Percutaneous Tracheostomy Research Articles (Page 1)

Percutaneous tracheostomy is commonly performed in intensive care unit (ICU) for patients requiring prolonged mechanical ventilation. The coronavirus disease-19 (COVID-19) pandemic raised concerns about potential complications during tracheostomy, particularly in critically ill patients with severe hypoxemia, coagulopathy, and procedural risks in infected patients. This study aimed to compare early and late complications of tracheostomy in ICU patients with and without COVID-19, and to assess the relationship between these complications, patient comorbidities, and antiplatelet/anticoagulant medication use. We conducted a retrospective cohort analysis of 132 ICU patients who underwent percutaneous tracheostomy between January 2019 and May 2021. Based on COVID-19 infection status, patients were assigned to either the COVID-19 group (Group-C) or the non-COVID-19 group (Group-NC). Data on demographics, comorbidities, medications, procedure details, and early/late complications were collected. A multivariable logistic regression model was used to assess associations between COVID-19 status and early complications, adjusting for confounding factors. A total of 132 patients were analyzed, including 33 in Group-C and 99 in Group-NC. Cannula insertion time was shorter in Group-C (6.1 ± 2.3 vs 7.3 ± 4.1 minutes, P = .031). No major bleeding or esophageal injuries were reported. Minor bleeding occurred in 9.1% of Group-C and 17.2% of Group-NC (P > .05). Although hypoxia was observed only in Group-NC, this difference was not statistically significant. Late complications, including tracheal stenosis and tracheoesophageal fistulas, were rare and showed no significant group differences. Use of antiplatelet or anticoagulant therapy was significantly higher in Group-C (90.9% vs 27.3%, P < .001), but was not associated with increased bleeding complications. Percutaneous tracheostomy appears to be equally safe in COVID-19 and non-COVID-19 ICU patients, even in the setting of higher anticoagulant and antiplatelet therapy. These findings support the continued feasibility and safety of tracheostomy in both populations when performed under appropriate precautions.

ObjectiveThis study aimed to investigate the clinical efficacy and safety of ultrasound localization with fiberoptic bronchoscopy-guided percutaneous tracheostomy (US-B PDT) in the intensive care unit (ICU) setting.MethodsA retrospective analysis was conducted on 122 patients who underwent tracheostomy between August 2016 and December 2024 at the Department of Critical Care Medicine, Beijing Electric Power Hospital. Based on the surgical technique employed, patients were divided into two groups: the ultrasound localization and fiberoptic bronchoscopy-guided percutaneous dilatational tracheostomy group (US-B PDT group, n = 62) and the conventional percutaneous dilatational tracheostomy group (PDT group, n = 60). Surgical parameters and intraoperative and postoperative complications were compared between the two groups.ResultsPatients in the US-B PDT group demonstrated statistically significant improvements in several parameters compared to the PDT group, including shorter surgical duration (8.30 ± 0.51 vs. 10.42 ± 1.29 min, respectively), reduced intraoperative blood loss (9.91 ± 0.97 vs. 13.92 ± 0.82 ml, respectively), lower tracheal tube cuff leakage rate (0% vs. 13.3%, respectively), higher first-attempt intubation success rate (96.8% vs. 90.2%, respectively), and decreased sputum overflow rate at the tracheostomy site (3.2% vs. 18.3%, respectively), with p-values < 0.05 for all comparisons. Additionally, the incidence of complications in patients of the US-B PDT group (9.7%) was significantly lower than that in the PDT group (45%) (P < 0.05). Notably, no cases of damage to the posterior tracheal wall or tracheoesophageal fistula were observed in either group.ConclusionThe use of US-B PDT significantly shortened surgical duration, reduced intraoperative blood loss, lowering tracheal tube cuff leakage, enhancing first-attempt intubation success rate, and preventing complications such as posterior tracheal wall injury and tracheoesophageal fistula, ensuring superior safety. These findings highlight the safety and efficacy of this surgical approach for widespread use in ICUs equipped with the necessary facilities.

Use of BUG-SAFE (Bougie guide safe percutaneous tracheostomy) to prevent airway loss in critically Ill patients: Cohort study.

