Complication Of Percutaneous Tracheostomy Research Articles

Griggs percutaneous tracheostomy without bronchoscopic guidance is a safe method: A case series of 300 patients in a tertiary care Intensive Care Unit

Introduction:Percutaneous tracheostomy (PCT) is being increasingly done by intensivists for critical care unit patients requiring either prolonged ventilation and/or for airway protection.[1] Bronchoscopic guidance considered a gold standard,[23] is not always possible due to logistic reasons and ventilation issues. We share our experience of Griggs PCT technique without bronchoscopic guidance with simple modifications to ensure safe execution of the procedure.Objective:The purpose of this study was to evaluate the safety issues and complications of PCT without bronchoscopic guidance in a multi-disciplinary tertiary Intensive Care Unit (ICU).Materials and Methods:A retrospective review of consecutive PCTs performed in our ICU between August 2010 and December 2013 by Griggs guide wire dilating forceps technique without bronchoscopic guidance is being presented. It is done by withdrawing endotracheal tube with inflated cuff while monitoring expired tidal volume on ventilator and ensuring the free mobility of guide wire during each step of the procedure, thereby ensuring a safe placement of the tracheostomy tube (TT) in trachea.Results:Analysis of 300 PCTs showed 26 patients (8.6%) had complications including 2 (0.6%) patients deteriorated neurologically and 2 (0.6%) deaths observed within 24 h following procedure. The median operating time was 3.5 min (range, 2.5–8 min). There were no TT placement problems in any case.Conclusion:Percutaneous tracheostomy can be safely performed without bronchoscopic guidance by adhering to simple steps as described.

Safety and complications of percutaneous tracheostomy in a cohort of 800 mixed ICU patients

Percutaneous tracheostomy is used primarily to assist weaning from mechanical ventilation in the intensive care unit. We report our experiences of 800 such procedures performed in the intensive care unit by a collaborative team (critical care and ENT specialists). Most procedures (85.6%) were performed by residents supervised by the intensive care unit staff. Complications occurred in 32 patients (4%). Intraprocedural complications occurred in 17 patients (2.1%), early postprocedural complications in six (0.75%), and late postprocedural complications in nine (1.1%). No deaths were directly related to percutaneous tracheostomy. The incidence of complications was greater in percutaneous tracheostomy performed by the residents during their initial five attempts compared to their later attempts (9.2% vs 2.6%, p < 0.05). The low incidence of complications indicates that bedside percutaneous tracheostomy can be performed safely as a routine procedure in daily care of intensive care unit patients.

Postal Survey of Long Term Complication of Percutaneous Tracheostomy in our ITU

Postal Survey of Long Term Complication of Percutaneous Tracheostomy in our ITU

Safety of Percutaneous Tracheostomy in Obese Critically Ill Patients: A Prospective Cohort Study

Obesity has been described as a relative contraindication for percutaneous tracheostomy. The objective of our study was to examine the safety and complications of percutaneous tracheostomy in obese patients. We conducted a prospective cohort study of all consecutive patients who underwent percutaneous tracheostomy at a tertiary medical-surgical intensive care unit between May 2004 and October 2005. We compared percutaneous tracheostomy in obese patients (body mass index > or = 30 kg/m2) to non-obese patients. We documented the occurrence of the following complications: aborting the procedure, accidental extubation, conversion to surgical tracheostomy, paratracheal placement, the development of pneumothorax, major bleeding (requiring blood product transfusion or surgical intervention) or death. We also documented hypoxia, minor bleeding (requiring pressure dressing or suturing), subcutaneous emphysema and transient hypotension. During the study period, 227 percutaneous tracheostomies were performed. There were 50 percutaneous tracheostomies in the obese group and 177 in the non-obese group. In 45 obese patients, percutaneous tracheostomy was performed without bronchoscopic guidance. Major complications were significantly higher in obese patients (12% vs. 2%, P = 0.04), while the rate of minor complications was not significantly different between the two groups. There were no instances of death or pneumothorax, subcutaneous emphysema or need for surgical intervention during or in the postoperative period in either group. Our study suggests that percutaneous tracheostomy can be performed safely in the majority of obese patients.

Aortic Arch Laceration: A Lethal Complication After Percutaneous Tracheostomy

Percutaneous dilatational tracheostomy (PDT) is not a new technique. However, it was not until Ciaglia introduced a simple technique using a needle, catheter, and guidewire that it became a possible alternative to open surgical tracheotomy. PDT is not performed blindly but with the assistance of fiberoptic endoscopy. However, even with fiberoptic endoscopic control, PDT can give rise to serious complications similar to those encountered with open surgical tracheostomy. We present an uncommon complication of percutaneous tracheostomy, a case of aortic arch laceration. We discuss the anatomy of the pretracheal space and how to avoid such a lethal complication.

Early complications of percutaneous tracheostomy using the Griggs method

This article presents our observations and experiences with the Griggs method of percutaneous dilation tracheostomy (PTD). We performed 200 tracheostomies on neurosurgical and surgical patients who needed temporary ventilatory support and protection. Early complications were defined and registered. Frequency of early complications was 22,5 %. The majority of complications were minor and improved quickly. Therefore, PTD was shown to be a safe and appropriate technique for patients treated in the intensive care unit (ICU). Unfortunately, lack of standardization and defined criteria deprive the opportunity for good comparisons between the Griggs method and other PTD methods.

