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

Abstract

Purpose

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.

Methods

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

Results

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.

Conclusions

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.

Keywords

Bronchoscope Intensive care Practice guidelines Tracheostomy 

Notes

Acknowledgments

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.

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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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