title: Repeat bedside percutaneous dilational tracheostomy is a safe procedure.
abstract: OBJECTIVE
  Previous tracheostomy has been considered a relative contraindication for percutaneous dilational tracheostomy. The objective of this study was to assess the safety of percutaneous dilational tracheostomy in critically ill patients with a history of previous tracheostomy.
  
  
  METHODS
  Retrospective, single-center case series of all consecutive patients requiring repeat tracheostomy for continued mechanical ventilatory support.
  
  
  METHODS
  Intensive care unit of a tertiary-care referral center.
  
  
  METHODS
  Fourteen patients (eight female, six male) with a median age of 70 yrs (range, 33-94). All patients had previously undergone tracheostomy.
  
  
  METHODS
  Bedside percutaneous dilational tracheostomy.
  
  
  RESULTS
  Subjects' previous tracheostomies dated back between 10 days and 8 yrs. Present intubation time before percutaneous dilational tracheostomy varied between 4 and 30 days. Bedside percutaneous dilational tracheostomy was performed successfully in all 14 patients by trained pulmonologists and surgeons. Eleven patients received an 8-mm and three received a 7-mm tracheostomy tube. There were no significant periprocedural complications, and no patient required surgical revision. The only postprocedural complication was accidental decannulation in one patient, which was managed with repeat percutaneous dilational tracheostomy.
  
  
  CONCLUSIONS
  Trained physicians can safely perform bedside percutaneous dilational tracheostomy after previous tracheostomy. Percutaneous dilational tracheostomy offers an alternative to surgical tracheostomy in this particular patient population and should not be considered contraindicated.
authors: Pulmonary Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors: Marianne
authors: M
authors: Meyer
authors: Jonathan
authors: J
authors: Critchlow
authors: Naresh
authors: N
authors: Mansharamani
authors: Luis F
authors: LF
authors: Angel
authors: Robert
authors: R
authors: Garland
authors: Armin
authors: A
authors: Ernst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D004106:Dilatation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012449:Safety; D014139:Tracheostomy / Q000379:methods*