title: Percutaneous Dilational Tracheotomy in Solid-Organ Transplant Recipients.
abstract: OBJECTIVE
  Solid-organ transplant recipients may require percutaneous dilational tracheotomy because of prolonged mechanical ventilation or airway issues, but data regarding its safety and effectiveness in solid-organ transplant recipients are scarce. Here, we evaluated the safety, effectiveness, and benefits in terms of lung mechanics, complications, and patient comfort of percutaneous dilational tracheotomy in solid-organ transplant recipients.
  
  
  METHODS
  Medical records from 31 solid-organ transplant recipients (median age of 41.0 years [interquartile range, 18.0-53.0 y]) who underwent percutaneous dilational tracheotomy at our hospital between January 2010 and March 2015 were analyzed, including primary diagnosis, comorbidities, duration of orotracheal intubation and mechanical ventilation, length of intensive care unit and hospital stays, the time interval between transplant to percutaneous dilational tracheotomy, Acute Physiology and Chronic Health Evaluation II score, tracheotomy-related complications, and pulmonary compliance and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen.
  
  
  RESULTS
  The median Acute Physiology and Chronic Health Evaluation II score on admission was 24.0 (interquartile range, 18.0-29.0). The median interval from transplant to percutaneous dilational tracheotomy was 105.5 days (interquartile range, 13.0-2165.0 d). The only major complication noted was left-sided pneumothorax in 1 patient. There were no significant differences in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen before and after procedure (170.0 [interquartile range, 102.2-302.0] vs 210.0 [interquartile range, 178.5-345.5]; P = .052). However, pulmonary compliance results preprocedure and postprocedure were significantly different (0.020 L/cm H2O [interquartile range, 0.015-0.030 L/cm H2O] vs 0.030 L/cm H2O [interquartile range, 0.020-0.041 L/cm H2O); P = .001]). Need for sedation significantly decreased after tracheotomy (from 17 patients [54.8%] to 8 patients [25.8%]; P = .004]).
  
  
  CONCLUSIONS
  Percutaneous dilational tracheotomy with bronchoscopic guidance is an efficacious and safe technique for maintaining airways in solidorgan transplant recipients who require prolonged mechanical ventilation, resulting in possible improvements in ventilatory mechanics and patient comfort.
authors.affiliation: From the Department of Anesthesiology and Critical Care Medicine, School of Medicine, Baskent University, Ankara, Turkey.
authors.forename: Aycan
authors.initials: A
authors.lastname: Ozdemirkan
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Ersoy
authors.forename: Pinar
authors.initials: P
authors.lastname: Zeyneloglu
authors.forename: Ender
authors.initials: E
authors.lastname: Gedik
authors.forename: Arash
authors.initials: A
authors.lastname: Pirat
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D001999:Bronchoscopy; D004106:Dilatation; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D020127:Recovery of Function; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015656:Respiratory Mechanics; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014140:Tracheotomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult