Complication rates of percutaneous tracheostomy in the intensive care unit

Since complication rates from clinical trials may not reflect those obtained in practice we report the prospectively audited complication rates from the 201 percutaneous tracheostomies performed on the intensive care unit at the Chelsea and Westminster Hospital, London between 6 March 1997 and 3 December 2002. All were performed under anaesthetic consultant supervision, and bronchoscopic confirmation of tracheostomy position and complications was utilised.

Of the 201 tracheostomy patients, 28 patients had complications; an incidence of 13.9%. Comparing the patients who suffered complications with those who did not, their median admission APACHE was worse (25 vs 21) and more died in intensive care (40% vs 19%) although length of stay was similar (26 days vs 25 days). There was a highly significant sex difference in the incidence of complications; for males the complication incidence was 6.3% (seven of 111 patients), whereas for females the complication incidence was 23.3% (21 of 90 patients), P = 0.0005.

Serious complications occurred in 15 patients, an incidence of 7.4%. Surgical intervention was required in four patients, two for major early bleeding and two for major late bleeding. There was one arrest secondary to respiratory obstruction by blood clot but no tracheostomy-associated mortality.

Three different insertion methods were used, without randomisation; Griggs' forceps (Portex, NH, USA) in 65 patients, Ciaglia sequential dilators (Cook, IN, USA) in 87 patients, and single tapered dilators in 49 patients (from Cook in 31 patients and from Portex in 18 patients). Comparing the different insertion methods, the incidence of complications was 11 of 65 patients or 17% with Griggs' forceps, 14 of 87 patients or 16% with sequential dilators, and three of 49 patients or 6% with a single tapered dilator, although differences were not significant.

In summary, we report a serious complication rate of 7.4% in 201 percutaneous tracheostomies performed on the Chelsea and Westminster intensive care unit, with no mortality. We found a lower incidence of complications using the single tapered dilator methods for tracheostomy insertion, as opposed to Griggs' forceps or sequential dilators, although differences did not reach statistical significance. We also found a highly significant association of complications with female sex.