title: Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve.
abstract: OBJECTIVE
  To assess the complication rate of bronchoscopically guided percutaneous dilational tracheostomy (PDT), with tracheal tube suture fixation and no elective tracheostomy tube exchange, after experience had been gained.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Anaesthesiological ICU with mixed surgical and medical patients in a university hospital.
  
  
  METHODS
  Hundred thirty-three mechanically ventilated patients (mean age: 54.8 years, range: 13-87 years) with indication for PDT, many with thrombocytopenia and/or coagulation deficits.
  
  
  METHODS
  Hundred thirty-six consecutive PDTs performed by residents under bronchoscopic guidance with stepwise dilation ( n=114, Ciaglia's conventional system) or conic dilation ( n=22, "Blue Rhino" approach) and supervision of experienced staff anaesthesiologists. Tracheostomy tubes were fixed to the skin with a suture and no routine exchange of tracheostomy tubes was performed. Complications were categorised and the results were also compared to an earlier prospective study.
  
  
  RESULTS
  The incidence of tracheostomy tube-related complications (hypoxaemia, cannula misplacement, accidental decannulation, cuff rupture and hernia, or posterior tracheal wall lesion) was low (0.7%) and significantly less (6.2%, p=0.01) than in our earlier study. No patient died of PDT-associated complications. We recorded four (2.9%) clinically relevant bleeding episodes. Insertion of tracheal tubes was easy or only moderately difficult in 86.7%.
  
  
  CONCLUSIONS
  With experience in performing PDT, fixation of the tracheal cannula, and omission of routine change of tracheostomy tubes complication rate of PDT is low.
authors.affiliation: Abteilung für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany. martin.beiderlinden@uni-essen.de
authors.forename: Martin
authors.initials: M
authors.lastname: Beiderlinden
authors.forename: Martin
authors.initials: M
authors.lastname: Karl Walz
authors.forename: Andreas
authors.initials: A
authors.lastname: Sander
authors.forename: Harald
authors.initials: H
authors.lastname: Groeben
authors.forename: Jürgen
authors.initials: J
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D006323:Heart Arrest / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007396:Internship and Residency; D008875:Middle Aged; D011446:Prospective Studies; D014139:Tracheostomy / Q000009:adverse effects* / Q000193:education / Q000379:methods