Complications of percutaneous tracheostomy in obese patients

Complications of percutaneous tracheostomy in obese patients

Evaluation of a Modified Percutaneous Tracheostomy Technique Without Bronchoscopic Guidance

Most complications of percutaneous tracheostomy are caused by failure to cannulate the trachea and injury to surrounding structures. Traditionally, the procedure has been performed under bronchoscopic assistance, which may interfere with the patient's ventilation and is cumbersome. A modification was described in which the subcutaneous tissue is bluntly dissected with a hemostat down to the pretracheal fascia. The procedure is then performed with the guidance of the operator's finger, making the routine use of a bronchoscope no longer necessary. The modified technique was adopted and prospectively evaluated in an observational clinical study over a 30-month period, in patients requiring elective tracheostomy. Two commercially available kits were used. Patients' records were kept in files, and they were evaluated with regard to operative technique, complications, failure rate, and loss of airway. During the study period, 61 procedures were attempted. All were performed at the patients' bedside. In three patients (4.9%), the percutaneous procedure was deferred due to anatomic problems: cervical venous engorgement in one patient, and difficulty in dissection in another patient. In the third patient, the trachea could be felt, but the tube provided with the kit was not long enough. One patient had persistent wound bleeding, requiring revision in the operating room. No other procedure-related complications were reported. In three patients, early tube dislodgement occurred, but whether this was related to the percutaneous procedure is debatable. Bronchoscopy was not used. The modified percutaneous technique, with limited surgical dissection, without routine bronchoscopy, is simple and safe when performed by physicians with surgical training. It is relatively easy to learn, saves costs and operating room burden, and carries low morbidity rates.

Short-term complications of percutaneous tracheostomy: experience of a district general hospital--otolaryngology department.

Percutaneous tracheostomy is a procedure frequently carried out in a critical care setting. It is performed in the majority of cases by anaesthetists in the United Kingdom. The ENT surgeon is only called in situations where it is deemed by the intensivist that percutanous tracheostomy would prove too great a risk. In this situation the patient was taken to the operating theatre for a surgical tracheostomy. In our paper, a retrospective analysis was performed of all percutaneous tracheostomies carried out by ENT surgeons in the Royal Glamorgan Hospital, during a two-year period from July 1999 to July 2001, to assess whether percutaneous tracheostomy is a feasible option as a first line procedure in all elective tracheostomies. Thirty-six patients were included in the study. The mean age was 60.2 years. Haemorrhage was noted to be a problem in only one patient and two patients developed postoperative wound infection that was treated with systemic antibiotics. No other complications were encountered. We propose that all ENT surgeons should be trained in performing percutaneous tracheostomy and that it should be used as the gold standard in elective tracheostomy insertion. In cases where difficulties are likely to be anticipated, percutaneous tracheostomy can still be considered as the first option. This can be performed in the operating theatre setting with the knowledge that if any complication should occur then conversion to surgical tracheostomy can be done without delay.

Percutaneous tracheostomy

Background:Percutaneous tracheostomy (PT) has gained an increasing acceptance as an alternative to the conventional surgical tracheostomy (ST). In experienced hands, and with proper patient selection, it is safe, easy and quick.Complications:Perioperative complications are comparable with those of ST and these are mostly minor. An important advantage of PT over ST is that there is no need to move a critically ill patient to the operating room and the rate of stomal infection is very low. Although data on late complications of PT are not yet sufficient, available reports show a favourable result.Techniques:Ciaglia's method is the most commonly applied, but no study has shown superiority of any of the percutaneous techniques described. The decision on which method to use should solely be made depending on the clinical situation and the experience of the operator. The learning curve demands caution, attention to detail and adequate experience on the part of the intensive care physician. Although PT is unfortunately declared 'easy', it must be left in the hands of experienced physicians to avoid unnecessary complications, and the risk of overimplementation should be kept in mind.

Percutaneous Tracheostomy After Trauma and Critical Illness

A method of percutaneous tracheostomy (PT) using a tracheostome, which permits insertion of a full-sized cuffed tracheostomy tube, was evaluated in 61 critically ill or injured patients (89% had trauma). Of the 54 trauma patients, 65% had brain injuries, 14% had injuries to the cervical spinal cord, 33% had face or jaw injuries, and 15% had lung injuries. The indications for PT were coma (46%), acute airway obstruction (5%), face or jaw injury (20%), pneumonitis (39%), adult respiratory distress syndrome (12%), and sepsis (21%). Tracheostomy was done in 51% of all cases specifically for managing pulmonary secretions, in 37% for prolonged intubation, and in 25% for neurologic lesions. The tracheostomy was done as an emergency in 5%, as urgent in 28%, and electively in 77%. Percutaneous tracheostomy was successful in 90% of the cases, and in 8% it was converted to a surgical tracheostomy after an initial percutaneous attempt. In 46% it was performed at the bedside, in 46% in the operating room, and in 7% in the emergency suite. A full-sized tracheostomy tube (#6 to #8) was used in all cases and was considered optimal or larger than needed in 87% of cases. With three exceptions the complications of PT were minor, but 30% of the patients died of their primary disease. In one case death occurred because of bronchospasm and cardiac arrest during the PT, but appeared to be independent of the type of tracheostomy. Healing after in-hospital removal (37%) was excellent in 95% of cases and 97% of physicians indicated that they would use the device again.