Human factors play a vital role in the outcome of percutaneous dilatational tracheostomy

Abstract

In a recent issue of Critical Care, we read with greatinterest the report by Simon and colleagues [1] on fatalcomplications of percutaneous dilatational tracheostomy(PDT). We agree with the authors’ suggestions for im-proving the safety of this procedure, but we think theseimprovements cover only part of the picture. We havepreviously concluded that PDT is a high-risk procedure[2]. This led us to perform a risk assessment of PDT inthe ICU, where we found that several non-technical fac-tors also influence the outcome of PDT [3]. In our riskassessment, we focused on the same two complicationsthat Simon and colleagues identified as the most com-mon: bleeding and airway complications. Similar to thefindings by Simon and colleagues, our findings identifiedtechnical causes for the complications, but these tech-nical causes were influenced by several non-technicalfactors (risk-influencing factors), like operator experi-ence, culture and attitudes of the team, and protocolquality.Given that 70% of errors in medicine are caused byhuman factors or non-technical causes [4], we believe itis important to stress the influence of non-technical fac-tors when trying to improve performance and outcomeof PDT in the ICU. As we postulated in our risk assess-ment, improving non-technical risk-influencing factorsmay reduce the incidence of bleeding complications by afactor of five. We think these factors should be takeninto account in the same manner as the measures sug-gested by Simon and colleagues when trying to improvethe safety of PDT in the ICU.