Safety of percutaneous dilatational tracheostomy with direct bronchoscopic guidance for solid organ allograft recipients.
OBJECTIVE
To determine the safety of percutaneous dilatational tracheostomy (PDT) for solid organ allograft recipients, who have increased risks of bleeding and infection.


METHODS
We reviewed the records of patients who underwent solid organ transplant between January 1, 2001, and September 30, 2005, followed by PDT (using the Ciaglia technique) with direct bronchoscopic guidance. We recorded comorbid conditions, number of days from intubation and transplant, positive end-expiratory pressures, ratios of PaO2 to fraction of inspired oxygen, coagulation study findings, complications, and procedure-related mortality rates.


RESULTS
Of the 51 patients in our study, 17 had undergone lung transplant; 32, liver transplant; and 2, kidney transplant. The median age was 55 years (range, 27-73), and 53% of patients were men. The median time from intubation to PDT was 10 days and from transplant to PDT, 22 days. The median ratio of PaO2 to fraction of inspired oxygen was 293, and the median positive end-expiratory pressure was 5 cm H2O. Twenty-one patients were receiving dialysis, and 11 were recovering from sepsis (of these, 8 were receiving vasopressors). Ten had coagulopathies (none of which were associated with bleeding complications). Complications were infrequent (7 periprocedural, 4 postprocedural) and included bleeding, bradycardia, hypotension, tracheal ring fracture, and cannula malfunction. Of the bleeding complications, only 2 were clinically remarkable and required removal of the tracheostomy or surgical revision. No infectious complications or procedure-related deaths were noted.


CONCLUSIONS
Percutaneous dilatational tracheostomy was tolerated well in recipients of solid organ allografts and had a relatively low risk of major complications and a low procedure-related mortality rate. This method should be considered an acceptable alternative to surgical tracheostomy.
Division of Pulmonary Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA.
E Andrew
EA
Waller
Javier F
JF
Aduen
David J
DJ
Kramer
Francisco
F
Alvarez
Michael G
MG
Heckman
Julia E
JE
Crook
Octavio E
OE
Pajaro
Lawrence R
LR
McBride
Cesar A
CA
Keller
D000328:Adult; D000368:Aged; D001999:Bronchoscopy; D015331:Cohort Studies; D004106:Dilatation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D011183:Postoperative Complications; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome