Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve.
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.
Beiderlinden
Martin
M
Abteilung für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany. martin.beiderlinden@uni-essen.de
Karl Walz
Martin
M
Sander
Andreas
A
Groeben
Harald
H
Peters
Jürgen
J
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