Percutaneous dilatational tracheostomy: results and long-term outcome of critically ill patients following cardiac surgery.

Abstract

Tracheostomy is widely regarded as the method of choice for long-term airway control in critically ill patients. The advantages of tracheostomy have to be balanced against the surgical risks of conventional surgical tracheostomy. However, the alternative technique of percutaneous dilatational tracheostomy (PDT) has been associated with fewer procedure-related complications. The results of PDT following cardiac surgery were investigated in a prospective study (1/1995-9/1997). The procedure of Ciaglia (1985), a modified Seldinger technique, was performed under endoscopic guidance in 88 patients, 30 women and 58 men, with a mean age of 56.6+/-14.5 years. PDT was successfully performed in all cases after a mean of 14.6+/-9.0 days of translaryngeal intubation. No serious procedural complications occurred; a minor hemorrhage occurred in 12 patients and a cuff defect in 2 patients. 49 patients (55.7%) were weaned from mechanical ventilation, and 45 patients (51.1%) were decannulated after a mean tracheostomy duration of 18.9+/-27.2 days. 38 patients died of their underlying disease while still being mechanically ventilated. A total of 20 postprocedural complications were observed in 15 patients: stomal infection (7), minor hemorrhage (4), tracheal stenosis (3), tube displacement (2), delayed wound healing (2), soft-tissue hemorrhage (1), and organ hemorrhage (1). During long-term follow-up a good functional and cosmetic result could be documented in the majority of 35 patients. PDT can be performed safely in patients following cardiac surgery as a bedside technique with a low incidence of procedural and postprocedural complications and an acceptable functional and cosmetic long-term outcome. Further studies are needed to define the optimal timing of PDT after translaryngeal intubation.