The utility of bedside screening tests for the prediction of difficult airways is limited. There is growing interest in the role of point-of-care-ultrasound in airway assessment and management. This systematic review and meta-analysis aimed to determine the diagnostic utility and clinical application of various upper airway point-of-care-ultrasound parameters in the prediction of difficult airways. We searched databases for randomised controlled trials, observational studies and case series with more than five cases. In total, 60 studies involving 10,580 patients, evaluating 58 parameters were included. For difficult facemask ventilation, a narrative synthesis showed that increased tongue thickness was associated with an increased incidence of a difficult airway. For prediction of difficult laryngoscopy, the sensitivity, specificity and area under the receiver operator characteristic curve (AUROC) for distance from-skin-to-vocal-cords were 0.84 (95%CI 0.74-0.91), 0.81 (95%CI 0.61-0.92) and 0.87 (95%CI 0.78-0.89), respectively (high certainty of evidence). For prediction of difficult tracheal intubation, distance from skin-to-epiglottis had the highest sensitivity (0.80 (95%CI 0.74-0.85)) and specificity (0.86 (95%CI 0.74-0.91)) (high certainty of evidence), while distance from skin-to-hyoid had the highest AUROC of 0.86 (95% CI 0.73-0.92), with a sensitivity and specificity of 0.78 (95%CI 0.60-0.89) and 0.81 (95%CI 0.63-0.91), respectively (moderate certainty of evidence). Ultrasound use was associated with higher first pass success in percutaneous tracheostomy (odds ratio (95%CI) 3.9 (2.1-71), (low-moderate certainty of evidence)) and improved cricothyroid membrane identification compared with palpation (odds ratio (95%CI) 3.61 (2.20-5.92) (moderate-high certainty of evidence)). Upper airway point-of-care ultrasound may improve prediction of difficult airways; its use is associated with improved first pass success in percutaneous tracheostomy. Future research should focus on evaluating its use in combination with a focused history and standard bedside examination tests, and in at-risk patient populations.

Percutaneous tracheostomy (PT) has gained increasing acceptance over surgical tracheostomy (ST) in the last few decades due to lower rates of postoperative infections, less bleeding, and cost-effectiveness. However, there has been little information regarding the PT practice in Malaysian adult general intensive care units (ICU). The objective of the study was to assess the current practice of PT in Malaysia. This observational cross-sectional study used a validated questionnaire with 15 items. A total of 61 ICUs consisting of adult general ICUs under Ministry of Health (MOH) hospitals and adult general ICUs in university teaching hospitals were recruited into the study whereas ICUs in private hospitals and specialist ICUs were excluded from this study. The questionnaire was subsequently distributed to the heads of those 61 ICUs through existing WhatsApp or Telegram groups and the data collection period lasted four months. Fifty-three out of 61 ICUs participated. Ninety point six percent of the responses came from MOH hospitals, whereas 9.4% came from university hospitals. The heads in participating ICUs comprised 35.8% intensivists and 64.2% anaesthetists. At the time of the survey, 45.3% of ICUs were still practicing PT, 13.2% had performed PTs in the past but stopped whereas 41.5% were not. The rate of PT (both actively practising and formerly practised combined) in intensivist-led ICUs was 94.7% compared to 38.2% in anaesthetist-led ICUs. Intensivists performed PTs in almost two-thirds of ICUs, while anaesthetists did so in another two-thirds. The vast majority of assistants were medical officers at 96.8%. The Ciaglia Blue Rhino technique was the predominant technique (71.0%) while airway management during the technique was solely via endotracheal tube. Ninety-six point eight percent of the ICUs employed routine infiltration of local anaesthetics prior to PT. Thirty-eight point seven percent of performers of PT routinely used fibreoptic bronchoscopy but only 6.4% used ultrasonography. Seventy-four point two percent used tracheostomy tubes with inner cannulae and 83.9% routinely followed up with patients post-discharge from the ICU. Seventy-nine point two percent of respondents believed PT was the method of choice for elective tracheostomy in the ICU but only 49.1% perceived PT to be safer compared to ST. PT is commonly practised in intensivist-led ICUs. PT is generally preferred for elective tracheostomy but there is a variability in perceptions regarding its safety compared to ST.

Introduction: The optimal timing of percutaneous dilatational tracheostomy (PDT) in critically ill stroke patients remains controversial. The procedure may facilitate ventilator weaning and neurological assessment, but carries inherent risks. This study aimed to determine the impact of early versus late PDT on clinical outcomes in this specific and vulnerable population. Methods: This retrospective cohort study was conducted at a single tertiary care center. We included all mechanically ventilated adult stroke patients who underwent PDT between January 2024 and December 2024. Patients were categorized into an Early PDT group (≤7 days of intubation) and a Late PDT group (&gt;7 days). The primary outcome was time to ventilator liberation, with in-hospital death as a competing risk. This was analyzed using a Fine-Gray subdistribution hazard model. Secondary outcomes included ICU and hospital mortality, length of stay (LOS), and ventilator-associated pneumonia (VAP), analyzed with multivariable regression. Results: Seventy patients were included (34 Early PDT, 36 Late PDT). After adjusting for age, admission GCS, NIHSS, and stroke type, early PDT remained significantly associated with a higher probability of ventilator liberation (adjusted subdistribution Hazard Ratio [sHR]: 2.48; 95% CI: 1.41–4.36; p=0.002). Early PDT was also independently associated with lower odds of developing VAP (adjusted Odds Ratio [aOR]: 0.31; 95% CI: 0.10–0.94; p=0.038). There were no significant differences in ICU mortality (aOR: 0.82; 95% CI: 0.28–2.41; p=0.721) or hospital mortality (aOR: 0.70; 95% CI: 0.25–1.96; p=0.495). Conclusion: In critically ill stroke patients, an early tracheostomy strategy is independently associated with a significantly shorter time to ventilator liberation and lower odds of VAP, after accounting for competing risks and baseline confounders. While not associated with a survival benefit, early PDT should be considered a key strategy to optimize respiratory management and reduce pulmonary complications in this population.

Introduction: Tracheostomy is a common procedure in intensive care units for critically ill patients with mechanical ventilation. Case: This case report describes the use of real-time ultrasonography (USG) guidance for percutaneous dilatational tracheostomy (PDT) in a 63-year-old female with prolonged mechanical ventilation following craniotomy. The patient had relative contraindications including short neck and morbid obesity (BMI 40.8). On day 7 of ICU admission, a PDT was successfully performed using real-time ultrasonography (USG) guidance. USG was utilized to identify key anatomical landmarks, such as tracheal rings and vascular structures, ensuring safe and accurate needle placement. The use of real-time USG significantly reduced the risk of complications including hemorrhage, tracheal injury, or pneumothorax. The procedure was completed without incident, and the patient showed clinical improvement post-intervention, including enhanced respiratory function and gradual weaning from mechanical ventilation. Conclusion: This report highlights the safety and efficacy of USG-guided PDT, especially in high-risk patients with difficult neck anatomy. It also underlines the importance of ultrasound as a widely available and cost-effective tool in ICU settings. The case supports further implementation of real-time USG-guided techniques in percutaneous tracheostomy to improve procedural success and patient outcomes. Further research involving a larger cohort is needed to establish standardized protocols and evaluate long-term outcomes of this approach.

Tracheostomy is one of the most performed procedures in intensive care unit. Dilatational techniques, such as those described by Ciaglia, Griggs, or Fantoni, are currently the best choices as they can be easily performed at the bedside. Like any other intervention, early and late complications can occur even if the procedure appears to be performed without any issues. Although using a bronchoscope can make tracheostomy easier and safer, its routine utilization remains controversial. We describe a new method to further reduce the incidence of some complications: retroversion bronchoscopy. This new approach is not difficult to master and may be useful in other intensive care unit scenarios as well.

IntroductionTracheostomy is a regularly performed procedure for patients requiring prolonged ventilatory support in the intensive care unit (ICU). Our community hospital implemented a new percutaneous tracheostomy (PT) program in an attempt to decrease operational costs and navigate operating room limitations. After the successful rollout, we performed a study comparing PT and surgical tracheostomy (ST) in terms of efficiency, ICU stay, and cost after one year to determine the outcomes a community hospital could expect in the early stages of PT implementation. MethodsThis is a cohort study with retrospective data collected from hospital records for both ST and PT over the years 2023-2024. Outcomes measured included consult-to-procedure time, procedural duration, ICU stay, and cost. Statistical significance was set at p<0.05. ResultsPT had a significantly shorter consult-to-procedure time (p=0.0039), with a mean of 1.76 days, compared to 4.139 days for ST. PT was also faster in procedural duration (p=0.0001), averaging 8.66 minutes, versus 53.93 minutes for ST. ICU length of stay showed no statistical difference (p=0.3919), with PT patients staying three days versus 3.79 days for ST. Cost analysis revealed PT was significantly more cost-effective, averaging $971.93, compared to $2,397.98 for ST. ConclusionPT is a more efficient and cost-effective alternative to ST, significantly reducing consult-to-procedure time and procedure duration. Although ICU length of stay did not reach statistical significance, PT demonstrates clear advantages in terms of resource utilization and cost savings.

