Percutaneous tracheostomy: a 6 yr prospective evaluation of the single tapered dilator technique

Dempsey, G. A.; Grant, C. A.; Jones, T. M.
December 2010
BJA: The British Journal of Anaesthesia;Dec2010, Vol. 105 Issue 6, p782
Academic Journal
Background The single tapered dilator (STD) percutaneous dilatational tracheostomy (PDT) technique now appears to be the single most common method of performing a tracheostomy in the critical care unit (CCU). Methods A single-centre, prospective evaluation of all PDTs performed in an adult mixed surgical and medical CCU between November 2003 and October 2009 was done. All procedures were undertaken by critical care physicians. A proforma recorded intraoperative complications and technical difficulties encountered during the procedure; all patients were followed up for a minimum of 3 months for delayed complications. Results A tracheostomy was performed on 589 patients during the study period. PDT was attempted in 576 patients and successfully completed in 572. PDT was abandoned in four patients due to bleeding, with three of these subsequently undergoing surgical tracheostomy (ST). ST was performed in 17 patients. Intraoperative technical difficulties were encountered in 149 (26%) cases. Sixteen (3%) procedures were deemed as having early complications. A further four (0.7%) cases had significant late complications including two tracheo-innominate fistulae (TIF). Both TIF patients died as a result of their complications giving a mortality directly attributable to PDT of 0.35%. There were no differences with respect to the occurrence of complications according to grade of operator. Conclusions PDT performed by the STD technique is a relatively safe procedure with more than 96% of procedures performed without any early or late complications. Using this technique, more than 97% of tracheostomies undertaken during the study period were performed percutaneously. Further audit at a national level is warranted to fully evaluate long-term complications after PDT.


Related Articles

  • Videobronchoscopic guidance makes percutaneous dilational tracheostomy safer. Oberwalder, M.; Weiss, H.; Nehoda, H.; Kafka-Ritsch, R.; Bonatti, H.; Prommegger, R.; Aigner, F.; Profanter, C.; Weis, H // Surgical Endoscopy;May2004, Vol. 18 Issue 5, p839 

    Background: Percutaneous dilational tracheostomy (PDT) can be performed under either conventional bronchoscopic or videobronchoscopic guidance. Only the latter procedure provides the surgeon with direct visual information. This study prospectively assessed procedural parameters and...

  • Characteristics of morbidity and mortality conferences associated with the implementation of patient safety improvement initiatives, an observational study. François, Patrice; Prate, Frédéric; Vidal-Trecan, Gwenaëlle; Quaranta, Jean-François; Labarere, José; Sellier, Elodie // BMC Health Services Research;1/30/2016, Vol. 16, p1 

    Background: The aim of this study was to identify the characteristics of morbidity and mortality conferences (MMCs) associated with the implementation of patient health-care quality and safety improvement initiatives.Methods: We conducted an observational study of MMCs...

  • Comparison in Outcomes at Two-Years of Age of Very Preterm Infants Born in 2000, 2005 and 2010. Abily-Donval, Lénaïg; Pinto-Cardoso, Gaëlle; Chadie, Alexandra; Guerrot, Anne-Marie; Torre, Stéphanie; Rondeau, Stéphane; Marret, Stéphane; null, null // PLoS ONE;Feb2015, Vol. 10 Issue 2, p1 

    Objective: To investigate alteration in 2-year neurological/behavioral outcomes of very preterm infants born in a French level three neonatal intensive care unit. Methods: We conducted a prospective, comparative study of very preterm infants born before 33 weeks’ gestation at 5-year...

  • The postoperative occurrence of cardio-respiratory adverse events in small infants undergoing gastrointestinal surgery: a prospective comparison of general anesthesia and combined spinal-epidural anesthesia. Somri, Mostafa; Coran, Arnold; Mattar, Ibrahim; Teszler, Christian; Shaoul, Ron; Tomkins, Oren; Tome, Riad; Mogilner, Jorge; Sukhotnik, Igor; Gaitini, Luis; Coran, Arnold G; Mogilner, Jorge G // Pediatric Surgery International;Nov2011, Vol. 27 Issue 11, p1173 

    Introduction: This study was designed to compare the occurrences of postoperative cardio-respiratory adverse events during an 8-day follow-up period in the neonatal intensive care unit in small infants who underwent elective gastrointestinal surgery under general and combined spinal...

  • Investing in a Surgical Outcomes Auditing System. Bermudez, Luis; Trost, Kristen; Ayala, Ruben // Plastic Surgery International;2013, p1 

    Background. Humanitarian surgical organizations consider both quantity of patients receiving care and quality of the care provided as a measure of success. However, organizational efficacy is often judged by the percent of resources spent towards direct intervention/surgery, which may discourage...

  • Surgical Outcome and Midterm Follow-Up After Transvaginal NOTES Hybrid Cholecystectomy: Analysis of a Prospective Clinical Series. Hensel, Mario; Schernikau, Utz; Schmidt, Axel; Arlt, Georg // Journal of Laparoendoscopic & Advanced Surgical Techniques;Mar2011, Vol. 21 Issue 2, p101 

    Background: In the last 3 years transvaginal hybrid cholecystectomy (TV-ChE) has gained widespread interest as a potential alternative to laparoscopic cholecystectomy. However, substantial doubts about the transvaginal access and possibly associated complaints and complications have been raised....

  • A Single Centre Analysis of Clinical Characteristics and Treatment of Endocrine Pancreatic Tumours. Adil, M. T.; Nagaraja, R.; Varma, V.; Mehta, N.; Kumaran, V.; Nundy, S. // International Journal of Surgical Oncology;6/8/2015, Vol. 2015, p1 

    Background. Endocrine Pancreatic Tumours (PENs) are rare and can be nonfunctioning or functioning. They carry a good prognosis overall though high grade lesions show a relatively shorter survival. The aim of the current study is to describe a single centre analysis of the clinical...

  • Surgical Treatment of a Case of Ledderhose’s Disease: A Safe Plantar Approach to Subtotal Fasciectomy. Souza, Bruno Gonçalves Schröder e; de Souza Júnior, Gilberto Zaquine; Rodrigues, Raíssa Mansilla Cabrera; Dias, Diogo Stelito Rezende; de Oliveira, Valdeci Manoel // Case Reports in Orthopedics;12/10/2015, p1 

    Plantar fibromatosis, Ledderhose’s disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren’s disease and failed all conservative...

  • Does Patellectomy Jeopardize Function After TKA? Yao, Reina; Lyons, Matthew; Howard, James; McAuley, James // Clinical Orthopaedics & Related Research;Feb2013, Vol. 471 Issue 2, p544 

    Background: The patella provides important mechanical leverage to the knee extensor mechanism. Patellectomy does not exclude the development of tibiofemoral arthrosis. Questions/purposes: We asked whether (1) TKA provides improvements in clinical outcome scores in patellectomized knees and (2)...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics