title: Safety and Efficiency of Percutaneous Dilatational Tracheostomy With Direct Bronchoscopic Guidance for Thoracic Transplant Recipients.
abstract: BACKGROUND
  Percutaneous dilatational tracheostomy (PDT) is the standard airway access in critically ill patients who require prolonged mechanical ventilation. However, the literature lacks reports about the effectiveness and safety of this procedure in thoracic organ transplant recipients, who have increased risks of bleeding and infection.
  
  
  METHODS
  We retrospectively reviewed the records of subjects who underwent thoracic organ transplantation at our institution between January 2004 and March 2011 followed by PDT (using the Ciaglia Blue Rhino technique with direct bronchoscopic guidance).
  
  
  RESULTS
  From a total of 312 thoracic transplant recipients, we identified 93 (29.8%) subjects with PDT. Of these, 79 had undergone double lung transplant, 11 had undergone heart transplant, 2 had undergone combined heart-lung transplant, and 1 had undergone combined heart-kidney transplant. Mean age was 49.5 ± 11.2 y, and 58% of subjects were female. The mean time from intubation to PDT was 3.7 ± 3.4 d, and mean time from transplant to PDT was 12.6 ± 28.3 d. Thirty-two subjects (34.4%) underwent PDT after re-intubation. Thirty-nine subjects were receiving renal replacement therapy (41.9%), and 28 had a coagulopathy (30.1%). Moderate but not significant bleeding was observed in 3 subjects. There were no major complications during PDT procedures. Forty-five subjects (48.4%) could be weaned successfully from the ventilator and the tracheostoma could be removed. Forty-eight subjects (51.6%) died due to sepsis, multi-organ failure, or transplant failure. No procedure-related deaths were noted. There were no significant late complications. Among the 45 who survived their stay in the ICU, the functional and cosmetic outcomes of PDT were excellent.
  
  
  CONCLUSIONS
  PDT can be safely performed on patients with acute respiratory failure after thoracic organ transplantation. Therefore, we recommend the use of this technique for prolonged airway management in these patients.
authors.affiliation: Department of Intensive Care Medicine, Imland Klinik Rendsburg, Rendsburg, Germany. kevin.pilarczyk@uk.essen.de.
authors.forename: Kevin
authors.initials: K
authors.lastname: Pilarczyk
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Carstens
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Heckmann
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Juri
authors.initials: J
authors.lastname: Lubarski
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Marggraf
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Pizanis
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Kamler
mesh_terms: D000328:Adult; D001999:Bronchoscopy / Q000379:methods; D004106:Dilatation / Q000379:methods*; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D016030:Kidney Transplantation; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects* / Q000379:methods; D019106:Postoperative Hemorrhage / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D014139:Tracheostomy / Q000379:methods*
keywords: airway management; cardiac transplantation; lung transplantation; percutaneous dilatational tracheostomy; thoracic transplantation