Document Detail


Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve.
MedLine Citation:
PMID:  11819001     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the complication rate of bronchoscopically guided percutaneous dilational tracheostomy (PDT), with tracheal tube suture fixation and no elective tracheostomy tube exchange, after experience had been gained. DESIGN: Prospective clinical study. SETTING: Anaesthesiological ICU with mixed surgical and medical patients in a university hospital. PATIENTS: Hundred thirty-three mechanically ventilated patients (mean age: 54.8 years, range: 13-87 years) with indication for PDT, many with thrombocytopenia and/or coagulation deficits. INTERVENTIONS: Hundred thirty-six consecutive PDTs performed by residents under bronchoscopic guidance with stepwise dilation ( n=114, Ciaglia's conventional system) or conic dilation ( n=22, "Blue Rhino" approach) and supervision of experienced staff anaesthesiologists. Tracheostomy tubes were fixed to the skin with a suture and no routine exchange of tracheostomy tubes was performed. Complications were categorised and the results were also compared to an earlier prospective study. RESULTS: The incidence of tracheostomy tube-related complications (hypoxaemia, cannula misplacement, accidental decannulation, cuff rupture and hernia, or posterior tracheal wall lesion) was low (0.7%) and significantly less (6.2%, p=0.01) than in our earlier study. No patient died of PDT-associated complications. We recorded four (2.9%) clinically relevant bleeding episodes. Insertion of tracheal tubes was easy or only moderately difficult in 86.7%. CONCLUSION: With experience in performing PDT, fixation of the tracheal cannula, and omission of routine change of tracheostomy tubes complication rate of PDT is low.
Authors:
Martin Beiderlinden; Martin Karl Walz; Andreas Sander; Harald Groeben; Jürgen Peters
Publication Detail:
Type:  Journal Article     Date:  2001-11-29
Journal Detail:
Title:  Intensive care medicine     Volume:  28     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2002 Jan 
Date Detail:
Created Date:  2002-03-06     Completed Date:  2002-03-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  59-62     Citation Subset:  IM    
Affiliation:
Abteilung für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany. martin.beiderlinden@uni-essen.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Bronchoscopy
Heart Arrest / etiology
Hemorrhage / etiology
Humans
Internship and Residency
Middle Aged
Prospective Studies
Tracheostomy / adverse effects*,  education,  methods

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