Tracheostomies are often done to facilitate weaning from the ventilator, or to prevent tracheal strictures from prolonged intubation. After the technique of open tracheostomy was developed, reports of strictures were found in the literature, and techniques to avoid those strictures were developed. Percutaneous tracheostomy allows bedside tracheostomy in the ICU, and thus avoid transporting a sick patient. After finding tracheal strictures in several patients who had undergone percutaneous tracheostomy we evaluated our experience in tracheal resections after tracheostomy.
All patients who had undergone tracheal resection were anlyzed. Their age, sex, race, length of stay, ICU stay, reason for tracheostomy, reason for intubation and pulmonary function tests were evaluated. Data were analyzed with means and standard deviations. Student’s t test was used to compare means–0.05 was accepted as significant.
Twelve patients underwent resection for tracheal stricture due to tracheostomy. Their average age was 51.6 years (range 28-76) and 33% (4 patients) were women. Ten of twelve had preoperative pulmonary function testing–average FEV1% was 36%. No patient was reintubated, but three patients spent additional time in the ICU (average 0.38 days; standard deviation 0.81 days). No patients died, nor suffered signficant complications. Three patients had strictures from open tracheostomy (25%) and nine from percutaneous tracheostomy (75%).
We can not compare the incidence of stricture between the procedures because the denominators are unknown. However, these patients were drawn from a large geographic region where open tracheostomy is still more common than percutaneous tracheostomy. These data suggest that patients with percutaneous tracheostomy are at signficant risk of tracheal stricture, perhaps more than those undergoing open tracheostomy.
Patients undergoing percutaneous tracheostomy are at risk for tracheal stricture.
John Roberts, None.