Efficacy of postprocedural chest radiographs after percutaneous dilational tracheostomy

Introduction

Both retrospective and prospective cohort studies of routine chest radiographs after uncomplicated dilational percutaneous tracheostomy have showed a low pick up rate of clinically important new data [1, 2]. It was felt that the true level of complications on insertion was much less than the reported rate of between 3% and 18% [3]. We decided to undertake a retrospective analysis of the last 100 percutaneous tracheostomies from our ICU population, looking at the utility of a postprocedural radiograph in terms of new data added.

Methods

Percutaneous tracheostomies were performed consistently by the Portex Blue Rhino™ (Portex, UK) dilational method under direct bronchoscopic control. At the end of the procedure the tip–carina distance was measured with the fibroscope and recorded. The bronchoscope logbook was examined to identify patients. Patients were excluded if aged under 18 or they could not be identified on the electronic radiographic database. The report on the postprocedural radiograph was compared with the previous report for data that could not be detected clinically or bronchoscopically.

Results

Two hundred and two records were examined to give 100 procedures. Of these, 89 could be identified on the radiology database. Eighty-three reports (93.25%) showed no new data. In three cases the tube tip was reported as close to the carina, which was not correct on direct vision. No radiograph showed any serious complication of the procedure.

Conclusion

In this series the pneumothorax rate was 0%, and over 93% of radiographs added no new clinical data. This evidence does not support the use of a routine radiograph, and we recommend them only if indicated clinically.