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Table 2 Complications of percutaneous dilatational tracheostomy

From: Impact of real-time ultrasound guidance on complications of percutaneous dilatational tracheostomy: a propensity score analysis

Patient number

RUSG used

High-risk factor present

Nature of complication

Days from procedure

Details

Technical/procedural issue identified

1

N

None

Bleeding requiring intervention, inability to complete procedure

0

Large neck hematoma during procedure, surgical tracheostomy and hemostatsis performed urgently in OR

Laceration of arterial branch along superior border of isthmus

2

N

Coagulopathy: dual antiplateley therapy

Bleeding requiring intervention

1

Copious persistent bleeding from stoma, requiring platelet transfusion and cessation of dual antiplatelet therapy

Vascular injury likely, specific source not identified

3

N

None

Tracheal granuloma

13

Inability to perform routine tube change at bedside, fiberoptic evaluation revealed a large tracheal granuloma causing luminal stenosis. Soft tracheal tube introduced over fiberoptic scope

None

4

N

None

Early dislodgment, need for surgical revision

5

Tracheal tube dislodged, inability to replace at bedside. Surgical revision required, initial stoma noted to be below 6th tracheal ring

Too low placement of tracheal tube

5

N

Coagulopathy: from therapeutic plasma exchange on consecutive days.

Bleeding requiring intervention

3

Persistent oozing with large hematoma in upper left quadrant of stoma. Surgical hemostasis with Surgicell® Fibrillar® absorbable hemostats

Vascular injury: focal bleeding identified at bedside at upper left quadrant of stoma

6

N

Coagulopathy: warfarin for venous thromboembolism

Death, bleeding requiring intervention

266

Massive bleeding and death from trachea-innominate fistula

Too low placement of tube on autopsy, proximity to innominate artery.

7

N

Coagulopathy: anticoagulation for venous thromboembolism

Bleeding requiring intervention

7

Persistent copious oozing during and after procedure. Anticoagulation reversed; surgical hemostasis performed in OR on day 7

Vascular injury: focus of bleeding identified in OR

8

N

None

Need for revision of tracheostomy

1

Persistent large air leak with loss of >30% tidal volume. Fiberoptic evaluation and emergent bedside revision performed post-procedure day 1

Too low placement: tube seen below 6th tracheal ring with suboptimal positioning on fiberoptic evaluation

9

N

None

Need for revision of tracheostomy, early dislodgment

4

Persistent large (20-25%) cuff leak post-procedure with dislodgment and inability to ventilate on day 4, surgical revision in OR

Too low placement of tracheal tube (below 8th ring) with consequent poor positioning

10

Y

Coagulopathy: end-stage liver disease, repeat tracheostomy

Early dislodgment

6

Tube dislodged following agitation and head shaking with subsequent brief period of hypoxia. Extended length tube replaced at bedside into stoma over a bougie.

? Inappropriate selection of tube length. Sonographic measurement pre-tracheal tissue thickness not performed.

  1. Details of complications in the standard percutaneous dilatational tracheostomy and real-time ultrasound guidance (RUSG) percutaneous dilatational tracheostomy groups. N, no; OR, operating room; Y, yes.