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Editorials |

Technique, Complications, and Improvements in Percutaneous Dilatational Tracheostomy

Pasquale Ciaglia, MD, FCCP (Utica, NY)
Author and Funding Information

Clinical Associate Professor of Surgery, State University of New York Health Science Center, Syracuse, NY; Coordinator of Clinical Research, St. Elizabeth Medical Center, Utica, NY.

Correspondence to: Pasquale Ciaglia, MD, FCCP, Department of General Thoracic Surgery, 2215 Genesee St, Utica, NY 13501; e-mail: pdt@borg.com



Chest. 1999;115(5):1229-1230. doi:10.1378/chest.115.5.1229
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Extract

In the excellent article in this issue of CHEST by Trottier and colleagues (see page 1383), the cause of posterior tracheal wall perforation during percutaneous dilatational tracheostomy (PDT) was studied clinically and in swine and cadaver experiments.

In the clinical part of the study, the authors were justifiably concerned about the high incidence of posterior tracheal wall trauma. Twenty-four medical-surgical ICU patients underwent PDT using the Per-fit Percutaneous Tracheostomy Kit (Smiths Industries Medical Systems Portex Inc; Keene, NH), and three patients suffered posterior tracheal wall perforations. After the PDT in each of the patients with a posterior perforation, the investigator noted that the guidewire had been kinked during the procedure. It was believed that the dilators were advancing over the guiding catheter intratracheally onto the guidewire during the procedure (see Trottier and colleagues, Fig 1, bottom). The guidewire alone, according to the investigators, would not provide enough support to keep the dilator within the trachea, and therefore predispose to perforation of the posterior tracheal wall. I agree. The authors, to test this theory, developed a protocol to evaluate the PDT in animal and cadaver models. This was excellent reasoning, and good animal and cadaver models were developed.


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