Relative contraindications for percutaneous tracheostomy: from the surgeons' perspective.
OBJECTIVE
Percutaneous tracheostomy (PT) has gained worldwide acceptance as a bedside procedure by intensivists, but its popularity has declined based on reports of some relative contraindications. The aim of this study was to ascertain the perioperative comorbidities of PT when it is performed by surgeons with experience performing standard tracheostomy.


METHODS
Prospective data were collected and analyzed for consecutive PTs performed in intensive care units.


RESULTS
No procedure-related mortality occurred in the present study. No significant differences in perioperative comorbidities, such as transient hemodynamic instability and postoperative wound infection, were noted between the relative contraindication (RC) and normal condition (NC) groups. Otherwise, instrument failure (5 cases, p = 0.052) and procedure failure (2 cases, p = 0.222) occurred in the RC group, but not in the NC group. Two patients in the NC group and one patient in the RC group needed to undergo a reoperation to check for bleeding. In a subgroup analysis, more bleeding events were noted for the patients with coagulopathy (p = 0.057), and premature extubation of the endotracheal tube/instrument failure (p = 0.073) was more common in the patients with neck anatomical difficulty in the RC group.


CONCLUSIONS
For patients with relative contraindications, the potential of using PT should be determined on an individual basis. Special attention should be paid to the possibility of instrument failure and bleeding events for the patients with relative contraindications for PT.
Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, 201 Section 2 Shih-Pai Road, Taipei, Taiwan, huangcs@vghtpe.gov.tw.
Chien-Sheng
CS
Huang
Pin-Tarng
PT
Chen
Shu-Hui
SH
Cheng
Chun-Ku
CK
Chen
Po-Kuei
PK
Hsu
Chih-Cheng
CC
Hsieh
Chun-Che
CC
Shih
Wen-Hu
WH
Hsu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation / Q000295:instrumentation; D001999:Bronchoscopy; D000075202:Contraindications; D003422:Critical Care; D004868:Equipment Failure; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014139:Tracheostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D055815:Young Adult