Routine chest radiography following percutaneous dilatational tracheostomy

Background and goal

The role of routine chest radiography (CXR) following percutaneous dilatational tracheostomy (PDT) has recently been questioned [1].

Materials and methods

We have performed a prospective observational study, on a mixed medical–surgical critical care unit, on 110 patients undergoing PDT under bronchoscopic guidance to assess the utility of routine postoperative chest radiography. Data were collected on all patients undergoing PDT from 1 November 2003–14 December 2004. Two post-procedure CXRs were reviewed and compared with those taken prior to PDT. Significant findings were barotrauma (pneumothorax, pneumomediastinum) and consolidation not noted on the pre-procedure film. Post-procedural films reviewed were those taken immediately after PDT and, to exclude the possibility of overlooking evidence of minor barotrauma, one further film taken between 24 and 96 hours.

Results and observations

One hundred and ten patients underwent PDT; 83 (75%) were uncomplicated. Complications were recorded in 27 (25%) patients. These included multiple attempts at needle insertion (> 2), bleeding (> 3 soaked gauze swabs), tracheal ring fracture, posterior tracheal wall injury, and malplacement. Ninety-five (86%) patients had two post-procedural CXRs reviewed. Fourteen (13%) patients had at least one CXR reviewed after PDT. One patient had no CXR after PDT. New abnormalities were noted on three (3%) post-procedure CXRs. No new pneumothoraces were seen. Patients having uncomplicated PDTs had no new CXR changes (Table 1).

Table 1

Conclusions

Routine CXR following uncomplicated PDT performed under bronchoscopic guidance is not warranted. Concern that evidence of minor barotrauma may be missed on the early post-procedural film is not bourne out by review of the film taken 24–96 hours after the event. The role of CXR following PDT appears to be restricted to those patients undergoing complicated procedures. This will lead to reductions in both medical costs [2] and exposure of staff and patients to ionising radiation.