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

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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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

Key words

  • Percutaneous dilatational tracheostomy
  • Complications
  • Results
  • Tracheal stenosis