The Utility of Chest Radiographs Following Percutaneous Dilatational Tracheostomy

Abstract

To determine the usefulness of performing routine postprocedure chest radiographs (CXRs) following percutaneous dilatational tracheostomy (PDT) under bronchoscopic visualization. Retrospective, chart review. Medical-surgical ICU of a teaching hospital. Sixty patients who underwent PDT under bronchoscopic visualization, for persistent ventilator dependence, in our medical-surgical ICU were studied. We noted the occurrence of any perioperative complications, physician anticipation of postoperative complications, and postprocedure CXR findings. We compared postprocedure CXRs with the last preprocedure CXR. Immediate postoperative complication was defined as a clinical worsening, hemodynamic instability, or a new radiographic finding such as atelectasis, paratracheal placement, pneumothorax, and pneumomediastinum. We determined whether the postprocedure CXRs led to any change in patient management. Two patients (3.3%) had postoperative complications detected on their CXRs, one with a pneumomediastinum and the other with a tension pneumothorax. Both procedures were noted to be difficult, with a high physician anticipation of complication. In the remaining 58 patients (96.7%), no postoperative complications were detected on the postprocedure CXRs that necessitated any change in patient management. We concluded that routine CXR following PDT that had been performed under bronchoscopic visualization is unnecessary in the absence of clinical deterioration or the anticipation of postoperative complications.