Tracheostomy is one of the most performed procedures in intensive care unit. Dilatational techniques, such as those described by Ciaglia, Griggs, or Fantoni, are currently the best choices as they can be easily performed at the bedside. Like any other intervention, early and late complications can occur even if the procedure appears to be performed without any issues. Although using a bronchoscope can make tracheostomy easier and safer, its routine utilization remains controversial. We describe a new method to further reduce the incidence of some complications: retroversion bronchoscopy. This new approach is not difficult to master and may be useful in other intensive care unit scenarios as well.

Intraoperative Tracheostomy Complications.

Introduction: Antiplatelet therapy (APT) increases bleeding risk and is frequently used in patients who undergo percutaneous dilatational tracheostomy (PDT). However, there are different techniques for single-step PDTs, which can be differently invasive. The aim of the present study was to investigate complications in patients undergoing PDT while being on APT, especially with regard to bleeding and the influence of different PDT techniques. Material and Methods: Between July 2016 and June 2021, 273 intensive care unit (ICU) patients underwent in-house PDT with two different techniques (direct or indirect) and were retrospectively enrolled. Results: A total of 273 patients (mean age: 68 years, 37% female) were included in the study. A total of 51% of patients were on APT on the day of PDT procedure (SAPT: 34%, DAPT: 17%). Direct and indirect PDTs were performed in 33% and 67% of patients. Periprocedural airway or skin bleedings and postprocedural bleedings occurred in 53%, 11%, and 1%. A need for bronchoscopic re-intervention was observed in 2% of APT patients. No death was procedure related. Periprocedural airway bleedings occurred more frequent in "APT patients" (60% vs. 46%, p = 0.03). Periprocedural airway and skin bleedings were more frequent in indirect PDTs (52% and 14%) than direct PDTs (32% and 0%, p = 0.04 and p = 0.02) in "no APT patients". In "APT patients" this difference was only seen in periprocedural airway bleeding (69% vs. 45%, p = 0.01). Moreover, periprocedural airway bleedings were more frequent in "APT patients" when performing an indirect PDT rather than a direct PDT (69% vs. 52%, p = 0.02). Conclusions: PDTs appear to be safe in patients receiving APT. Indirect PDTs appear to generally increase the risk of clinically irrelevant, minor periprocedural airway and possibly skin bleedings, especially in APT patients.

Amyotrophic lateral sclerosis (ALS) stands as the leading neurodegenerative disorder affecting the motor system. One of the hallmarks of ALS, especially its bulbar form, is dysarthria, which significantly impairs the quality of life of ALS patients. This review provides a comprehensive overview of the current knowledge on the clinical manifestations, diagnostic differentiation, underlying mechanisms, diagnostic tools, and therapeutic strategies for the treatment of dysarthria in ALS. We update on the most promising digital speech biomarkers of ALS that are critical for early and differential diagnosis. Advances in artificial intelligence and digital speech processing have transformed the analysis of speech patterns, and offer the opportunity to start therapy early to improve vocal function, as speech rate appears to decline significantly before the diagnosis of ALS is confirmed. In addition, we discuss the impact of interventions that can improve vocal function and quality of life for patients, such as compensatory speech techniques, surgical options, improving lung function and respiratory muscle strength, and percutaneous dilated tracheostomy, possibly with adjunctive therapies to treat respiratory insufficiency, and finally assistive devices for alternative communication.

Experimental model for percutaneous tracheostomy training.

Background Delays in surgical tracheostomy can impact patients, families, and ICU systems. This case highlights the consequences of delays and gives suggestions on how to optimize care delivery. Patient case A 32-year-old female diagnosed with severe pneumococcal pneumonia presented with progressive shortness of breath, chest pain and cough. She continued to deteriorate despite non-invasive respiratory support, resulting in tracheal intubation and prolonged invasive ventilation. Intervention She required surgical tracheostomy to aid weaning because of anticipated difficulty with bedside percutaneous dilatational tracheostomy (PDT). Logistical and operating room scheduling problems led to a five-day delay. Outcome Delayed surgical tracheostomy resulted in significantly prolonged sedation burden, likely contributed to post-emergence delirium, delayed laryngeal and physical rehabilitation, distress for the relatives, and pressure on the healthcare system in terms of bed-days and economic costs. Conclusion Minimizing delays between decision for ICU tracheostomy and insertion improves outcomes for patients, their relatives, and hospital systems. Innovations enabling more ICU bedside PDT to be undertaken could reduce delays.

Intensive care units (ICUs) frequently perform percutaneous tracheostomy (PDT) on patients who need continuous mechanical ventilation. Percutaneous dilatational tracheostomy has a number of postoperative complications that vary in intensity and time, although being less invasive than surgical tracheostomy. This retrospective observational study looked at complication rates in adult patients who had PDT in a tertiary anesthetic ICU between January 2015 and December 2024. Patients who spent <30 days in the hospital overall were not included. The mean age of the 647 patients who were included was 67.1 ± 17.1 years. A total of 139 patients (21.5%) experienced complications following surgery. Minor bleeding and subcutaneous emphysema were among the minor complications (12.2%). Pneumothorax, bleeding requiring transfusion, and deep tissue infection were among the major complications (10.5%). Life-threatening complications (2.3%) included tracheoesophageal and tracheoarterial fistulas. There were no documented deaths from the surgery. Early postoperative surveillance is crucial, as the majority of problems (89.9%) happened within 7 days of surgery. Patients who developed complications had prolonged ICU stays and more complex treatment requirements during hospitalization. The results highlight the necessity of systematic postoperative care and surveillance by confirming that, despite PDT's general safety, considerable morbidity can occur. These findings back up upcoming multicenter research aimed at improving patient outcomes and complication management procedures.

ABSTRACTBackgroundThe European laryngological society predicted an increased incidence of laryngotracheal complications as a result of the COVID‐19 pandemic. During the first pandemic wave in the Stockholm region, 31% of critically ill COVID‐19 patients were tracheotomized by an open surgical (OST) or a percutaneous tracheotomy (PCT). The aim of this study was to investigate the incidence of visible laryngotracheal pathologies in tracheotomized and long‐term intubated COVID‐19 survivors ≥ 12 months after initial intubation, to examine whether these pathologies were symptomatic and to assess possible associated factors.MethodsStudy participants underwent laryngotracheoscopy under local anaesthesia, and tracheostomy skin and soft tissue scars were photo documented. Patient‐reported outcome measures — the Voice Handicap Index‐10 (VHI‐10), the Eating Assessment Tool‐10 (EAT‐10) and the Dyspnea Index (DI), and demographics were retrospectively extracted from patient medical records.ResultsOf 73 included study participants (40 OST, 24 PCT and 9 long‐term intubated), 58% had visible laryngotracheal pathologies. Tracheostomy tube size and the number of days with tracheostomy were associated with skin and soft tissue pathology and tracheal pathology (p < 0.05). The results of the VHI‐10 and EAT‐10 were congruent with both laryngeal and skin and soft tissue pathologies. Participants with the highest DI scores, indicating breathing difficulties, had both laryngeal and tracheal pathologies followed by tracheal pathology alone.ConclusionsA high incidence of visible laryngotracheal pathologies, two airway management‐related factors, and symptom‐pathology associations for VHI‐10 and EAT‐10 scores were found in a cohort of COVID‐19 survivors ≥ 12 months after critical care.

The management of geriatric patients with multiple severe injuries presents a formidable clinical challenge due to reduced physiological reserve and the complex interplay of competing therapeutic goals. This report details the case of a geriatric patient suffering from the triad of pulmonary contusion (PC), moderate traumatic brain injury (TBI), and an unstable cervical spine fracture, highlighting the intricate balance required in neuroprotective and lung-protective ventilatory strategies. A 68-year-old male was admitted following a 10-meter fall, sustaining a moderate TBI with a temporoparietal subdural hemorrhage, a complete C3 vertebral fracture, and significant bilateral pulmonary contusions. His hospital course was marked by acute respiratory distress and neurological deterioration, with a Glasgow Coma Scale (GCS) score of E3V4M5 and hypoxemia requiring intubation and mechanical ventilation in the intensive care unit (ICU). Management focused on the cautious application of positive end-expiratory pressure (PEEP) to improve oxygenation without exacerbating intracranial pressure (ICP), alongside strict cervical spine immobilization and neuro-monitoring. After eight days of complex critical care, the patient’s prolonged need for mechanical ventilation and significant sputum retention necessitated a percutaneous dilational tracheostomy (PDT) to facilitate respiratory weaning and improve pulmonary toilet. In conclusion, this case underscores the profound difficulty of managing concurrent lung and brain injuries in the context of cervical instability. The successful navigation of this trauma triad hinged on a highly individualized, multidisciplinary approach, with judicious ventilator management and timely procedural intervention like PDT being pivotal. It affirms the need for integrated care protocols that can dynamically balance competing organ-system priorities in complex geriatric trauma.

