Long-Term Follow-up of Percutaneous Dilatational Tracheostomy in the Intensive Care Unit

Abstract

Objective: The primary objective was to analyze percutaneous dilatation tracheostomy (PDT) management in the intensive care unit (ICU) by comparison with surgical tracheostomy (ST) outside of the ICU, with respect to: (i) long-term postoperative outcomes, including rate of follow-up, return to the emergency department, and major and minor complications; (ii) timing of decannulation, including time to decannulation, decannulation after >30 days, and decannulation at discharge. The secondary objective was to compare perioperative outcomes, including major and minor complications.

Methods: A retrospective study from April 2013 to 2024 at a tertiary referral center. Eligible patients included those over 18 years old without PDT contraindications who received PDT in the ICU or ST.

Results: Final analysis included 250 patients (125 [50%] PDT; 125 [50%] ST). The mean (SD) age of patients was 60.05 (16.41) years, and 85 (34.0%) were female. Compared with the ST group, the PDT group experienced significantly decreased long-term follow-up (41 [39.8%] vs. 115 [95.0%], respectively, p < 0.001), increased emergency department returns (61 [64.2%] vs. 31 [26.1%], p < 0.001), longer time to decannulation (estimated median difference: 11.00 days [95% CI: 7.00 to 15.00, p < 0.001]), increased decannulation after >30 days (23 [34.8%] vs. 13 [12.7%], p < 0.001), and similar postoperative complications (8 [8.4%] vs. 8 [6.8%], p = 0.664). The PDT group experienced significantly more perioperative complications (37 [30.1%] vs. 22 [17.6%], p = 0.021).

Conclusion: The decreased long-term follow-up, delayed decannulation, and increased complications after PDT highlight potential pitfalls in ICU tracheostomy management, demonstrating the need for refined protocols, appropriate consultant involvement, and improved patient selection.

Level of evidence: 3 Laryngoscope, 135:2306-2313, 2025.

Keywords: critically ill; follow‐up; long‐term; percutaneous; tracheostomy.

Fig. 1

Postoperative (>30 days after tracheostomy) and perioperative (≤30 days after tracheostomy) complication rates for percutaneous dilatational tracheostomy versus surgical tracheostomy showing a similar risk of postoperative complications (8 [8.4%] vs. 8 [6.8%], p = 0.664) and a significantly greater risk of perioperative complications in the percutaneous group (37 [30.1%] vs. 22 [17.6%], p = 0.021). *p < 0.05. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]

Fig. 2

By comparing percutaneous dilatational tracheostomy (PDT) in the intensive care unit (ICU) to the established baseline of surgical tracheostomy (ST) outside of the ICU, this study aimed to inform clinical practice guidelines and enhance the overall care of critically ill patients requiring tracheostomy interventions, with a particular focus on sustained long‐term follow‐up. Compared to the ST group outside of the ICU, the PDT group in the ICU experienced significantly decreased long‐term follow‐up (39.8% vs. 95.0%, respectively), increased emergency department returns (64.2% vs. 26.1%), longer time to decannulation (estimated median difference: 11.00 days), and increased perioperative complications (30.1% vs. 17.6%). The decreased long‐term follow‐up, delayed decannulation, and increased complications after PDT highlight potential pitfalls in ICU tracheostomy management, demonstrating the need for refined protocols, appropriate consultant involvement, and improved patient selection. *p < 0.05. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]