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Communications to the Editor |

Complications Following Percutaneous Tracheostomy Complications Following Percutaneous Tracheostomy FREE TO VIEW

Sarah Hedges, MBBS; Vincent Perkins
Author and Funding Information

Affiliations: Dumfries and Galloway Royal Infirmary Dumfries, United Kingdom,  Hôpital d’Instruction des Armées Clamart, France

Correspondence to: Sarah Hedges, MBBS, Dumfries and Galloway Royal Infirmary, Bankend Rd, Dumfries, United Kingdom DG1 4AP



Chest. 2001;120(5):1751-1752. doi:10.1378/chest.120.5.1751
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To the Editor:

We were interested to read the article by Briche et al (April 2001)1concerning complications following percutaneous tracheostomy. However, in both cases, we are simply told that“ percutaneous tracheostomy was performed.” There was no comment as to whether or not the procedure was aided by a separate operator performing simultaneous fiberoptic bronchoscopy of the trachea. The complication rate of percutaneous dilational tracheostomy may be reduced using endoscopic guidance,2since experience does not seem to reduce the incidence of paramedian wire insertion.3The study of Dexter,4 assessing blind wire placement, found that only 45% of wires entered the trachea at the intended level, 30% of wires pierced the thyroid isthmus, and only 15% of wires punctured the trachea centrally.

The proposed mechanism of stenoses in the two cases (a difficult perforation of the trachea causing fracture of the tracheal ring, thus creating an intralumenal tracheal flap) would surely have been noted if the fiberoptic bronchoscope had been used. We would advocate the use of bronchoscopy in all cases of percutaneous dilational tracheostomy in order to minimize immediate and long-term complications resulting from this valuable bedside technique.

Briche, T, Le Manach, Y, Pats, B (2001) Complications of percutaneous tracheostomy.Chest119,1282-1283. [PubMed] [CrossRef]
 
Thomas, EO, Manara, MB A review of percutaneous tracheostomy.Br J Intensive Care1998;8,122-129
 
Winkler, WB, Karnik, R, Seelmann, O, et al Bedside percutaneous dilational tracheostomy with endoscopic guidance: experience with 71 ICU patients.Intensive Care Med1994;20,476-479. [PubMed]
 
Dexter, TJ A cadaver study appraising accuracy of blind placement of percutaneous tracheostomy.Anaesthesia1995;50,863-864. [PubMed]
 

Complications Following Percutaneous Tracheostomy

To the Editor:

For 4 years, we have performed bedside percutaneous tracheostomy with two physicians, always with the same procedures. The first physician, in each case a senior physician, is located at the head of the patient and performs fiberoptic bronchoscopy (Olympus NFT3 Rhino-Laryngo Fiberscope; Olympus Optical; Hamburg, Germany) to prevent complications. The second physician performs the procedure.

To prevent abnormal insertion and tracheal injury, the use of a single progressive conic dilator (Ciaglia Blue Rhino; William Cook Europe; Bjaeverskov, Denmark) is better than the use of several dilators with progressive size. In our experience, complications can occur even if we are satisfied with the immediate fiberoptic bronchoscopy result. I agree with Dr. Perkins’s opinion that fiberoptic bronchoscopy is required. Even better, it must be performed for a long time even after decannulation. Other methods can be performed to reduce tracheal impaction. A kit by Mallinckrodt (Tracheostomia translazingea Fautoni methode; Mallinckrodt Medical; Mirandola, Italy) uses a similar procedure as an endoscopic gastrostomy (internal to external procedure), but in our experience, this procedure is more complicated at bedside.


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References

Briche, T, Le Manach, Y, Pats, B (2001) Complications of percutaneous tracheostomy.Chest119,1282-1283. [PubMed] [CrossRef]
 
Thomas, EO, Manara, MB A review of percutaneous tracheostomy.Br J Intensive Care1998;8,122-129
 
Winkler, WB, Karnik, R, Seelmann, O, et al Bedside percutaneous dilational tracheostomy with endoscopic guidance: experience with 71 ICU patients.Intensive Care Med1994;20,476-479. [PubMed]
 
Dexter, TJ A cadaver study appraising accuracy of blind placement of percutaneous tracheostomy.Anaesthesia1995;50,863-864. [PubMed]
 
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