Tracheal Stenosis After Placement of Percutaneous Dilational Tracheotomy

Abstract

Percutaneous dilational tracheotomy procedures have been used successfully as a bedside alternative to open surgical tracheotomy. At our institution, we have seen patients with tracheal injuries following this procedure. In this paper, we review those cases to demonstrate that tracheal stenosis is a potential long-term complication of percutaneous dilational tracheotomy. Case series. Patients were evaluated with computed tomography and operative endoscopy. Inpatient and outpatient records were reviewed retrospectively. Nine patients were referred to our practice for management of tracheal stenosis after percutaneous dilational tracheotomy between 2003 and 2006. Presence of anterior tracheal ring compression and destruction or lateral wall collapse was noted in each case. Endoscopy revealed stenosis secondary to anterior tracheal wall injury in all cases. In eight of nine cases, operative intervention was needed to correct the stenotic segment. It has been demonstrated in the literature that with 20 years of experience, the percutaneous dilational tracheotomy procedure is more affordable, faster to perform, and a generally safe procedure when performed under appropriate conditions. Most case series of percutaneous dilational tracheotomy reveal an equal or lower risk of short-term complications than open tracheotomy. This series demonstrates that tracheal stenosis is a potential long-term complication. Longitudinal follow-up of patients undergoing percutaneous dilational tracheotomy is indicated.