Laryngotracheal injury after percutaneous dilational tracheostomy in cadaver specimens.
OBJECTIVE
To evaluate the stoma and surrounding insertion site for common laryngotracheal injury patterns after percutaneous dilational tracheostomy that may contribute to clinically significant tracheal stenosis.


METHODS
Preliminary prospective cadaver study.


METHODS
A preliminary prospective cadaver study was performed in which percutaneous dilational tracheostomy (Ciaglia Blue Rhino kit) was placed in six fixed cadaveric specimens. Laryngotracheal segments were harvested. Two independent evaluators graded cadaver features and characteristic injuries in laryngotracheal specimens the tracheal site of stoma placement was identified. Cadaver features evaluated included gender, obesity, and ease of landmark identification. Mucosal and cartilage injuries were evaluated on a scale of 0 to 4, with 4 representing severe comminuted injuries beyond the intended stoma site.


RESULTS
Accurate prediction of tracheal placement was achieved in only three (50%) of the specimens. In the remaining cadavers, one stoma site was placed higher than intended (16%) and two sites were lower than intended (33%). Mucosal injury was most severe at the anterior internal surface of the trachea with all specimens sustaining tears beyond one tracheal ring (mean mucosal injury score, 3.5). Cartilaginous injury was severe in five of six specimens (83%) that sustained multiple comminuted injuries to two or more adjacent rings (mean cartilage injury score, 3.34). Cricoid comminutions and a posterior membranous tracheal wall injury were each found in one specimen.


CONCLUSIONS
Laryngotracheal injuries found after percutaneous dilational tracheostomy in the study indicated that severe damage to mucosa and cartilage surrounding the intended stoma site occurs at the time of placement. These injuries may contribute to clinically significant tracheal stenosis preventing decannulation in patients undergoing percutaneous dilational tracheostomy. Two case studies that support this hypothesis are also presented.
Hotchkiss
Karin S
KS
Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa 33612, USA. khotchki@hsc.usf.edu
McCaffrey
Judith Czaja
JC
D000328:Adult; D002102:Cadaver; D004106:Dilatation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D007830:Larynx / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D011183:Postoperative Complications / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods; D011446:Prospective Studies; D054047:Surgical Stomas; D014132:Trachea / Q000293:injuries*; D014135:Tracheal Stenosis / Q000209:etiology / Q000517:prevention & control; D014139:Tracheostomy / Q000009:adverse effects* / Q000379:methods