Percutaneous dilatational tracheostomy--early results and long-term outcome of 326 critically ill patients.
OBJECTIVE
To analyze perioperative and postoperative complications and long-term sequelae following percutaneous dilatational tracheostomy (PDT).


METHODS
A prospective clinical study of patients undergoing PDT.


METHODS
Seven intensive care units at a University hospital


METHODS
326 intensive care patients (202 male, 124 female; age: 11-95 years) with indications for tracheostomy.


METHODS
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.


CONCLUSIONS
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.
Department of General Surgery, Medical School, University of Essen, Germany.
M K
MK
Walz
K
K
Peitgen
N
N
Thürauf
H A
HA
Trost
U
U
Wolfhard
A
A
Sander
C
C
Ahmadi
F W
FW
Eigler
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002648:Child; D016638:Critical Illness; D004106:Dilatation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors; D014135:Tracheal Stenosis / Q000209:etiology; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome