Evaluation of early and late complications of percutaneous dilatational tracheostomy in 86 ICU patients
© Biomed central limited 2001
Published: 1 March 2002
Due to the prolonged stay of the critically ill under mechanical ventilation in ICU often stomatotracheal intubation should be replaced by tracheostomy. In our ICU for over the last 18 months we are practicing percutaneous dilatational tracheostomy as described by Griggs. The aim of our study is to estimate the safety of the method by evaluating the early and late complications that occurred.
In a retrospective study including 86 patients that have been trachiostomised by the above method we registered all complication that occurred for a period of 40 days after the procedure. In all of the cases the procedure was carried out in the ICU. The average time for the procedure varied between 2–10 min depending mainly on the experience of the performing surgeon.
In all cases per-operative mortality was 0%. The complications registered were grouped in Minor (A): Bleeding up to 20 ml in eight cases, rapture of the cuff in four cases, difficulty in advancing the tube into the trachea in four cases, minor subcutaneous emphysema in the region in two cases, and Major (B): Bleeding 20–150 ml in four cases, prolonged oxygen desaturation to 80% in two cases, extended subcutaneous emphysema in one case.
In group A complications did not request any specific treatment, in contrast with group B that all complication necessitated specific treatment.
Early post-operatively in two cases we had suppuration of the stoma. In two cases we had minor lung atelectasias possibly due to bleeding. Evaluation on the 40th day was possible only in 55 cases that survived. Among these cases we had kelloid formations at the wound site in two cases.
The performance of tracheostomy by the above method is quick and effective in experienced hands in spite of the low possibility of major bleeding. However, the whole procedure should be performed in the presence of surgeon. Post operative scars were minimal.