SurgeryTaipei Veterans General HospitalTaipeiTaiwan
  6. 6.Institute of Clinical Medicine, School of MedicineNational Yang-Ming UniversityTaipeiTaiwan

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