Objective: To systematically evaluate the impact of early tracheostomy on clinical outcomes compared to other therapeutic strategies in adult patients undergoing invasive mechanical ventilation (IMV) in intensive care units (ICUs), focusing on the incidence of ventilator-associated pneumonia (VAP), mortality, duration of ventilation, and ICU length of stay. Background: Prolonged MV increases the risk of complications, particularly VAP, which remains one of the leading causes of morbidity and mortality in critically ill patients. Tracheostomy has been widely employed to facilitate weaning from ventilation, reduce respiratory complications, and potentially lower the incidence of VAP. However, the optimal timing for its implementation remains controversial. Methods: A systematic review was conducted using the PubMed and Cochrane Library databases, including observational and interventional studies published within the last five years. Studies involving patients aged above 16 years and under MV were selected, comparing early tracheostomy with late tracheostomy or no tracheostomy. PROSPERO protocol registration number: CRD420250652487. Results: Twelve studies were included, encompassing a total of 158,677 patients. Most studies indicated that early tracheostomy was associated with reduced ventilation duration, shorter ICU stays and lower incidence of VAP, with an absolute reduction of up to 12%. Conversely, two studies reported a higher risk of VAP among tracheostomized patients. Mortality outcomes were inconclusive. One study comparing techniques reported better results with percutaneous tracheostomy. Conclusion: Early tracheostomy may offer potential benefits in respiratory outcomes and hospitalization efficiency; however, inconsistency among studies warrants caution. High-quality randomized clinical trials are needed to confirm these findings and inform clinical decision-making.

Percutaneous dilatational tracheostomy (PDT) has become the primary surgical technique for airway access during prolonged ventilatory support in critically ill patients. There are several techniques for performing PDT. The most commonly used are the Ciaglia technique and the Griggs technique. While performing tracheostomy according to the Ciaglia technique in the Blue Rhino modification, the trachea is punctured with a needle, a guidewire is inserted into the trachea, and a tracheostomy is formed with a curved conical bougie dilator, which is inserted into the tracheal lumen through the guidewire on a guiding catheter. Damage to the posterior tracheal wall during tracheostomy is a well-known and potentially dangerous complication of this procedure. Depending on the defect size, the manifestation may vary from asymptomatic to a severe multiorgan dysfunction. In the presented clinical case, PDT was complicated by combined tracheal injury significantly below the puncture site (at the level of tracheal bifurcation). Tracheal injury led to the development of pneumomediastinum, bilateral tension pneumothorax. To prevent life-threatening consequences of this complication, emergency endoscopic tracheal stenting and pleural cavity drainage followed by long-term intensive therapy were required. The article presents a critical analysis of the mechanism of tracheal injury, as well as conclusions to avoid similar injuries in the future. Пункционная дилатационная трахеостомия в течение последних 30 лет стала основной хирургической методикой доступа к дыхательным путям при проведении длительной искусственной вентиляции легких(ИВЛ) у пациентов, находящихся в критическом состоянии. Существует несколько методик выполнения пункционной дилатационной трахеостомии (ПДТ). Наиболее часто в мире используются методика Сиглиа и методика Григгза. При выполнении трахеостомии по методике Сиглиа в модификации Блю Рино производится пункция трахеи иглой, заведение проводника-струны в трахею и формирование трахеостомы с помощью изогнутого конического расширителя-бужа, вводимого в просвет трахеи по проводнику на направляющем катетере. Повреждение задней стенки трахеи при выполнении трахеостомии хорошо известное и потенциально опасное осложнение данной процедуры. В зависимости от величины дефекта, тяжесть его проявления может колебаться от бессимптомного течения до формирования тяжелой полиорганной дисфункции. В пред- ставленном клиническом наблюдении выполнение ПДТ осложнилось сочетанным повреждением трахеи значительно ниже места пункции (на уровне бифуркации трахеи). Повреждение трахеи привело к развитию пневмомедиастинума, напряженного двустороннего пневмоторакса. Для предотвращения жизнеугрожающих последствий этого осложнения потребовалось экстренное эндоскопическое стентирование трахеи и выпол- нение дренирования плевральных полостей с последующей длительной интенсивной терапией. В статье представлен критический разбор механизма повреждения трахеи, а также сделаны выводы, позволяющие избежать подобных повреждений в будущем.