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  • Letter
  • Open Access

Human factors play a vital role in the outcome of percutaneous dilatational tracheostomy

Critical Care201418:409

  • Published:


  • Public Health
  • Risk Assessment
  • Emergency Medicine
  • Vital Role
  • Human Factor

In a recent issue of Critical Care, we read with great interest the report by Simon and colleagues [1] on fatal complications of percutaneous dilatational tracheostomy (PDT). We agree with the authors’ suggestions for improving the safety of this procedure, but we think these improvements cover only part of the picture. We have previously concluded that PDT is a high-risk procedure [2]. This led us to perform a risk assessment of PDT in the ICU, where we found that several non-technical factors also influence the outcome of PDT [3]. In our risk assessment, we focused on the same two complications that Simon and colleagues identified as the most common: bleeding and airway complications. Similar to the findings by Simon and colleagues, our findings identified technical causes for the complications, but these technical causes were influenced by several non-technical factors (risk-influencing factors), like operator experience, culture and attitudes of the team, and protocol quality.

Given that 70% of errors in medicine are caused by human factors or non-technical causes [4], we believe it is important to stress the influence of non-technical factors when trying to improve performance and outcome of PDT in the ICU. As we postulated in our risk assessment, improving non-technical risk-influencing factors may reduce the incidence of bleeding complications by a factor of five. We think these factors should be taken into account in the same manner as the measures suggested by Simon and colleagues when trying to improve the safety of PDT in the ICU.



Percutaneous dilatational tracheostomy.


Authors’ Affiliations

Department of Health Sciences, University of Stavanger, Stavanger, 4036, Norway
Department of Anaesthesiology and Critical care, Stavanger University Hospital, Postal Box 8100, Stavanger, 4068, Norway


  1. Simon M, Metschke M, Braune SA, Puschel K, Kluge S: Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors. Crit Care 2013, 17: R258. 10.1186/cc13085PubMed CentralView ArticlePubMedGoogle Scholar
  2. Sollid SJ, Strand K, Søreide E: Percutanous dilatational tracheotomy in the ICU: a Norwegian survey focusing on perceived risk and safety attitudes. Eur J Anaesthesiol 2008, 25: 925-932. 10.1017/S0265021508004791View ArticlePubMedGoogle Scholar
  3. Sollid SJ, Eidesen K, Aven T, Søreide E: Assessing the risk of percutaneous dilatational tracheostomy in ICUs using a broad event-consequence-uncertainty perspective. Int J Risk Saf Med 2010, 22: 115-129.Google Scholar
  4. Kohn LT, Corrigan J, Donaldson MS, Institute of Medicine (US), Committee on Quality of Health Care in America: To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.Google Scholar


© BioMed Central Ltd. 2014