Open Access

Complications of percutaneous dilating tracheostomy

  • Dave A Dongelmans1,
  • Ary-Jan van der Lely2,
  • Robert Tepaske3 and
  • Marcus J Schultz4Email author
Critical Care20048:397

DOI: 10.1186/cc2941

Published: 24 August 2004

We read with interest the retrospective analysis of patients who underwent percutaneous tracheostomy by Fikkers and colleagues [1]. We were surprised by the high complication rates with both the guidewire dilating forceps (GWDF) technique and the Ciaglia Blue Rhino (CBR) technique in their series (25.1% and 41.5%, respectively).

We prospectively collected data on perioperative complications of CBR from February 2000 to February 2003; in this period we performed 128 percutaneous dilating tracheostomies with the CBR technique. The complication rate was extremely low (Table 1). Although we must mention that we considered bleeding to have taken place only when blood loss was 'guesstimated' to be more than 20 ml, life-threatening blood loss or blood loss requiring surgical exploration was never encountered. Furthermore, we identified no complications related to needle insertion.
Table 1

Perioperative complications of Ciaglia Blue Rhino

Complication

n

%

No complications

121

94.5

Minor complications

  

   Bleeding

5

3.9

   Subcutaneous emphysema

0

0

   Air leakage cuff

0

0

   Puncture endotracheal tube

0

0

   Puncture posterior tracheal wall

0

0

   Accidental detubation

0

0

   Hypotension

1

0.8

Major complications

  

   Bleeding

0

0

   Fausse route

0

0

   Oesophageal perforation

0

0

   Pneumothorax

0

0

Conversion to surgical procedure1

1

0.8

1In one patient the percutaneous tracheostomy was converted into a surgical procedure, because of an overlying thyroid gland.

Our complication rate is in accordance with those found in other series [2, 3].

Authors' response

Bernard G Fikkers and Johannes G van der Hoeven

We thank Dr Dongelmans and coworkers for their interest in our study. They state that they are surprised by our high complication rate and that their complication rate is in accordance with those found in other series, referring to just two studies.

The first study, that by Polderman and coworkers [2], which employed the GWDF technique, found a major complication rate of 4.0%. The other study, that by Berrouschot and coworkers [3], in which the multiple dilator technique was employed, reported a 7.9% major perioperative complication rate, including one death (caused by tracheal laceration). Minor complications were not reported. It is difficult to believe that the patients in those two series suffered only from major complications and not any minor ones! We prospectively collected all our data and found major complication rates of 7.6% with GWDF and 5.3% with CBR. Because the difference between major and minor complications is important, we have decided for future research to categorize complications related to percutaneous tracheostomy as minor, intermediate and major (Fig. 1). Using these new definitions, the major complication rates in our series are 2.3% and 2.9%, respectively, because most major complications would be redefined as intermediate. Moreover, because we meticulously registered our perioperative complications, we are able to inform readers about all other complications they may encounter, although the majority is rarely clinically relevant.
https://static-content.springer.com/image/art%3A10.1186%2Fcc2941/MediaObjects/13054_2004_Article_2926_Fig1_HTML.jpg
Figure 1

Complications of percutaneous tracheostomy.

We congratulate our colleagues from Amsterdam for their excellent results. We analyzed the available literature published up until 2002 and found that major complications varied from 0% to 14% (average 3.0%) in 28 studies (4066 patients) that used the multiple dilator technique; from 0% to 4.9% (average 3.0%) in six studies (461 patients) that used the GWDF technique; and from 1.3% to 5.0% (average 2.8%) in three studies (286 patients) using the CBR technique. We therefore feel that our results are completely in accordance with the existing literature. (For full details of our analysis and reference details, see Additional file 1.)

Abbreviations

CBR: 

Ciaglia Blue Rhino

GWDF: 

guidewire dilating forceps

Declarations

Authors’ Affiliations

(1)
Anaesthesiologist-Intensivist, Departments of Intensive Care Medicine and Anaesthesiology, Academic Medical Center
(2)
Fellow Intensive Care Medicine, Department of Intensive Care Medicine, Academic Medical Center
(3)
Anaesthesiologist-Intensivist, Department of Intensive Care Medicine, Academic Medical Center
(4)
Internist-Intensivist, Department of Intensive Care and Laboratory of Experimental Internal Medicine, Academic Medical Center

References

  1. Fikkers BG, Staatsen M, Lardenoije SGGF, van den Hoogen FJA, van der Hoeven JG: Comparison of two percutaneous tracheostomy techniques, guide wire dilating forceps and Ciaglia Blue Rhino: a sequential cohort study. Crit Care 2004, 8: R299-R305. 10.1186/cc2907PubMed CentralView ArticlePubMed
  2. Polderman KH, Spijkstra JJ, de Bree R, Christiaans HM, Gelissen HP, Wester JP, Girbes AR: Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication. Chest 2003, 123: 1595-1602. 10.1378/chest.123.5.1595View ArticlePubMed
  3. Berrouschot J, Oeken J, Steiniger L, Schneider D: Perioperative complications of percutaneous dilational tracheostomy. Laryngoscope 1997, 107: 1538-1544. 10.1097/00005537-199711000-00021View ArticlePubMed

Copyright

© BioMed Central Ltd 2004

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