Reduction of complication rate in percutaneous dilation tracheostomies

Abstract

Introduction: Percutaneous dilation tracheotomy (PDT) is now an accepted alternative to surgical tracheotomy in certain patients. We began performing these procedures in 2000 and use it regularly in select intensive care unit patients requiring prolonged intubation and mechanical ventilation.

Materials and methods: A retrospective chart review of consecutive PDTs performed in the Department of Otolaryngology-Head and Neck Surgery at the John Hopkins Hospital between 2002 and 2005 was undertaken. Procedural and postoperative complications in an earlier group were compared with those in the later group for both frequency and severity.

Results: Three hundred eighteen PDTs were performed on intensive care patients during this time period. All were performed using the Ciaglia method and the Cook Blue Rhino (Cook Medical Products, Bloomington, IN) set under direct bronchoscopic visualization. In group A (first 159 patients), there were a total of 12 complications (7.5%), including six cases of perioperative hemorrhage, whereas in group B (second 159 PDTs), there were seven complications (4.4%) with no cases of perioperative hemorrhage.

Conclusions: PDT provides an easy and convenient alternative to open tracheotomy (OT) and should be added to the otolaryngologist's armamentarium of surgical airway procedures. The complication rate of PDT is low and similar to that of open operative tracheotomy. However, with experience and the use of strict protocols in both patient selection and PDT procedure, the complication rate can be significantly reduced further both in frequency and severity, making it even safer than an open operative tracheotomy.