Objectives: Part 1: To describe the complication of
posterior tracheal wall injury and perforation associated with the
percutaneous dilational tracheostomy (PDT). Part 2: To determine the
mechanism of posterior tracheal wall injury during PDT.
Design: Prospective observational study.
Subjects: Part 1: Medical-surgical ICU patients requiring
tracheostomy. Part 2: Swine and cadaver models.
Interventions: Part 1: Consecutive medical-surgical ICU
patients undergoing tracheostomy tube insertion via the percutaneous
dilation technique with bronchoscopic guidance were enrolled in the
study. Demographic data and complications were recorded. Part 2:
Tracheostomy tubes were inserted via the percutaneous dilational
technique in the swine model with concomitant bronchoscopic video
recording from the proximal and distal airways. Tracheostomy tubes were
inserted via the percutaneous dilational technique in the cadaver model
followed by anatomic inspection of the airway.
Results: Part 1: Seven (29%) of 24 medical-surgical ICU
patients sustained complications associated with PDT. Three patients
(12.5%) sustained posterior tracheal wall perforations followed by the
development of tension pneumothoraces. Part 2: The swine model
demonstrated that posterior tracheal wall perforation may occur during
PDT when the guiding catheter is withdrawn into the dilating catheters.
Five-centimeter posterior tracheal wall mucosal lacerations occurred
when the guidewire and the guiding catheter were not properly
stabilized during PDT.
dilational tracheostomy was associated with a 29% complication rate in
this observational study. Of concern was the high rate (12.5%) of
posterior tracheal wall perforation. The swine and cadaver models
suggest that posterior tracheal wall injury or perforation may occur if
the guidewire and guiding catheter are not properly stabilized. To
avoid posterior tracheal wall injury, the guidewire and guiding
catheter should be firmly stabilized during
Abbreviations: PDT = percutaneous