Safety of percutaneous dilatational tracheotomy (PDT) with the rigid tracheotomy endoscope (TED): a 6-month follow-up multicenter investigation

Andreas Nowak,Caroline Michaelsen,Sven Koscielny,Eckart Klemm,Taras I Usichenko

doi:10.1186/s12871-021-01264-2

Abstract

BackgroundThe rigid tracheotomy endoscope (TED) was recently introduced to improve the fiberoptic technique during percutaneous dilatational tracheotomy (PDT) in critically ill patients. The aim was to evaluate the long-term complications of PDT using TED equipment in a prospective multicenter investigation.MethodsOne hundred eighty adult patients underwent PDT using TED in four German hospitals. Patients who were alive or their guardians were contacted via telephone and interviewed using a structured questionnaire 6 months following the tracheostomy procedure. Patients with airway complaints were invited for outpatient clinical ENT examination. The incidence of adverse events related to PDT was registered.ResultsOf 180 patients who received tracheostomy, 137 (76.1%) were alive at the time of follow-up. None of the 43 lethal events was related to the PDT. Fifty-three (38.7%) patients were available for follow-up examination, whereas 14 (10.2%) were able to visit ENT physicians. Two (3.8%) out of 53 patients developed tracheocutaneous fistula with required surgical closure of tracheostoma. Dyspnea (7.5%), hoarseness (5.7%), stridor and swallowing difficulties (both with 3.8%) were the most common complaints. Tracheal stenosis was confirmed in 1 patient (1.88% [95% CI: 0.33; 9.93]).ConclusionThe use of TED for PDT in the clinical setting is safe regarding adverse events at 6-month follow-up. The incidence of tracheal stenosis after PDT with TED is comparable with that of flexible bronchoscopy; however, its role for PDT at the intensive care unit should be clarified in further investigations.

Highlights

The rigid tracheotomy endoscope (TED) was recently introduced to improve the fiberoptic technique during percutaneous dilatational tracheotomy (PDT) in critically ill patients
As an alternative to open surgical tracheotomy (OST), PDT has been increasingly used for temporary access to the trachea in the intensive care unit because it is associated with a low complication rate and is at least as safe as surgical tracheotomy in the ICU setting [2, 3]
Patients with an expected short ventilation period in the ICU are likely to benefit from PDT since it can be performed with less effort than OST directly at the bed side in the ICU

Summary

Introduction

The rigid tracheotomy endoscope (TED) was recently introduced to improve the fiberoptic technique during percutaneous dilatational tracheotomy (PDT) in critically ill patients. Percutaneous dilatational tracheotomy (PDT), performed in the ICU, is considered the procedure of choice to establish the tracheostomy airway in critically ill adult patients [1]. As an alternative to open surgical tracheotomy (OST), PDT has been increasingly used for temporary access to the trachea in the intensive care unit because it is associated with a low complication rate and is at least as safe as surgical tracheotomy in the ICU setting [2, 3]. Recent systematic review demonstrated that PDT can be associated with severe early and late complications, such as hemorrhage, loss of airway, injury to posterior tracheal wall and via falsa including death [4]

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Discussion

Conclusion