Percutaneous dilational tracheostomy: early and late complications

Introduction

Percutaneous dilational tracheostomy (PDT) is a common procedure in ICU patients. In this study we evaluated perioperative complications. Moreover we looked for late complications by telephone interview together with a clinical evaluation in the suspected cases.

Methods

We included 170 consecutive patients admitted to GB Morgagni Hospital ICU, between June 2005 and June 2007 who underwent PDT. Demographic data, clinical data and severity scores (SAPS II), data about the tracheostomy technique and tracheostomy major complications were collected. We used the Ciaglia technique with endoscopic guidance throughout the procedure. Twelve months after discharge, we traced and interviewed our patients about possible late complications connected with the tracheostomy. Symptomatic patients were referred to the ENT specialist for fiberoptic laryngoscopy control.

Results

PDT was performed in 170 patients as a routine procedure by intensivists. The main primary indications for PDT were weaning failure (29%) and neurological dysfunction (71%). One hundred and five patients were male and 65 female, with an age average of 68 ± 15 years. The mean SAPS II was 53 ± 10 points. The intubated time before PDT was 5 ± 2 days and the time in the ICU after PDT was 14 ± 8 days. The ICU mortality was 16%. Placement was successful in all cases. The total incidence of major complications was 1.18%: a simple pneumothorax successfully treated with chest tube insertion and one early (after 72 hours) cannula displacement evolved to cardiorespiratory arrest and death. We traced 38 patients alive 12 months after discharge; 22 patients answered the telephone interview. None complained of respiratory symptoms, Four patients described symptoms that were considered worth further examination and were invited to an ENT control. In two patients, swallowing uncoordination was found. In another two patients, a 20% tracheal stenosis was found. The stenosis was, however, asymptomatic.

Conclusion

In our experience PDT had an overall low rate of major complications (1.8%). Only one patient had severe early complication. We did not find severe late complication. In selected patients, PDT with endoscopic guidance guarantees a high safety standard [1, 2].