Service evaluation of complications following tracheostomy insertion in ICU patients

Introduction

We prospectively studied the tracheostomy complication rate in ICU patients (four ICUs, 36 beds) over a 6-month period. Quoted complication rates following tracheostomy vary widely [1, 2].

Methods

We evaluated all tracheostomies sited in ICU patients in our trust between June and November 2008. Complications on insertion, whilst cannulated and post (tracheal) decannulation were recorded. Patients were followed up until 4 weeks post decannulation, hospital discharge or death.

Results

Sixty-four patients underwent tracheostomy (58 percutaneous, six surgical). The mean time with tracheostomy was 24.8 days. Twenty-six insertion complications occurred in 20 (31%) of 64 patients. Fifty-five patients received follow-up (four transferred to another hospital, one died, four lost to follow up before first visit). Eighteen complications occurred whilst cannulated in 12 (22%) of 55 patients. The number (%) of insertion complications were: all, 26 (41%); major, five (8%) – major bleed, four (6%); posterior tracheal wall injury, one (2%); minor – minor bleed, 12 (19%); abandonment/conversion to surgical procedure, four (6%); tracheal cartilage fracture, three (5%); other, two (3%). The numbers (%) of complications whilst cannulated were: all, 18 (33%); major, seven (13%) – tracheostomy tube blockage/displacement, four (7%); loss of airway with severe hypoxia, three (5%); minor – prolonged bleeding, two (4%); local infection, one (2%); surgical revision, two (4%); other, six (11%). Post decannulation, 38 patients were followed up. There were no major complications. The number (%) of post-decannulation complications were: all, 28 (74%); difficulty swallowing, eight (21%); regurgitation of liquid, eight (21%); voice change, six (16%); hoarseness, two (5%); regurgitation of solids, two (5%); altered cough, one (3%); abnormal breathing, one (3%). One patient had complications lasting >30 days post decannulation. Overall patient outcomes 30 days post decannulation (excluding 15 patients transferred to other hospitals) were: 59% discharged from hospital, 29% dead, 12% inpatient decannulated.

Conclusion

Although the tracheostomy complication rate in our trust was 41% at insertion (8% major), 33% whilst cannulated (13% major) and 74% post decannulation, only one post-decannulation complication persisted beyond 30 days and none was major. Seventy-one per cent of patients undergoing tracheostomy survived to 30 days post decannulation.