Routine chest radiography following percutaneous dilatational tracheostomy

Background and objective

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

Materials and methods

We performed a prospective observational study, on a mixed medical-surgical critical care unit, in 291 patients undergoing PDT under bronchoscopic guidance to assess the utility of routine postoperative CXR. Data were collected on all patients undergoing PDT from 1 November 2003 to 5 December 2006. Two postprocedure CXRs were reviewed and compared with those taken prior to PDT. Significant findings were barotraumas (pneumothorax, pneumomediastinum) and consolidation not noted on the preprocedure film. Postprocedural 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

A total of 291 patients underwent PDT. Two hundred and six (71%) were uncomplicated. Complications were recorded in 85 (29%) patients. Of these, 71 (24%) were minor procedural complications (multiple attempts at needle insertion (>2), minor bleeding, tracheal ring fracture) and there were 14 (5%) major complications (malplacement, major bleeding). Two hundred and thirty-six (81%) patients had two postprocedural CXRs reviewed. Of the remainder, 44 (15%) patients had at least one CXR reviewed after PDT and in 11 (4%) patients neither the report nor the CXR could be reviewed. New abnormalities were noted on 25 (9.0%) postprocedure CXRs. No new pneumothoraces were seen (Table 1). In 11 (4%) patients, neither the report nor the CXR could be reviewed.

Table 1 abstract

Conclusion

Routine CXR following uncomplicated PDT performed under bronchoscopic guidance appears unwarranted. Review of later films failed to reveal new abnormalities. 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 to ionising radiation.