title: Repeat percutaneous tracheostomy in the neurocritically ill patient.
abstract: BACKGROUND
  Percutaneous tracheostomy is a widely used and accepted method for long-term mechanical ventilation and airway protection. Neurocritically ill patients sometimes require repeat tracheostomy, which is traditionally considered a relative contraindication for percutaneous procedure. The aim of this study was to determine the safety of repeat percutaneous tracheostomy in neurocritically ill patients with a history of previous tracheostomy.
  
  
  METHODS
  In the 16-bed academic neurointensive care unit, we prospectively enrolled patients who needed new tracheostomy placement for airway protection or prolonged mechanical ventilation and had previously undergone percutaneous tracheostomy placement. We collected data on indications, procedure, periprocedural complications, and outcome of repeated tracheostomy.
  
  
  RESULTS
  Between January 2001 and October 2005, we enrolled 12 consecutive patients (mean age 35.4 +/- 7.0 years) who underwent repeat percutaneous tracheostomy. Head injury was the most common underlying diagnosis (seven patients, 58%). Tracheostomy tube placement was easy and successful in all patients, and none of the patients needed conversion to surgical tracheostomy. In three patients, ultrasound-guided needle aspiration was used before the procedure to confirm the position of the trachea. No patients died or experienced serious complication related to the procedure. Two patients (17%) had a minor periprocedural bleeding, which was controlled with local compression. Long-term outcome was poor, with only two patients alive and off the ventilator at hospital discharge, both with serious disability.
  
  
  CONCLUSIONS
  Repeat percutaneous tracheostomy can be performed safely in neurocritically ill patients who have undergone previous tracheostomy.
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Antalya, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Yilmaz
authors.forename: Levent
authors.initials: L
authors.lastname: Dosemeci
authors.forename: Melike
authors.initials: M
authors.lastname: Cengiz
authors.forename: Suat
authors.initials: S
authors.lastname: Sanli
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.forename: Atilla
authors.initials: A
authors.lastname: Ramazanoglu
mesh_terms: D000328:Adult; D003422:Critical Care; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014139:Tracheostomy; D016896:Treatment Outcome