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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.